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Managing fatigue after a brain injury

Information Services

Cognitive effects

Managing fatigue after a brain injury

Fatigue is a common and very disabling symptom experienced by people with a brain injury.

It 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, often resulting in mind-numbing fatigue that can last for several days. 


Brain disorders such as traumatic brain injury can be likened 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 any other problems are worsened 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, organizing a work schedule or simply reading.


Fatigue can be managed with good planning and rest periods, but carers and the family member must realize fatigue is a very real problem. 


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?

Work out what triggers it and what factors make the symptoms worse, such as 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 you should discuss options with your doctor. 


Be aware of the first signs of fatigue and immediately stop and rest - overloading your brain can easily result in several days of extreme tiredness. Make a note of how long you can do certain activities before fatigue starts e.g. if fatigue starts after 30 minutes of reading, only read for 20 minutes in future. 


Managing fatigue

Contingency plans: Fatigue may occur at the least convenient times - on public transport or during a meeting. You need to negotiate ways of coping when this happens. You can use specific strategies or call in extra support. Work out contingency plans with your family member. Your rehab team, occupational therapist or physiotherapist can help with suggestions.


Assess best hours: Some people function best in the mornings, so complete demanding tasks then. Others function better in the afternoon or the evening. Organize your routine accordingly. Don't drive when you are tired.


Assess your environment: Provide an uncluttered environment that is easy to move around and work in. Think about how and where things are stored; bench heights, entrances, types of furnishing and lighting. For example, some people may find fluorescent lighting or dim lighting more tiring.


Schedule rest periods: Make a daily or weekly schedule, and include regular rest periods. "Rest" means do nothing at all. If you have a nap, don't oversleep in case this affects your normal sleep cycle. 


Use aids: Use mechanical aids to conserve energy for when it really counts. One man spared his legs extra effort by using his wheelchair to get from his house to the car, then from the car to the church, before walking his daughter, the bride, down the aisle.


Break it down: Break down activities into a series of smaller tasks. This provides opportunities to rest while allowing the person to complete the task. Encourage sensible shortcuts.


Set priorities: Focus on things that must be done and let the others go.


Medication highs and lows: Be aware of changes throughout the day that relate to medication. Is the person better or worse immediately after their tablets? Plan their activities around these times.


Weather: Hot weather can also increase fatigue. Plan around this.


Seek support: Ask for advice. In particular, an occupational therapist can visit your home and advise on an energy-conserving plan. For more information, talk to your doctor or condition-specific support organization.


Healthy lifestyle

AS with virtually every aspect of a traumatic brain injury and similar brain disorders, fatigue will be less of a problem if you focus on a healthy lifestyle:

  • Sleep well
  • Get regular exercise
  • Avoid alcohol or limit your intake
  • Eat a healthy diet and watch your weight
  • Learn stress management techniques
  • Maintain contact with friends and family. 

References and further information

This article has been reproduced with the permission of BrainLink from one their excellent brain injury resources. Their website has a wide range of fact sheets on many other issues. BrainLink is a Victorian service dedicated to improving the quality of life of people affected by conditions of the brain, and providing support to their families.


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