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Scottish Head Injury Forum 2010 Fatigue Management After Brain Injury

Scottish Head Injury Forum 2010 Fatigue Management After Brain Injury. Naomi Bidwell 5 th November 2010. Contents. What is Fatigue? Causes of Fatigue Impact of Fatigue Approaches to Fatigue Management. What is Fatigue?.

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Scottish Head Injury Forum 2010 Fatigue Management After Brain Injury

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

  2. Contents • What is Fatigue? • Causes of Fatigue • Impact of Fatigue • Approaches to Fatigue Management 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) 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 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 Naomi Bidwell Specialist Occupational Therapist

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

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

  13. Coping strategies • 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 tosleep, late at night 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 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! Naomi Bidwell Specialist Occupational Therapist

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

  17. Any questions? Naomi Bidwell Specialist Occupational Therapist

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