Scottish Head Injury Forum 2010 Fatigue Management After Brain Injury Naomi Bidwell 5 th November 2010

November 2010 Naomi Bidwell Specialist Occupational Therapist 2 Contents What is Fatigue? Causes of Fatigue Impact of Fatigue Approaches to Fatigue Management

November 2010 Naomi Bidwell Specialist Occupational Therapist 3 What is Fatigue? “ The experience of exhaustion and a decreased capacity for physical and or mental activity due to an imbalance in the availability, utilisation and/ or restoration of resources needed to perform activity” Aaronson, et al (1999) adapted by Quinn (2004)

November 2010 Naomi Bidwell Specialist Occupational Therapist 4 What is Fatigue? One of the "top 5" post-injury complaints Often described as – “exhaustion, – tiredness, – weakness, – can’t concentrate, – no energy, – feel drained” Makes people less able to engage in physical/ mental/ social activity

November 2010 Naomi Bidwell Specialist Occupational Therapist 5 Types of fatigue in Brain Injury Physical – Increased effort to perform physical tasks – Relearn to coordinate the muscles – Build up strength – Tends to go away after 6 months Mental – Increased mental effort to engage in activities communication and thinking skills – Concentration/attention span – Slowed processing – Mental block – Tends to persist longer term

November 2010 Naomi Bidwell Specialist Occupational Therapist 6 Are There Other Causes of Fatigue? Sleep Disturbance Pain Medication side effects Depression Spasticity Posture Nutrition Hydration

November 2010 Naomi Bidwell Specialist Occupational Therapist 7 Symptoms of fatigue Reduced Attention/Concentration Memory difficulties Word finding difficulties Physical weakness Irritability/Agitation Exacerbated symptoms Feeling of going backwards

November 2010 Naomi Bidwell Specialist Occupational Therapist 8 Impact of fatigue on function Participation in desired activities Mood Self-esteem Interpersonal relationships Sustained physical functioning Roles and responsibilities Quality of life

November 2010 Naomi Bidwell Specialist Occupational Therapist 9 Fatigue Management After Brain Injury Aims – to maximise daily functioning within constraints of fatigue – overcome fatigue How? – Pacing Energy diaries Lifestyle Planning Grading Activities Activity Schedules

November 2010 Naomi Bidwell Specialist Occupational Therapist 10 Energy diaries Assessing fatigue levels Used to rate fatigue levels – At different times of the day – In relation to different activities Monitor how person sleeps at night More detail given the more useful the diary Complete on good and bad days Once identified may be managed using lifestyle planning

November 2010 Naomi Bidwell Specialist Occupational Therapist 11 Over-Activity/Rest Cycle Goal Activity Rest Trying to catch up Time

November 2010 Naomi Bidwell Specialist Occupational Therapist 12 Lifestyle planning Planning and carrying out activities within ability levels – Acknowledge the problem – Recognise trigger factors – Energy saving methods – Value rest – Separate tasks into component parts – Setting goals – Balance work/rest/play

November 2010 Naomi Bidwell Specialist Occupational Therapist 13 Grading activities – Altering task – Altering intensity of activities – Schedule brain breaks during the day. This might include an afternoon nap Activity schedules – Planning – Diaries/ wall planners/ calendars – Avoid difficult tasks when you feel tired Stopping and removing self from situation, Managing trigger situations when known Have a set routine for sleeping at a certain time ever night Avoid food or drinks such as coffee that are detrimental to sleep, late at night Coping strategies

November 2010 Naomi Bidwell Specialist Occupational Therapist 14 Putting Pacing into Practice Know your own abilities - energy diary Set Baseline - what you can do, even on a bad day Set Goals - precise, realistic and right for you Break the task up into achievable steps Incorporating rest periods Prioritise tasks Delegate tasks Improve fitness

November 2010 Naomi Bidwell Specialist Occupational Therapist 15 Putting pacing into practice Set activity at baseline for a week and then slowly progress Do what you planned not what you feel like! Aim for consistency in activity Do not to go over agreed activity level even if feeling good Value real rest Remember setbacks are normal Don’t increase activity if fatigue persisting Be flexible, don’t set a time limit!

November 2010 Naomi Bidwell Specialist Occupational Therapist 16 Effective Pacing Goal Activity Time Setback Too much

November 2010 Naomi Bidwell Specialist Occupational Therapist 17 Any questions?