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Fatigue after TBI

A nearly universal complaint that people have after brain injury is fatigue. Although fatigue decreases over time, it is a very persistent problem. Many patients recover from nearly all of their other deficits, only to have fatigue prevent them from returning to their pre-injury level of activity. Many children are used to going to school all day, participating in after-school activities, coming home and doing homework. Fatigue from a head injury drastically alters their lifestyle.

Mental versus Physical Fatigue
There are two types of fatigue: physical fatigue and mental fatigue. "Physical" refers to doing some sort of physical activity. After a head injury, patients may spend substantial time in physical therapy re-learning to coordinate muscles and to build up strength. They will likely experience significant physical fatigue. "Mental" refers to activities requiring concentration and reasoning such as doing homework, taking an exam, listening to a lecture. Patients are often surprised at the extent of mental fatigue they experience after even mild TBIs.

Management
  • Fatigue often occurs in the afternoon, generally around 2:00 or 3:00. If the child has to do something that is stressful or hard, it should be done in the morning when the mind is clearer and less prone to making mistakes.
  • Fatigue affects memory. Skills and information learned when the mind is fresh are more likely to be remembered.
  • Exercise improves the ability to think. Why? Even though the brain weighs less than 5% of the entire body, it uses 30% of the oxygen in the body, and probably the same amount of glucose needed for energy. With exercise, the patient gets more oxygen into the blood system. Some types of exercise, such as swimming, can be beneficial for chronic pain, in particular neck or back pain, which may contribute to fatigue.
  • Diet is another important consideration. It is important to eat 3 well balanced meals a day. The sugar from a doughnut or the caffeine in a soda may provide a brief burst of energy, but that energy doesn't last. The goal is to have a constant supply of energy to the brain. Healthy, between-meal snacks should be provided depending on the age of the child and their caloric needs.
  • Gradually increase stamina so that the child can build a tolerance to fatigue. Going from no school to being in school all day is not appropriate for the brain-injured child. Begin with 1 to 3 hours and gradually add hours. If the child cannot tolerate school, he or she should begin participating in some activity that helps increase stamina.
  • Modafinil (Provigil) is used by some clinicians to treat fatigue after brain injury, but there are not currently any controlled studies proving efficacy. [Kumar: 2008]

Prognosis
For most, fatigue improves with time but does not go away completely. Physical illness or emotional upset can increase fatigue dramatically.

Authors

Author: Teresa Such-Neibar, DO - 11/2008

Page Bibliography

Kumar R.
Approved and investigational uses of modafinil : an evidence-based review.
Drugs. 2008;68(13):1803-39. PubMed abstract