Fatigue after a concussion

Physiological causes

After an injury, your brain may process information less effectively, resulting in slower processing, increased fatigue and feeling overwhelmed. Your brain has to work harder for daily activities, depleting your "energy bank."

Chronic health conditions, poor nutrition and pain can also lead to fatigue. Medication side effects can contribute to fatigue.

Emotional causes

Anxiety, depression and stress can cause fatigue and emotional dyscontrol, such as irritability and mood swings.

Environmental causes

Noisy or busy environments and working under artificial lights can lead to fatigue. You may need to concentrate harder as your brain may not filter distracting noises or lights as easily.

Not all activities are equal in the amount of brain energy required. Certain tasks are more demanding of your cognitive abilities. For example, sitting on the beach eating an ice cream requires less brain energy than balancing a cheque book.

Disrupted sleep caused by noise, light or worries can also contribute to tiredness.

Our energy bank

Consider your energy as a "bank" with deposits and withdrawals. Budget your energy to have reserves and prioritize, plan and pace your activities to balance your energy bank.

Sleep

• Make sure you get sleep, with fixed hours for going to sleep and waking up. If necessary, talk to your doctor about sleep medication. Reduce or eliminate caffeine and alcohol in your diet.

Health

• Eat regular, nutritious meals and snacks.
• Avoid alcohol.
• Start light aerobic exercise, gradually building up to 20-30 minutes, at least three times a week (e.g., walking outdoors or on a treadmill, cycling on a stationary bicycle). Talk to your health professional if more guidance is required.
• Manage pain and headaches with your health care provider
• Find ways to reduce stress in your life. Prolonged stress can lead to serious health problems and will slow down your recovery.

1. Priority setting

Create a daily activity list and organize your activities into categories such as work/school, leisure, family, personal care and household. Is your balance of activities healthy?

Spending all your energy solely on work or school isn't the path to a healthy life. Make lists and decide for yourself which tasks are:

1. Urgent (must be done today)
2. Important (must be done in the next few days)
3. For later (must be done this week or month)
4. Perhaps never (consider the bigger picture)

2. Planning

Similar to budgeting your money to avoid overspending, you should plan your energy for your activities.

Keep your energy bank as full as possible. Make time to refill your energy reserves.

• Keep a daily diary of how much energy (scale of one to ten) it takes to do each activity. Add up your totals for the day, note frequent activities that drain your energy and make adjustments to the number and type of activities you do during the day.
• Plan your week the Friday before and prepare a weekly calendar/schedule that lists the urgent and important things to do. If you find yourself overwhelmed with urgent tasks, reconsider your priorities, delegate responsibilities and learn to say no without feeling guilty.
• Identify your energy boosters and plan time for them each day.

3. Pacing

A common mistake is to disregard your tiredness and continue at your usual pace. Instead, establish a new pace that allows for more rest periods and different approaches to tasks. Be realistic.

Learn to recognize signs of brain fatigue:

• Light-headed, headache, decreased balance.
• Slower thinking, pain, clumsiness.
• Irritability, stress etc.

When you notice these symptoms, take a break for as long as needed. Fine-tuning your activity balance may take several days.

• Identify your own pace and stay within it.
• Be prepared to cut your “to do” list in half until you know your speed.
• Build in time for unanticipated mistakes or distractions.
  
  • Use energy conservation techniques.
    Plan individual tasks by gathering all your tools and materials for your workplace to avoid unnecessary stair climbing and trips from room to room.
  • Analyze the activities you do and simplify them into manageable chunks that you can work on at different times.
• Delegate tasks to others.
• Schedule rest breaks in your day. Spread out your activities over the day.
• Vary your activities during the day (physical, thinking and relaxation).
• Consider your commute time to and from work or school when planning your workday.
• If you are anticipating a heavy day, build in time before and after for some rest and relaxation.

4. Positioning

Your environment and posture can make a significant difference.

• Ensure you maintain a supportive sleep posture, with a straight spine and relaxed limbs. Use a neck-supportive pillow and consider sleeping with a pillow between your knees when lying on your side.
• Minimize noise and clutter. Use lights that are neither too bright nor too dim.
• Make sure your work area is ergonomically correct with work surfaces at the correct height and good posture. Utilize proper lifting techniques.
• Change your position every 15 minutes.

5. Prevention

• Listen to your body's natural need for rest and don't feel guilty about resting when necessary.
• Try to work in quiet surroundings and minimize the amount of white noise.
• Go shopping when it is least busy.
• Avoid driving in rush hour.

Increase gradually

As your symptoms diminish, you can slowly step up the number and intensity of the activities that you do. Use your energy diary to guide you.

Get back to normal activity and work by easy stages

As you find you can do more and more, you can think of starting work again.

For a smooth return to work, work with health professionals, your employer and your long-term disability plan or insurance company to:

• Modify your duties, your hours and days of work. The ideal is to start working just two to four hours, Monday, Wednesday and Friday. Slowly increase the number of hours you work, when certain that you can cope, and your fatigue is not increasing from day to day.
• If your symptoms increase at any time, your body is telling you that you are overdoing it. Take an immediate break and review your daily activities to determine the cause of increased fatigue and make necessary changes.