Managing chronic fatigue
Posted by: Vicky Carruthers (Occupational Therapist – Neural Pathways)
Chronic fatigue is a very common symptom of any neurological condition; whether that’s caused by a traumatic brain injury, concussion, a stroke, or in long term conditions such as Multiple Sclerosis and Parkinson’s disease.
It is more than just feeling tired and is often described as an overwhelming feeling of exhaustion that does not improve following sleep. Fatigue can be incredibly debilitating and does not only affect a person physically (e.g. strength, energy levels, balance) but can affect someone’s cognition or “thinking skills” such as concentration, memory, decision making, motivation and mood. As a hidden symptom of a neurological condition, it can also prove difficult to fully explain how you are feeling to others.
I’ve been working with a client who has been experiencing significant fatigue following a relatively minor traumatic brain injury. One year after being hit by a car at very slow speed, my client had made a good physical recovery, having improved her balance and ability to walk independently. However, fatigue was leaving her unable to participate in daily activities and made her feel “trapped” in her own home. This meant she often spent days in bed or on the sofa due to head and body pain, lack of energy, weakness, slowed down thinking and poor concentration. As a previously active and busy lady, she also described feelings of guilt and uselessness wondering why she couldn’t just “power through” the fatigue and “get on with it.”
Occupational Therapy was recommended to help her learn and implement strategies to self-manage and gain control over her fatigue; ultimately helping her do the things she needed and wanted to do! Although everyone experiences fatigue in a completely unique way, the following tips are taken from the work I did with my client over a 3 month period, as an idea what fatigue management may involve:
Keep a fatigue diary
I encouraged my client to record what activities she completed each day and how she felt throughout the day. This helped to identify when she started to feel fatigued and recognise fatigue “warning signs.” The information captured by the diary helped her to implement some of the strategies below to avoid exhausting herself.
Prioritise your activities and plan ahead
Prioritising activities to help save energy for the things you really want and need to do is a really effective way to manage fatigue. For example, can certain housework jobs be left for another time? Plan for any important events you may have that week (such as birthday celebrations) so that you can enjoy them but you don’t overexert yourself. You may not be able to attend the whole event and may experience increased fatigue the days following the event.
Break down any large or complicated tasks into smaller, more manageable ones. Taking rests and completing tasks sitting down can help.
Organise your space and adopt a good posture
Make sure your space, whether that is at home or work, is clutter free, organised and with items easily to hand. This can reduce the amount of physical effort required to complete tasks and help manage your fatigue.
Look after your general health and wellbeing
This includes eating a healthy balanced diet, getting sufficient good quality sleep and trying to complete regular gentle exercise.
Build rest and down time into your daily routine
This does not always mean going to bed or lying down. Activities such as meditation, mindfulness, yoga and tai chi can also be helpful. Find a method that works for you. For example, my client found that she felt best after an afternoon rest and built this in to her routine, using a mobile app to aid her meditation.
Accept offers of help
Although this can be hard, if friends and family offer to help with tasks try to accept this help.
Set yourself realistic goals
Try not to take on too much, be realistic and think of ways to congratulate yourself when you reach a goal. Reflect on any progress you have made – ask friends and family to help remind you how well you are doing!
Over the past 3 months, through implementing the above strategies, my client has gone from only being able to go to local shops for very short periods with her husband, to joining her local gym, attending Pilates classes, starting to complete more household jobs and being able to visit family. Although she still has good and bad days, she says she feels that while fatigue is still a problem, she is more in control of it rather than it being in control of her.