Coping with Fatigue after Brain Injury
- Life Beyond Rehab
- Jul 30, 2019
- 4 min read
I can’t tell you how many times in my career I have talked with my patients about slowing down. Taking your time to try to “return to real life” is just as important as doing your physical therapy exercises.
Gradual return to activities, especially complex activities like work and school, should not be underestimated. Taking on too much too soon can have a long lasting, negative effect including depression and constant fatigue.
Let’s take a minute to talk about fatigue.
Anyone living with a brain injury can tell you that the struggle with fatigue is real. My patients tell me all the time that it can come out of nowhere – you are cruising along and suddenly…
BAM! You need a break.
Check out the following statistic:
Fatigue is present in 43–73% of patients [after a brain injury] and is one of the first symptoms for 7% of them. Fatigue does not seem to be significantly related to injury severity nor to time since injury. It can be related to mental effort necessary to overcome attention deficit and slowed processing (“coping hypothesis”).
(A. Belmont, 2006)*
What does that mean? It means that we don’t know all the reasons why fatigue is such an issue after a TBI, but it is the first symptom to show up and it’s pretty common. I really want to focus on two things from the quote above:
Fatigue related to mental effort
Fatigue NOT related to severity of injury
Often we as professionals spend a lot of time talking about physical fatigue - working on walking farther, completing high level balance activities, lifting heavier weights - when we should really be taking as much time, if not more, to talk about cognitive fatigue. Ask any one of my clients and they will tell you that once they leave a session with me it feels just as exhausting as leaving a physical therapy session.
They aren’t exaggerating. After a brain injury, your brain has to work harder in all areas, even just thinking. This is related to the coping hypothesis. Here we go with the “fancy talk”. All it means is, your brain gets tired doing normal, everyday tasks because of the extra effort it takes to pay attention and to process loads of information quickly. This relates to one of the main reasons why returning to school and work at a reasonable pace is so important. No one cares that you are at work for a million hours if you are getting irritable and making more and more mistakes.
Obviously, this is easier said than done. You’ve been going to school for years and you were always able to handle a regular class load. You’ve been at your job since the company started, it was never an issue to make it through a 60-hour work week.
Brain injury changes everything, so what do we do?
For those of you trying to return to school, whether it’s grade level (elementary through high school) or college, it is important to have a plan in place. When I say plan, I mean a legally binding plan that requires your school to accommodate your needs and create an environment that allows you to be successful. For grade level, this may mean creating or making changes to an Individualized Education Plan (IEP) including seating in the front row of the classroom. For college it starts with making a phone call and setting up a meeting with your school’s accessibility department to discuss testing accommodations (e.g. taking tests in a quiet room).
When returning to work, you may want to start with talking to your employer. Negotiate a gradual return to work such as going in for half a day, three days a week and slowly increasing your hours every other week. It may also be beneficial to start with your state’s vocational rehabilitation services, please see the link below to find your state:
The second point I wanted to talk about is that there is little, if any, correlation between fatigue, severity of injury, and/or time since an injury. This means that if you sustained a mild traumatic brain injury (mTBI), it has been 7 years since the initial injury and you’re still dealing with fatigue, IT’S OK. I feel like it is often difficult for us to comprehend the truly life-altering nature of brain injury and as a result we quickly lose sympathy and understanding (for ourselves and others) when things aren’t immediately “back to normal”. The first step is just reminding yourself that you have lived through an event that not everyone can understand, you have had to make changes in every aspect of your life, and you are a strong and amazing person.
Then, time to problem solve: “How can I make a change to my life and compensate for how tired I get?”
It may be helpful to start with keeping track of what you are trying to accomplish in a day – you might find that you are simply cramming too many things into one day.
Is there a time of day when you just need a break? – I don’t mean sitting and watching TV (because your brain is still processing information when you watch a TV show), I mean taking a 5 to 10 minute break where you sit in complete silence and allow your brain to simply stop and rest. Keep track of the time of day you are getting tired and try to allow for a “total rest of the brain”.
Remember, some days will be easier than others and you are doing great.
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* Please see the full article by clicking the link below:
“Fatigue and traumatic brain injury”
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