Fatigue after brain injury: an introduction

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We all experience fatigue at some point in our lives but it is usually only for a limited time and gets better once we take a break or get a good night’s sleep. Fatigue after brain injury, however, is different. It does not necessarily get better with rest and can have a significant impact on a person’s quality of life, mood, relationships, ability to do everyday things, and rehabilitation. 

What is fatigue and how can it impact a person’s life?

Fatigue is a commonly reported issue after brain injury and is experienced by each person differently. Some people describe it as overwhelming tiredness or exhaustion that can make them feel weak, completely lacking in energy, sleepy and unmotivated.  As a result, people may avoid doing certain activities or find it very effortful to do everyday tasks.  

Fatigue can also worsen other difficulties resulting from the injury, such as problems with memory, concentration and speech. Many people report feeling that they have no control over their fatigue, and this can lead to feelings of helplessness, hopelessness, anger and irritability.

What causes fatigue?

The underlying causes of severe fatigue after brain injury are poorly understood, but numerous factors are likely to be involved.

  • ‘Central fatigue’ can arise directly from damage to certain areas of the brain, in particular the ascending reticular activating system – a complex network of neurons in the brainstem which plays a key role in maintaining arousal and wakefulness.   Central fatigue does not appear to be related to the severity of the injury, and is sometimes experienced by people with mild brain injury.
  • ‘Mental fatigue’ can result from cognitive impairments caused by the brain injury. These often take the form of problems with sustaining attention and reducing the speed at which people can process information.  As a result they have to put a lot of effort into undertaking activities and tasks that were previously easy, giving rise to ‘cognitive overload’ and mental fatigue.   If the fatigue is not well managed, it can then amplify the person’s cognitive impairments and other problems.
  • Other factors which can make people more vulnerable to fatigue after brain injury include the side effects of some medication; disturbances of mood and/or sleep; pain; poor nutrition; and lack of exercise.

How long does fatigue last after brain injury?

For some people, fatigue improves over time.  However for others it can persist and needs to be managed in the long term.

What treatment is available for fatigue?

There is no single or simple way of eliminating fatigue after brain injury, but assessment and guidance from healthcare professionals can be very effective in reducing fatigue and the associated problems.   They will typically take a holistic ‘fatigue management’ approach in which they help each individual to identify and address underlying or contributory factors, with the aims of enhancing their overall quality of life by increasing their feeling of control over their fatigue and their abilities to do the things they want or need to do.

It is very common for people to get caught up in a ‘boom-bust’ cycle of activity where they do too much one day and then experience increased fatigue or exhaustion the next.   Education can help to increase their awareness and understanding of their fatigue and what triggers it – and if they know which activities are likely to be particularly draining for them personally, they can anticipate, plan, and take steps to respond to warning signs and symptoms.  

Fatigue management might entail the person doing some or all of the following:

  • keeping a diary to monitor changes in their fatigue levels before and after everyday activities
  • pacing, prioritising and planning activities
  • establishing healthy sleep routines
  • engaging in appropriate physical exercise 
  • ensuring adequate nutrition
  • developing effective responses to cope with or reduce fatigue when there are signs that it is building up

How can Cognivate help with fatigue after brain injury?

Fatigue management is almost always a key element in our individually tailored rehabilitation programmes because it is so important to helping people reach their potential. 

Our Occupational Therapist also runs an online group called Managing Fatigue after Brain Injury, which can be valuable to people at any stage of their recovery. You can find out more here.