July 28th, 2021

Fatigue - An overview

What is Fatigue?

Fatigue is an overwhelming sense of physical or mental tiredness that may affect any or all areas of functioning: physical, cognitive, and social.  For people who have had a brain injury, fatigue is a very common and persistent problem.

‘Mental’ versus ‘physical’ fatigue

Physical fatigue refers to the fatigue that results from any kind of physical labour such as exercising, mowing the lawn, and playing outside with the children.  Just after a brain injury, physical fatigue may be a problem.  For example, it requires a lot of energy to relearn how to walk.  For most people, physical fatigue tends to subside after about six months following the injury.

Mental fatigue refers to the fatigue that results from ‘brain work’, such as working on the computer, writing a letter, reading the newspaper, conversing, studying, planning and problem solving, and driving.  Although mental fatigue also decreases over time, it tends to be a very persistent problem that needs to be managed carefully.  For most people it does not go away completely.
 
Why is mental fatigue a common symptom of brain injury?
 
It is not known exactly why fatigue is such a common problem for people who have had a brain injury.  However, it is thought that fatigue results because the brain has to work a lot harder than it did prior to the injury.  Some of the brain cells are damaged, and do not work as efficiently as they should – information does not flow as easily around the brain.  
The brain has to work harder to cope with this, resulting in fatigue.  Also, the brain takes longer to restore its energy, meaning that it takes longer to recover from fatigue than it did prior to the injury.
 
Fatigue may also be a side effect of some medication.
 
Mental fatigue can affect the success of all rehabilitation efforts.  Fatigue decreases concentration, memory, and social interactions.  It increases irritability, distractibility, depression, and anxiety.  Fatigue can cause confusion and decrease the ability to make good decisions.  It may also increase physical symptoms such as headaches and dizziness.  It is therefore very important to manage fatigue.
 
What can be done about it?
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 It is a good idea to slowly build up active hours, gradually increasing stamina.  The number of home and social activities undertaken may also need to be reduced.
 
​There are a number of basic strategies that can be used to manage fatigue:

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• Learn the early signs of fatigue.  These include puffiness and redness of the eyes, slowed or slurred speech, muddling of words, irritability and increased forgetfulness.  These should be acted on as soon as possible, e.g. taking a nap.
  
• Schedule important, difficult, or stressful tasks and appointments at times where energy levels are at their peak.  For most people, this is in the morning.  Fatigue tends to set in during the afternoon, around 2-3pm.
  
• Fatigue affects your ability to attend to, process and store, information in your memory.  It is therefore important to learn new information when you are not fatigued.
• Evaluate what a job requires.  By planning how long a task will take to complete, you reduce the stress of unrealistic time pressures.
  
• Rest periods during the day are crucial, particularly after cognitive (brain) work.  It is a good idea to schedule in a regular rest period each day, e.g. an hour in the early afternoon.  Plan extra rest periods for before and after big or tiring events.

                      ‘Rest’ can be simply lying down, or sitting quietly.  It does not have to be a ‘sleep’.

• Avoid ‘overload’.  Where possible, spread jobs, home, and social activities evenly throughout the week, ensuring adequate rest periods.
• Recognise that fatigue may have a cumulative affect.  For example, one may continue on with normal activities, not take rest periods, and feel ‘fine’ for a week, only to be hit by extreme fatigue that disrupts functioning for several days.
• Relaxation can help reduce stress, which can be a major cause of fatigue.  The rehabilitation team can provide information on various relaxation techniques, and hints on how to help poor sleep patterns.
• Physical activity increases the amount of oxygen that gets into the blood system.  Oxygen improves our ability to think.   
• A sensible and healthy diet helps us to maintain energy levels.  

 
Conclusion
 
Fatigue is a common and persistent problem following a brain injury, which may require some lifestyle changes.  However, effective fatigue management can be achieved.  Much of this revolves around weekly scheduling of activities, rest periods, and appointments.  
 
If you need help relaxing, with physical exercise or diet, our friendly therapists can help, just contact Therapy Professionals Ltd 

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                                             Ph:  03 377 5280      Email:  admin@tpl.nz     

References:     ACC
                          Laura Fergusson insight rehab