I just don’t have energy anymore. I can’t get my words out at the end of the day. After I go to work, I come home and I just crash. I used to be able to get my whole to-do list done, now I do one task, and I’m done for the day.

What is fatigue?

For many individuals who have sustained brain injury, fatigue is one of the most common, persistent, and difficult to manage symptoms. It is estimated that 21-70% of individuals experience some ongoing fatigue after a brain injury. Everyone experiences fatigue at times, but fatigue after brain injury differs in that it may be brought on more easily and is not simply alleviated by breaks or extra rest. This fatigue is sometimes referred to as neurofatigue.

Fatigue is particularly troublesome as it can significantly impact an individual’s life participation and overall quality of life. Many think of fatigue only as a feeling of physical exhaustion, however neurofatigue may cause a host of cognitive and emotional symptoms in addition to physical fatigue. Below are symptoms which may be related to an individual’s fatigue. 

Physical symptoms: physical tiredness, headache, dizziness, muscle tension, decreased coordination, slowed speech, slowed movement. 

Cognitive symptoms: difficulty concentrating or paying attention, slowed processing speed, forgetfulness, trouble communicating effectively, trouble thinking of the, difficulty following sets of instructions, making more errors when completing tasks.

Emotional symptoms: irritability, restlessness, apparent disinterest in usual activities, mood swings, withdrawal, lack of emotional expression.

There are activities many people engage in on a daily basis which can contribute to or even worsen fatigue. These include: long periods of time using screens (such as time spent on the computer, using a smartphone, or watching television), stimulating sensory environments (background music, background noise, large numbers of people, visually cluttered area), long periods of time engaged in cognitively demanding activities (work tasks, paperwork, reading), and tasks which have a great physical or emotional demand. 

What can be done about fatigue after brain injury? 

One of the most helpful things that can be done is to identify triggers to fatigue and modify one’s daily schedule or exposure to these triggers. This looks different for each person. For some individuals, keeping a fatigue journal can be helpful to identify patterns to fatigue or even specific triggers. It may also be helpful to use a planner to plan out daily activities, build in time for breaks, and ensure that one part of the day does not contain too many activities. This is referred to as pacing. While many of us like to try to accomplish large to-do lists every day, prioritizing and completing only the most important tasks can prevent fatigue. 

Building in time for breaks is imperative to preventing excessive fatigue. Some individuals may prefer a couple of longer breaks during the day, while others may benefit from more frequent, short breaks. Breaks should be restful and free from excess stimulation. It is important that breaks are screen-free, as even though something like scrolling on a phone feels passive, it is a demanding task for your brain. Break activities may include: a short nap, sitting or lying quietly, meditation, focusing on breathing, listening to calming music, stretching, going outdoors, or even a slow-paced walk.

If you have had a brain injury and are struggling with cognitive fatigue or struggling to use strategies to manage your cognitive fatigue, you may benefit from evaluation and treatment by a speech-language pathologist who specializes in brain injury or concussion.