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A brain injured person discusses their situation with a care worker illustrating fatigue after brain injury

Fatigue is something that many of us may have experienced from time to time, normally after a particularly intense period of activity. Signs may include; difficulty concentrating or maintaining attention, eyes feeling heavy, head feeling fuzzy or fidgeting and feeling irritable. It is our body’s sign that we need to take a break, and it is normally solved after a period of rest.

Fatigue after brain injury – or ‘pathological’ fatigue – is different and can be present most or all of the time and can therefore significantly impact the lives of those who experience it. It is estimated that fatigue is one of the most common problems people have after brain injury, with as many as 70% of people who have suffered brain injury reporting fatigue. It may cause intense feelings of sleepiness, lack of motivation, lack of energy, none of which is alleviated with rest. It can also mean a worsening of other difficulties related to their injury, including; forgetfulness, word finding difficulties, low mood, dizziness and headaches.

What is the cause of fatigue?

Fatigue after brain injury can be caused by several, or a combination of different, factors. For example, it can arise as a result of direct damage to certain brain structures, or as a result of needing to make more effort to carry out other daily functions such as movement or speech.

However, the underlying causes are still relatively poorly understood despite how commonly the symptom is reported.

How can fatigue be managed?

Understanding fatigue after brain injury is, of course, very individual and involves developing an understanding of what any possible triggers may be. Some people report that certain activities – like working at a computer, or being in a busy and overly stimulating environment – can trigger feelings of fatigue.

Once any such triggers have been identified, it is then a case of trying to find suitable ways to manage that, for example, trying to limit screen time.

Before management strategies are in place, it can feel like fatigue is difficult to manage and control. It can sometimes be helpful, as a starting point, to keep a diary of daily activities and then feelings of fatigue on a scale of 1-10. This may just give an idea of which activities cause more or less fatigue, and can therefore provide useful information in terms of management strategies moving forwards and realistic targets of what may be achievable in a particular day or week.

What is the outlook?

Recovery following brain injury looks very different for every injured person. For some, improvements may continue over time and fatigue may improve, particularly once management strategies are formed and put into place. For others, fatigue may remain a feature and something that needs to be managed in the long-term, with thought being given to various factors, such as:

  1. Pay attention to what triggers your fatigue, and learn to identify the early signs of fatigue, such as becoming more irritable or distracted.
  2. Get more sleep and rest. If you have insomnia, tell your doctor.
  3. Set a regular schedule of going to bed and awakening the same time every day.
  4. Resume activities gradually, over weeks or even months.
  5. Avoid over-scheduling.
  6. Exercise daily. Research has shown that people with TBI who exercise have better mental function and alertness. Over time, exercise and being more active helps lessen physical and mental fatigue and builds stamina. It also may decrease depression and improve sleep.
  7. Talk to your doctor.
  8. Discuss medical or physical problems that may be causing fatigue.
  9. Have your doctor review all your current medications.
  10. Tell your doctor if you think you might be depressed so treatment can be started.
  11. Ask your doctor if there are any blood tests that could help to find out what is causing your fatigue.

Evidence to support the impact of fatigue

I have represented several clients who have suffered extreme levels of fatigue post brain injury. This has two vitally important consequences for me; firstly, in all my contact with them, I need to ensure that I respect this aspect of their symptoms so that I am not a trigger or cause of excessive fatigue. I will always ask the following questions: When is the best time to speak? How long would you like the call or meeting to last? How would you like the information and advice I am going to give to you presented?

Secondly, it is vital that comprehensive evidence of the impact of the fatigue is gathered – crucially in witness statements from family and friends and from employers, schools or colleges if relevant but also by discussing and understanding and then evidencing management strategies with those clinicians who are treating or supporting my client.

Finally, as the incidence of disabling fatigue post brain injury becomes more widely understood, there are a range of specialist fatigue management programmes now available. Discuss these options with your expert witnesses and ask if they would consider this a reasonable recommendation for your client. It can be all too easy to overlook the profoundly disabling impact of fatigue after a brain injury; it is vital to ensure that this is fully explored and evidenced.

Alice Hall, Specialist Serious Injury Solicitor at Irwin Mitchell

Alice is a solicitor in the Irwin Mitchell Serious Injury Team, based in our Birmingham office. Alice specialises in cases involving brain injury, spinal injury, polytrauma and complex fatal accidents. She is an APIL accredited Litigator.

How can Brain Injury Group help?

If you have been injured in a work-related accident and would like a free, no-obligation chat with a specialist brain injury solicitor about the circumstances surrounding your accident, please email, telephone 0330 311 2541 or visit our website to access live chat.

We are also able to offer free welfare benefit checkups to all affected by brain injury, to ensure you are receiving the right benefits for your individual circumstances.

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