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What is fatigue?

Fatigue may be a continual sense of mental fatigue,  or it can happen when a person is trying to do too much and the brain is overloaded. This often results in mind-numbing fatigue that can last for several days.

Brain disorders such as traumatic brain injury (TBI) can be compared to a highway when one of three lanes is closed down. If traffic is light, there will be no difference but once the traffic reaches a critical point, the cars barely move and it can take ages for the traffic jam to clear.

It is important to avoid fatigue as much as possible, as it will make any other problems worse as well, such as:

  • vision problems
  • slurred speech
  • difficulty finding words
  • poor concentration
  • cramps or weak muscles
  • poor coordination or balance.

Fatigue can occur for no apparent reason or after physical activity, but is quite likely to occur from too much mental activity. Examples include planning the week’s errands, organising a work schedule or simply reading. While it can be managed with good planning and rest periods, families should keep in mind that fatigue is a very real problem.

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Symptoms of fatigue

The following symptoms may all suggest fatigue:

  • withdrawal, short answers, dull tone of voice
  • loss of appetite
  • shortness of breath
  • slower movement and speech
  • irritability, anxiety, crying episodes
  • increased forgetfulness
  • lack of motivation and interest.

What are the triggers of fatigue?

It can be helpful to identify what triggers fatigue and what factors make the symptoms worse. Some things that cause fatigue include long conversations, noisy shopping centres, movies with complicated plots or talking with two or more people at once. In some cases, fatigue could be a side effect of certain medications, in which case it is recommended to see your doctor.

It is important for a person with brain injury to recognise the first signs of fatigue, and to immediately stop and rest. Ignoring these signs can lead to several days of extreme tiredness due to brain overload. A useful strategy is to make notes on how long it takes to do certain activities before fatigue sets in. For example, a person who is getting tired after 30 minutes of reading should only read for 20 minutes in the future.

Managing fatigue

Contingency plans: fatigue may occur at the least convenient times – on public transport or during a meeting. Coping strategies can be developed ahead of time. This may involve the injured person working out a plan with family, or consulting their rehab team, occupational therapist or physiotherapist to help with suggestions.

Assess best hours: it is best to organise routines around the times when people function best, and to avoid driving when tired.

Assess your environment: an uncluttered environment that is easy to move around and work in will save energy. It is useful to think about how and where items are stored, whether bench heights are suitable or how easy it is to navigate entrances. Even furnishing and lights can affect fatigue. For example, people can feel tired when exposed to fluorescent or dim lighting.

Schedule rest periods: regular rest periods should be built into daily or weekly schedules. The best rest is to do nothing at all. A short nap can be restful; oversleeping can affect normal sleep cycles.

Use aids: mechanical aids such as wheelchairs should be used to conserve energy.  As an example, one man at his daughter’s wedding used a wheelchair to spare his legs the extra effort of walking from the house to the car, then from the car to the church, before walking his daughter down the aisle.

Break it down: activities are more manageable when broken down into a series of smaller tasks. This provides opportunities to rest in between. Sensible shortcuts should also be encouraged.

Set priorities: it is important for people to focus on what needs to be done and then decide on what to let go.

Medication highs and lows: medication can affect how people feel at different times of the day. Activities should be planned accordingly.

Weather: hot weather can also increase fatigue and should be taken into consideration when planning activities.

Seek support: health professionals are available for advice. For example, an occupational therapist can do a home visit to see how they can reduce the effort it takes to perform everyday activities.

Healthy lifestyle

As with virtually every aspect of brain injury, fatigue will be less of a problem when following a healthy lifestyle that includes:

  • plenty of sleep
  • staying as active as possible
  • avoiding or limiting alcohol
  • a healthy diet and maintaining a healthy weight
  • using strategies for reducing stress
  • spending time in nature
  • maintaining contact with friends and family