Managing fatigue after brain injury

What is fatigue?

Fatigue is an extreme tiredness experienced by everyone at some point after a period of physical or mental activity. It is a signal telling us to take a break. Tiredness, loss of physical stamina and fatigue after brain injury are some of the main ongoing symptoms. They affect everything that a person does. Unlike ‘normal’ fatigue, these symptoms are not always improved with rest alone.

What causes fatigue after brain injury?

Some of the suggested causes of fatigue after brain injury are:

• Damage of the brain stem which controls consciousness, wakefulness and the rhythm of sleeping.
• Inflammation of the nerves in the brain, which happen following brain injury, can disrupt information processing and memory. If these skills are affected then greater effort is needed in all mental and physical tasks leading to increased levels of fatigue.
• Post-concussion syndrome – collection of symptoms linked to mild head injury.

Triggers to fatigue

Activities which trigger fatigue will be different for everyone and can include tasks which require physical or mental effort, for example:

• Working at a computer.
• Going for a walk.
• Being in a busy environment such as a shopping centre or restaurant.
• Going to the gym.

Managing fatigue

For some people fatigue improves over time. However, for many, fatigue is a condition that they have to learn to manage. Often there is a tendency to try and return to the same levels of activity that were achieved before the brain injury. This can lead to a ‘vicious cycle’ of good and bad days.

Bad days

A ‘bad day’ is when there is very little activity but lots of rest to ‘recover’. This can lead to a lower level of fitness and a lack of motivation.

Good days

A ‘good day’ is when a person feels better with the temptation to do all the things left undone during the bad day. As fitness is reduced, this can lead to feeling worse and the need to rest again.

Pacing

Pacing means keeping to the same amount of activity each day; whether you are having a good or bad day. If everyday activities can be successfully paced using a ‘little and often’ approach then fitness is likely to improve over time.

Prioritising

It is important to prioritise activities to manage your energy levels. This will involve thinking about all of the activities that have to be done each day or week and considering the following:

• Which jobs are most important or essential?
• Which activities are most enjoyed?
• Which tasks could be delegated to someone else?
• Could any activities be done less often or stopped altogether?

Ways to assist in managing fatigue

• Balance activity and rest.
• Use energy saving techniques throughout the day (for example, complete activities sitting down).
• Alternate between mental and physical activities.
• Get to know your triggers to fatigue.
• Get to know your energy limits for different activities.
• Work within your energy limits, do not wait until you feel you have gone too far.
• Pace activities throughout the week.
• If necessary, only tackle 1 larger activity a day.
• Take regular rest breaks. If you need to sleep during the day, try to have 30 minute ‘power naps’ and avoid sleeping after 4:00pm.
• Recommended restful activities include listening to music or completing a meditation exercise rather than watching TV or reading, as these activities can be mentally tiring.
• Prioritise where to use your energy.
• Try to make sure that you have good quality sleep each night. This will help with your energy levels for the next day.
• Have a regular routine by going to bed at the same time each day and getting up at the same time.
• Exercise regularly within your physical capability.

Contact information

If you need further information or advice, please contact the Gloucestershire Brain Injury Team.

Gloucestershire Brain Injury Team

Gloucestershire Royal Hospital

Tel: 0300 422 5139

Monday to Friday, 9:30am to 4:00pm