Dr Debbie Snell
A feeling of profound tiredness or weariness that affects daily functioning and wellbeing, often called fatigue, is one of the most common symptoms experienced after a brain injury. In fact overseas studies suggest up to 80% of people after brain injury report fatigue even up to five years after their injury. These are staggering figures but what do we really mean by fatigue after brain injury? Is this the same thing as feeling tired after a hard day at work?
While it is not completely clear what causes fatigue after brain injury, this is often described as a significant lowering of one’s physiological reserve, both physically and mentally, a little like the draining of a battery charge. However in this scenario the battery takes much longer to recharge and seems to recharge less completely. For the person with a brain injury, sleep is less restorative and when fatigued there is no ‘give’. That is, there is a point where the person cannot continue to function. Their speech deteriorates, they cannot get their thoughts together and sentences out, their headaches, co-ordination and balance problems worsen. They can also become very irritable and short tempered. This is not the normal tiredness we all experience when we have had a big day.
There are a few published studies that have examined what might cause fatigue after a brain injury. These studies have suggested that in many cases fatigue is actually a result of the brain injury itself, sometimes called primary fatigue. In other cases there are secondary factors such as stress, depression or chronic pain that can cause or compound this fatigue. In the case of primary fatigue there is some evidence that after a brain injury a person needs to work much harder and put more effort and attention into everyday activities, even activities like talking clearly and walking, things we all do without thinking. This translates into draining of energy and an overwhelming exhaustion that can interfere with completion of ordinary everyday tasks. Other things that can contribute to fatigue after brain injury include side-effects of some medications, not getting enough exercise or nutrition, and sleep problems.
So what helps? Getting into a good routine around sleep can help, for example going to bed and getting up around the same time each day. Pacing activities with short rest periods of up to 30 minutes during the day can help avoid getting over tired. Many people with brain injuries report that they feel a little better in the morning but peter-out during the afternoon and evening. This means it is much better for them to complete complicated activities, go to appointments and work, in the mornings when they feel most fresh. Getting light daily exercise can help avoid the deconditioning that can occur with reduced activity levels and that can feed into fatigue. Paying attention to the triggers and learning to identify early warning signs of fatigue can also help. For example for some people, getting involved in complicated thinking tasks is more tiring than physical activities. Finally, in some cases, certain medications can help this brain injury fatigue however this kind of approach is usually the last thing to try because these medications can have side effects of their own.
If fatigue after a brain injury is affecting your daily life and relationships, ask for help. Visit your GP and talk about how you are feeling. Your GP can make sure there are no causes of your fatigue that can be addressed such as depression or stress. You could ask for a referral to a clinical psychologist who knows about recovering after brain injury or you could contact the Brain Injury Association for advice by calling the local field officer (ph 365 3262) or by visiting their website (www.brain-injury.org.nz).
Dr Debbie Snell is a clinical psychologist specializing in neuropsychology, concussion and rehabilitation.
