Scottish Head Injury Forum 2010
Fatigue Management After Brain Injury
Naomi Bidwell
5th November 2010
Contents
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What is Fatigue?
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Causes of Fatigue
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Impact of Fatigue
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Approaches to Fatigue Management
November 2010
Naomi Bidwell
Specialist Occupational Therapist
What is Fatigue?
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“ The experience of exhaustion and a
decreased capacity for physical and or
mental activity due to an imbalance in the
availability, utilisation and/ or restoration of
resources needed to perform activity”
Aaronson, et al (1999) adapted by Quinn (2004)
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November 2010
Naomi Bidwell
Specialist Occupational Therapist
What is Fatigue?
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One of the "top 5" post-injury complaints
Often described as
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“exhaustion,
tiredness,
weakness,
can’t concentrate,
no energy,
feel drained”
Makes people less able to engage in physical/
mental/ social activity
November 2010
Naomi Bidwell
Specialist Occupational Therapist
Types of fatigue in Brain Injury
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Physical
– Increased effort to perform physical tasks
– Relearn to coordinate the muscles
– Build up strength
– Tends to go away after 6 months
Mental
– Increased mental effort to engage in activities
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communication and thinking skills
Concentration/attention span
Slowed processing
Mental block
Tends to persist longer term
November 2010
Naomi Bidwell
Specialist Occupational Therapist
Are There Other Causes of Fatigue?
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Sleep Disturbance
Pain
Medication side effects
Depression
Spasticity
Posture
Nutrition
Hydration
November 2010
Naomi Bidwell
Specialist Occupational Therapist
Symptoms of fatigue
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Reduced Attention/Concentration
Memory difficulties
Word finding difficulties
Physical weakness
Irritability/Agitation
Exacerbated symptoms
Feeling of going backwards
November 2010
Naomi Bidwell
Specialist Occupational Therapist
Impact of fatigue on function
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Participation in desired activities
Mood
Self-esteem
Interpersonal relationships
Sustained physical functioning
Roles and responsibilities
Quality of life
November 2010
Naomi Bidwell
Specialist Occupational Therapist
Fatigue Management After Brain Injury
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Aims
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to maximise daily functioning within constraints of fatigue
overcome fatigue
How?
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Pacing
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Energy diaries
Lifestyle Planning
Grading Activities
Activity Schedules
November 2010
Naomi Bidwell
Specialist Occupational Therapist
Energy diaries
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Assessing fatigue levels
Used to rate fatigue levels
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At different times of the day
In relation to different activities
Monitor how person sleeps at night
More detail given the more useful the diary
Complete on good and bad days
Once identified may be managed using lifestyle
planning
November 2010
Naomi Bidwell
Specialist Occupational Therapist
Over-Activity/Rest Cycle
Goal
Trying to catch up
Trying to catch up
Activity
Rest
Rest
Rest
Time
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November 2010
Naomi Bidwell
Specialist Occupational Therapist
Lifestyle planning
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Planning and carrying out activities within ability
levels
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Acknowledge the problem
Recognise trigger factors
Energy saving methods
Value rest
Separate tasks into component parts
Setting goals
Balance work/rest/play
November 2010
Naomi Bidwell
Specialist Occupational Therapist
Coping strategies
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Grading activities
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Activity schedules
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Altering task
Altering intensity of activities
Schedule brain breaks during the day. This might include an
afternoon nap
Planning
Diaries/ wall planners/ calendars
Avoid difficult tasks when you feel tired
Stopping and removing self from situation,
Managing trigger situations when known
Have a set routine for sleeping at a certain time ever night
Avoid food or drinks such as coffee that are detrimental to sleep,
late at night
November 2010
Naomi Bidwell
Specialist Occupational Therapist
Putting Pacing into Practice
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Know your own abilities - energy diary
Set Baseline - what you can do, even on a bad day
Set Goals - precise, realistic and right for you
Break the task up into achievable steps
Incorporating rest periods
Prioritise tasks
Delegate tasks
Improve fitness
November 2010
Naomi Bidwell
Specialist Occupational Therapist
Putting pacing into practice
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Set activity at baseline for a week and then slowly
progress
Do what you planned not what you feel like!
Aim for consistency in activity
Do not to go over agreed activity level even if feeling
good
Value real rest
Remember setbacks are normal
Don’t increase activity if fatigue persisting
Be flexible, don’t set a time limit!
November 2010
Naomi Bidwell
Specialist Occupational Therapist
Effective Pacing
Goal
Too much
Activity
Setback
Time
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November 2010
Naomi Bidwell
Specialist Occupational Therapist
Any questions?
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November 2010
Naomi Bidwell
Specialist Occupational Therapist