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Fatigue is an almost universal complaint that affects people with head injury. Although fatigue decreases over time, it is a persistent problem. Many patients recover from nearly all of their other deficits, only to have fatigue prevent them from returning to work full time (they may go back, but at a part-time level). A lot of people are used to working 50, sometimes even 60 hours, or more, a week. Fatigue from a head injury can alter 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 labor such as mowing the lawn or working in a flower garden. Just after a head injury, physical fatigue may be troublesome. For example, if you’re relearning to walk, the amount of effort it requires to relearn to coordinate the muscles and build up strength will be substantial. For most people, physical fatigue tends to go away after 6 months. What surprises people with a head injury is the mental fatigue. For example, you could spend all day in your garden pulling out weeds and not feel tired from it, but an hour of balancing the household budget will leave you exhausted. This is mental fatigue, and may go on for long periods of time.
Why does this occur? Let’s look at the brain as a motorway system. We intend to make a car journey from Carlisle to London, taking the M6 and M1. Reasonably straightforward and direct. However because of traffic problems the M6 is closed at Crewe so you decide to reroute across the M60 but that is log jammed too causing massive delays. You therefore cut across country and join the M1 near Sheffield. There are serious delays at Watford Gap so you decide to cut across country again, finally ending up on the M40 and much later than planned arrive at your destination. More time and energy is needed to achieve the same result. This analogy seems to make sense. People with a head injury tell me that it takes much more effort to get the same answer.
Does fatigue get better over time? For most, it does. Does it go away completely? For most, it does not. At first, people may work for, say, 3 hours and then they are exhausted. Eventually, they work for 4 hours, then 5 hours, then 6. Many people finally work 8 hours a day, but are extremely tired in the evenings and need the weekend to recover. If you become physically ill with a cold, or have surgery, this fatigue disorder can briefly come back.
What Can I Do?
Most people tend to get fatigued in the mid-afternoon. If you are going to do something that is stressful or hard, do it in the morning. Generally speaking your mind will be a lot clearer in the morning and less prone to making mistakes. Realise that fatigue will affect your memory. If you learn information when you are fresh, it is more likely to stay with you. If you stay up late studying for a big exam, you will have more problems trying to recall this information the next day.
Exercise improves your ability to think. This seems pretty obvious, but for individuals with head injury, it becomes crucial. If your doctor has cleared you to do exercise, you should make a conscious effort to do it. 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 (which is the energy that runs your body). If we use a car analogy, a clogged fuel system will not allow full power. With exercise, you get more oxygen into your blood system. Also, for people who have chronic pain syndromes, some types of exercise are very beneficial. For example, swimming is a very good exercise for people who have neck or back pain. Always talk with your doctor about what exercise is likely to work best for you.
Diet is another important consideration. When I say "diet", I don’t necessarily mean to lose weight. It’s important to eat correctly. In our rushed society, we eat a lot of fast food rubbish a lot of the time; burgers, fries, pizzas, crisps, doughnuts, coffee. That’s not a very good diet. The sugar that you get from a doughnut or the caffeine from coffee gives you a brief burst of energy, but that energy doesn’t last.
We’ve all heard of a "sugar buzz." Children are very prone to this. The same thing occurs in adults. The problem with sugar is that you "roller coaster". You get that burst of energy but you come crashing down. The trick is to have a constant supply of energy to the brain. Talk to a qualified dietician. You may already know one from your experience in hospital. Alternatively ask your GP to recommend one. You are what you eat.
You need to gradually increase your stamina. Going from not working to working 40 hours a week is very stressful. For the head-injured individual, this is nearly impossible. You must give the brain time to build a tolerance to fatigue. A common approach to this problem is by having people gradually return to work. You might start off with part-time, beginning with 1 to 3 hours on returning to work. Gradually, add hours only as you can tolerate it. What’s the problem with this? Most employers only want you 100%. They want you there 40 hours or they don’t want you there at all. Good employers are good at facilitating rehabilitation of their employees. If you can’t return to work, however, some sort of productivity e.g. a hobby or volunteer work, or both, is a good means of rebuilding your skills. This will also help to decrease fatigue and will improve self-esteem.
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