Fatigue is a major problem with a variety of neurologic conditions.  Feeling fatigued can be a HUGE barrier in your physical recovery and it can also dramatically impact your overall quality of life.That being said, managing fatigue might be the single most important area to address in neurologic rehabilitation.

Before we dive into the “how” (to manage fatigue), it is helpful to understand the “why” (to you experience fatigue). In other words, what is the root cause of your fatigue? Knowing this can help you get to the  best healthcare professionals to help you.

What is Fatigue?

Fatigue can be subjective and objective. Subjective fatigue is a feeling of weariness. On the other hand, objective fatigue is more measurable. Objective fatigue is a decline in performance with increasing repetitions of a physical or mental exercise. That being said, objective fatigue is easy to identify because you can see a measurable decline in performance.  Subjective fatigue is a little more vague, and often times, requires a healthcare professional who can take the time to listen to how you are describing the way you are feeling in an effort to get to the root cause of what is making you feel “weary”.   This is a less than ideal transition into the next matter of clarification regarding fatigue.  

What are the different sub-types of fatigue?

There are three different types of fatigue. Physical fatigue, mental fatigue and psychological fatigue.

Physical Fatigue

vector image physical fatigue

Physical fatigue is a decline in physical performance with increasing repetitions of a physical activity

Mental Fatigue

vector image of mental fatigue

Mental fatigue is a decline in cognition (memory, thinking, problems solving, planning…etc) with increasing time and/or repetitions of activities that require thinking.

Psychologic Fatigue

vector image psychologic fatigue

Is lack of interest in activities (you once enjoyed), and/or a feeling of weariness with little to no effort.

Medications that can cause a feeling of fatigue

Medications are a necessary evil when living with or recovering from a neurologic injury. However, medications also have side effects. Any many times fatigue and/or “drowsiness” is one of them.  IMPORTANT: you should never stop a medication without first consulting with your physician. That being said, it is critical that you talk to you doctor about how the medications make you feel. Many times, the doctor can make adjustments to decrease the severity of the side effects. Here are a list of medications that have drowsiness and/or fatigue as one of the potential side effects: 

Blood Pressure Medications

Anti-spasmodics: Oral medications that control muscle spasms are “relaxers”. That being said, these medications have “drowsiness” as one of the side effects

Nerve Pain: Medications that control nerve pain are often times central nervous system inhibitors. Therefore, this group of medications also have “drowsiness” as a side effect

Beta Blockers: Beta blockers help to control heart rate. These mediations also have “drowsiness” as a potential side effect. 

What Medical Conditions can cause fatigue and why?

Multiple Sclerosis and Fatigue

Nerve damaged by multiple sclerosis

Multiple sclerosis is a demyelinating autoimmune disease. Myelin is an insulating layer that forms around the nerves in the brain and spinal cord. This myelin allows electrical impulses to transmit quickly and efficiently down nerve cells. With multiple sclerosis, nerves lose this myelin sheath and therefore nerves do not conduct as quickly. As a result of this decreased conduction, activities will require more energy. This in turn can make someone with multiple sclerosis feel weary and/or experience a decline in performance prematurely.

It is also important to note that warm temperatures can also exacerbate feelings of fatigue.

Parkinson’s Disease and Fatigue

Parkinson’s disease is a progressive condition where the nerve cells that produce dopamine (an important neurotransmitter) die.  Loss of dopamine causes the movement problems associated with parkinsons disease. These movement problems include tremors, stiffness in the muscles and joints, slow movement, small movements, and/or impaired balance and coordination. Dealing with these movement problems means that everyday activities will have a tendency to require more energy. This in turn can cause someone with parkinsons disease to experience physical fatigue prematurely.

Stroke and Traumatic Brain Injury and Fatigue

It is extremely common to experience fatigue after a stroke or a traumatic brain injury.  A stroke or brain injury effects the ability to move, think, and control emotions. Therefore, fatigue is most likely a combination of factors. In other words it is most likely a combination of physical, mental, and psychological fatigue. 

Managing Fatigue Appropriately

  1. Talk to your healthcare team about how you are feeling. 
  2. Talk to your doctor about how you feel immediately before and 30 min after taking your medications
  3. Implement energy conservations strategies
  4. Plan your day and your week accordingly

Energy Conservation Strategies

Energy conservation strategies are adaptations to reduce the amount of energy exerted throughout the day. These adaptations include: 

  1. Always look for ways to simplify a task
  2. Move slower – moving fast uses more energy than moving slow and efficient
  3. Rest before and after activities
  4. Ask for help – believe it or not, your friends and family WANT to help
  5. Eliminate unnecessary tasks
  6. Keep your environment organized: disorder requires more moving around to find every day items. 

Keep an activity Journal – learn more about this in this video: