Neurofatigue

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Fatigue fatigue fatigue, that is what people with brain injury often experience.

Everything takes effort. The energy for the whole day is often consumed completely within two hours. There are many brain injury victims who have insomnia ón top of this all. Another group of brain injury survivors have an increased need for sleep. But the similarity is FATIGUE.

Mental fatigue is different from physical fatigue.
We can all get an idea when talking about physical fatigue. Being tired after an exercise, after a brisk walk, after strenuous physical labor, after housework and so on.

Mental fatigue comes in thinking processes, learning and information processing, watching television extensively, doing computer actvities, but also solving problems, interpreting the behavior of other people and thinking logically.

A healthy person can also be mentally tired of all such functions if it is intense and long enough. Healthy people can also come to a point that they become annoyed when the "energy" is low, and especially if that mental activity was filled with noise. It seems like you cannot endure radio or TV, or something like that, anymore.

For brain injury victims that is many times worse. The mental energy has already been exhausted after a short time. They use more parts of the brain, because the dead area must be passed by, in the communication between braincells.

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Neuro-fatigue is one of the most debilitating consequences of a brain injury, as it influences everything the injured person does, both physically and mentally. A person’s emotions can also become raw when they are tired.

At the beginning, the ABI survivor is likely to find out that he or she will be tired easily after any activity, even chatting to friends or watching television, but particularly after tasks that require concentration or physical effort. This can be very depressing, particularly if the individual is aware of this change.

They will often try to push themselves to complete a task in the belief that they might overcome their fatigue. This is seldom the right thing to do as it can lead to increased fatigue in long-term. It takes time to build up energy. Taking rest periods both in between activities and when feeling tired is essential.

More brain activity in brain injury patients

Scientists have discovered that the brain of a brain injured works harder and uses more braincells. To process information more nerve activity is shown. They try to make more interconnections to braincells.

More brain areas are involved in activities than before the brain injury. That difference can be seen with PET scans. Parts in the brain that normally show little activity in the conduct of an activity, become actively involved in the thinking process after a brain injury.

This requires many extra bypasses and energy. Therefore, the reaction is often a bit slower on a brain injured person and it requires more energy. For each brain signal between brain cells, needs electricity to be generated and that takes energy. It can make someone really tired.


Definition of fatigue in the scientific literature: "the sense of a reduction in the capacity for physical and / or mental labor, caused by an imbalance in the presence, the use and / or recovery of energy that is needed to perform activities" Aaronson et al (1999)

So....Brain injury = Top Sport. It deserves respect.

 

Fatigue management

Fatigue management is the starting point for a recovery. In order to manage fatigue, a person first need to accept that he or she does not have the same physical and mental stamina that he or she had before the accident.

 

Signals that the battery is running low

Tell-tale signs of fatigue can be a drawn, tense look, a pale or greyish pallor, glazed eyes, irritability and, ironically, too much activity in that the person may become restless, more distracted or more talkative and make an increased number of mistakes.

During the day, for some much earlier, the person get signals that the battery is running low.
For example, they notice that they are tired,  make more mistakes or loses concentration. Some people get headaches, others lose the overview or become irritated. These are signs that let you know that the bottom of the battery is in sight. It's time to take a rest so that the battery can charge again.

Pay attention to bodily signals:

Do you get headaches, do you feel dizzy or feel a tension in neck and shoulders?

Pay attention to the way you do things:
Is the pace going down or do you make more mistakes than usual?

Please take notice of negative feelings: Are you cranky, you have somewhere lost interest in something, or do you feel irritated?

Please take notice of negative thoughts:

For example do you think: "I can't take it anymore', "How long is this gonna last?'

'I feel inferior because I can not do it', 'It no longer interests me' ?

Do you notice anything yourself these signs, ask people who know you well, whether they have in mind when your energy runs out. Ask them what signals they notice. A person’s emotions can become raw when they are tired.

 

Sleepingdisorders

Many brain injured suffer from sleeping disorders as well.

Read these factsheets..thanks to synapse.org.au

See for example our page on CSAS.

Lack of sleep has a negative effect on our cognition, mood, energy levels and appetite. The average person needs eight hours of sleep a night or will suffer from decreased concentration, energy and many other problems. These effects are multiplied many times by a brain injury.

Unfortunately, brain injury can often lead to a sleep disorder. The American Academy of Neurology reports that as many as 40 to 65 percent of people with mild traumatic brain injury complain of insomnia.

This can be hard to detect because people with brain injuries can also have a fatigue disorder. Although some may have problems with getting too much sleep, the usual sleep disorder is trouble sleeping at night, particularly problems with timing of sleep, then feeling drowsy during the day.

Causes

After a brain injury many find it not only difficult to sleep, but they are very easily awakened, sometimes dozens of times a night. On top of this, they may find themselves unable to sleep at all around 3 am, despite being desperately tired. Sleep will usually be very light, so the smallest noise brings the person instantly awake. Research suggests a major cause is disruption to normal release of certain quantities of certain neurotransmitters in the brain during sleep which causes "sleep fragmentation" due to waking up so often.

There can be a variety of other causes disrupting sleep. Discomfort from headache, neck pain or back pain will always make it hard to get to sleep. Depression is a common feature after a brain injury and survivors may find they fall asleep easily but wake up several hours before dawn, unable to sleep again. Anxiety and inability to handle stress are other problems for many. Negative thoughts whirring through the mind will usually make it very hard to fall asleep.

 

 

 

Resources: Brain injury-explanation, Rehabilitationcentre de Hoogstraat, Cognitive Therapy (Joke Heins, Rose Sevat, Corine Werkhoven) nebasnsg.nl, stroke association of The Netherlands, The rehab group ABI webportal