Research
Ouellet, M and Morin, CM. (2006) Fatigue following traumatic brain injury: frequency, characteristics and associated factors. Rehabilitation Psychology. 51(2): 140-149.
If you have ever been involved in rehabilitation for people with traumatic brain injury (TBI), you will have come across the concept of ‘fatigue’. There are a number of things that I’ve heard said (and repeated myself) about fatigue and TBI. For example: that TBI fatigue is not like ‘normal’ physical fatigue, that TBI fatigue is ‘cognitive’ fatigue not ‘body’ fatigue, that TBI fatigue can influence other brain injury related impairments like attention, concentration, and physical performance, etc. But what scientific evidence exists for all this clinical opinion? Given the amount of talk about fatigue and TBI, there has in fact been very little research done on the topic. Ouellet and Morin (2006) suggest that this is for a number of reasons: 1) TBI fatigue is multifactorial and subjective, 2) there is a lack of consensus about its definition, and 3) there are few reliable subjective or objective measures of fatigue. Therefore, these authors have set about collecting a little more descriptive information about fatigue.
Ouellet and Morin (based in Quebec) conducted a mail-out questionnaire to people with TBI. They received 452 completed questionnaires from people with mild through to severe TBI (average time since injury: 7 years). The questionnaire included a number of psychometrically-robust measures such as the Multidimensional Fatigue Inventory, the Insomnia Severity Index, and a Quebec-specific measure of psychological distress. Among the findings were the following results of interest:
- Almost all of the participants reported being more fatigue after their TBI compared to before, but 68.5% were significantly more fatigued than prior to their injuries.
- In terms of the type of fatigue, ‘Mental Fatigue’ was reported as most common followed by ‘Physical Fatigue’.
- There was a correlation between the severity of fatigue and time since injury, indicating that the problem of fatigue appears to improve with time. (This is a positive finding that should reassure people with newly acquired TBI.)
- Interestingly, there appeared to be no correlation between severity of TBI and severity of fatigue.
- Compared to people who were categorised as not significantly fatigued, people with fatigue were significantly more likely to have higher scores of depression, anxiety, cognitive disturbances, anger & irritability, more severe/more frequent pain, and higher total psychological distress.
- Fatigue was reported as affecting activities of daily living (for 25% of the respondents), mood (for 44%), memory and concentration (for 58%), social or leisure activities (for 43%) and work (for 45%).
- 33% reported that fatigue had interfered with their past or present rehabilitation activities!
- 39% stated that they were ‘very much’ or ‘extremely’ preoccupied with their level of fatigue.
So there you have it – the clinician opinion about fatigue can be largely substantiated by empirical evidence. The authors conclude that this is a very important but much neglected area of research, and point to the immediate need for future studies into treatment options for fatigue following TBI. PhD thesis anyone?
William Levack
Nice to hear from you. Sounds like a great area to study. My problem is too many research questions and not enough time! Good to hear there is some enthusiasm for following up this line of research however. Good luck with your work in Aus.
WilliamPosted by William Levack - 05 / Jun 2009 / 01:06am
Kind Regards
David PhilpottPosted by David Philpot - 03 / Jun 2009 / 01:45am
My name is Craig J. Phillips. I am a traumatic brain injury survivor and a master's level rehabilitation counselor. My tbi occurred in 1967 when I was 10 years of age. I remained in a coma for 3 weeks with right frontal lobe damage, a severe brain contusion and brain stem damage. Follow-up EEG’s, cognitive and psyche / social testing revealed that I would not be able to succeed academically beyond high school.
In 1967 Neurological Rehabilitation was not available, so I was essentially on my own. I had to re-teach myself how to walk, talk, read, write and speak in complete sentences again. Although I was not expected to live the night of the accident nor succeed academically beyond high school I went on to obtain both my undergraduate and graduate degrees.
On February 6, 2007 at the encouragement of a friend I created Second Chance to Live to share the strategies and principles that have empowered my capacity to succeed beyond all reasonable expectations. You may read about my process in my article My Journey thus Far at http://secondchancetolive.wordpress.com/2007/02/18
In my experience I have discovered that my circumstances are not meant to keep me down.
Over the past 20 months material from Second Chance to Live has been published through out the United States, in Canada, the United Kingdom, Europe and Australia. The focus of Second Chance to Live is to encourage, motivate and empower the reader to dream again regardless of how circumstances may look at the present time, because I believe that those circumstances are meant to build us up.
Please consider sharing my message of hope with the people that you serve. Please also consider adding Second Chance to Live http://secondchancetolive.wordpress.com/ to your web site as a helpful resource.
Thank you for your time and kindness. Please let me know if I can help to promote your vision. For more information please visit my Media Page at http://secondchancetolive.wordpress.com/press/
Have a simply phenomenal day!
Craig J. Phillips MRC, BA
Second Chance to Live
Our circumstances are not meant to keep us down, but they are meant to build us up!Posted by Craig J. Phillips MRC, BA - 18 / Nov 2008 / 08:46am