Fatigue and Traumatic Brain Injury 

It is the most commonly reported symptom in the wake of brain injury, but what can be done to combat fatigue when it strikes without warning and lasts for so long? 

Mind-numbing mental and physical fatigue sets in when the brain becomes over-loaded. Fatigue has been in the spot light recently and has been dubbed the ‘brain drain’ by the UK’s leading brain injury association, Headway. 

But fatigue is much more than tiredness; it can have a significant impact on an individual’s ability to engage in daily tasks or activities. 

It can be constant or occur for several days, it can make other brain injury symptoms worse, including:

• vision and speech problems 
• poor concentration 
• difficulties with thinking skills
• cramps or weak muscles 
• poor co-ordination or balance. 
     

What are the signs of fatigue following brain injury?

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

What triggers fatigue can be just as wide-ranging, from lengthy conversations to noisy shopping centres and, of course, certain medications. But what is clear, however, is the need to manage the fatigue.  

Individuals should consider some of the coping strategies outlined below that can put in place themselves, or draw up contingency plans with their family members or carers, including, where possible, the support and expertise of their neuro OT. There are a number of strategies that can be introduced to help cope with fatigue or alleviate the symptoms. 

How can you fight and manage fatigue following traumatic brain injury (TBI)? 
 

• Recognise the early signs of fatigue and manage your activities levels; a change in activity may reduce the fatigue. Consider; 
  • do I keep going until I am exhausted? 
  • can I stop what I am doing before I become overwhelmed?  
  • could I use my energy differently?  

• Educate yourself about your own unique needs - knowledge is power:
  • become aware of your unique response to fatigue, including the symptoms you experience.
  • make a note of what you were doing before fatigue started so you can alter your plans or avoid activities, people or places in future if they are unhelpful 
  • What activities are helpful to help me wind down? 
     
• Manage your energy levels to avoid a cycle of ‘boom and bust’. Do not be afraid to reschedule activities for when you’re not fatigued, try to avoid ‘over doing it’ during episodes where you feel full of energy as this can exacerbate a negative ‘yo-yo’ cycle of fatigue. 
• Focus on things you’ve done well and celebrate these.
• Plan time for things that make you feel good about yourself.
• Take care with your routine and look after yourself: 
  • ensure you have regular rest breaks
  • establish regular sleep, eat, drink and exercise routines 
  • modify your environment to take the effort out of daily tasks that may include not seeing certain people if they take too much of your energy and introducing changes to lighting or room layouts.  
• consider a review with your GP

Practical solutions to overcoming fatigue following brain injury  

In a new survey by Headway (1), 75 per cent of brain injury survivors felt that people in their life did not understand their fatigue. 

87 per cent of them felt fatigue negatively impacted on their lives, with 68 per cent reporting a worsening of their romantic relationships too. 

The skills of a neuro OT can help you to understand your fatigue and consider practical strategies to help manage symptoms and promote independence and wellbeing.

• Do one thing at a time and use strategies. To reduce cognitive load, use checklists such as a shopping list to help you stay on track, make the most of charts, diaries and electronic or phone organisers, and make written, ‘post-it’ notes or cue cards as reminders. 
• Use alarms to ensure you stay on task or take breaks. 
• Use your energy wisely, think carefully about which activities you value and those you don’t want to spend time doing. 
• Plan ahead and consider the impact of work activities, social activities and home-based activities when planning your week / month. 
• Use mechanical aids, such as wheelchairs, to save energy for when it counts.
• Look after your emotional wellbeing, make time for yourself and consider activities that help you to relax and step away from energy sapping tasks or environments. Walking, mindfulness and yoga may be helpful.
• Watch the weather as heat can increase fatigue. 

Evidenced based research and alternative approaches to fend off fatigue following brain injury 
 

Research is on-going into the effectiveness of alternative therapies that might help combat fatigue after brain injury. 

But in a recent study (2), four therapies in particular were found to provide ‘significant’ improvements, including: 

• 8 weeks of water-based physical activity (3) 
• 8 weeks of Mindfulness-Based Stress Reduction (4) using yoga and meditation
• 5 weeks of computerized working memory or ‘brain’ training (5)
•  4 weeks of blue light therapy (6) 
   

The researchers concluded however that despite the promising preliminary findings, the most effective fatigue treatment strategies have not yet been established. 

More information on the link between chronic fatigue and Vitamin D here. 

References 

(1) Headway, The Brain Injury Association.Experiences of fatigue after brain injury. 2019. 
(2) Xu , Gang-Zhu, et al.Complementary and alternative interventions for fatigue management after traumatic brain injury: a systematic review. Xi'an, China : Therapeutic Advances in Neurological Disorders, 2017. 
(3) Bijkers, M P and Bushnik, T.Assessing fatigue after traumatic brain injury: an evaluation of the HIV-Related Fatigue Scale [corrected]. New York : J Head Trauma Rehabilitation, 2008. 
(4) Johansson, B., Bjhur, H and Ronnback, L.Mindfulness-based stress reduction (MBSR) improves long-term mental fatigue after stroke or traumatic brain injury. s.l. : NCBI. 
(5) Bjorkdahl, A, et al.Randomized study of computerized working memory training and effects on functioning in everyday life for patients with brain injury. s.l. : PubMed, 2013. 
(6) Sinclair, K L, et al.Randomized controlled trial of light therapy for fatigue following traumatic brain injury. s.l. : PubMed, 2014.