Fatigue Post-Concussion


Defining Fatigue:

A general definition of fatigue is the “awareness of a decreased capacity for physical and/or mental activity as the result of an imbalance in the availability, utilization and/or restoration of resources needed to perform a given activity”.

 

In simpler terms, it can be thought of as a discrepancy between effort and reward; the damage sustained from a concussion demands that the brain must increase its workload to compensate for inefficiencies in information processing. This is known more specifically as primary fatigue; a form of fatigue that is the direct result of the brain injury itself, rather than some intermediate factor such as poor sleep quality. 

 

Primary fatigue is among the most common symptoms of a concussion. The subtypes of fatigue are cognitive fatigue, physical fatigue, emotional fatigue, and stress fatigue. It can be incredibly difficult to reliably identify fatigue due to its subjective nature. There is often both a physical and mental component, which poses a challenge for those creating or trying to establish some sort of objective measure for fatigue. Countless scales have been created in an attempt to account for severity, lifestyle implications and emotional effects, however, self-reporting is the predominant measure of fatigue. 

 

An Explanation of Fatigue by Post-Concussive Individuals:

 

A focus group comprised of individuals suffering from fatigue post-concussion described the experience of fatigue as follows:

 

  • “Anytime I have to focus… I’m fatigued.”
  • “It’s like you disconnect- I can’t lift my arms, I just can’t- I’m not here so I have to go to sleep.”
  • “If we are thinking in terms of words to describe fatigue- overwhelmed.”
  • “You lose what you were talking about, and you can’t hear what anybody else is saying either, and you are trying to grab that thought. It is totally exhausting and fatiguing, and it changes your life. It just makes me want to cry thinking about it just because it drives you so easily, you just want to go lay down, you don’t want to participate anymore, you quit and a major part of that fatigue is that it changes how you react with everybody . . . but you lose it and it is disconnecting on all levels, then you are frustrated with yourself.”

 

These statements taken from several individuals, relay the idea that fatigue is a pervasive symptom that envelops every aspect of everyday life. The overwhelming feeling of depletion can be debilitating and often, cannot be resolved by rest and sustenance unlike other forms of fatigue. The incidence of post-concussion fatigue varies from 21-73% depending on the characteristics of the surveyed population; but this statistic is evidence of the degradation of life quality experienced by post-concussive individuals suffering from fatigue.

 

Explanations for Post-Concussion Fatigue:

 

There are various biological and physiological explanations for the fatigue experienced following a concussion. One main idea hypothesizes that the brain damage results in reduced cognitive functioning particularly in the areas responsible for processing speed and attention. This decrease results in compensatory increased brain activity, which subsequently results in fatigue. 

 

Researchers have solidified this explanation using studies that monitor brain and physiological activity; they ascertained that individuals suffering from concussions experience fatigue because of the heightened level of processing required to complete tasks.  

 

Psychosocial factors may also play a role in post-concussion fatigue. The persistent nature of fatigue has been linked to societal and familial perceptions of the fatigued individual. Researchers believe that those surrounded by negative perceptions of post-concussion fatigue, face greater difficulty in recovery. Adverse psychosocial reactions may exacerbate post-concussion symptoms.

 

Treating Fatigue:

 

There is no fixed treatment for post-concussion fatigue but there are several strategies for managing fatigue. The most common suggestions for the reduction of fatigue are: 

 

  • scheduling designated rest periods to reduce tiredness or overstimulation
  • being mindful of how extraneous factors can affect energy levels
  • monitoring fluctuations in fatigue 
  • educating you and those around you about the implications of post-concussion fatigue
  • finding compensatory strategies to minimize the effort needed to perform strenuous tasks

Written by Anne Mburu

 

References:

Cantor, J. B., Gordon, W., & Gumber, S. (2013). What is post TBI fatigue?. NeuroRehabilitation, 32(4),     875-883.

Norrie, J., Heitger, M., Leathem, J., Anderson, T., Jones, R., & Flett, R. (2010). Mild traumatic brain injury     and fatigue: a prospective longitudinal study. Brain injury, 24(13-14), 1528-1538.

Wylie, Glenn R, and Laura A Flashman. “Understanding the interplay between mild traumatic brain injury     and cognitive fatigue: models and treatments.” Concussion (London, England) vol. 2,4 CNC50. 27 Oct. 2017, doi:10.2217/cnc-2017-0003

Resting and conserving energy After concussion. (n.d.). Retrieved February 13, 2021, from https://sunnybrook.ca/content/?page=bsp-concussion-conserving-energy