Fatigue Flashcards
what is fatigue
decreased mental and physical endurance, decreased motivation, depletion of reserves, lassitude, miss match between effort and actual performance
objective and subjective fatigue
subjective- overwhelming sense of tiredness, weakness, lack of energy and exhaustion
objective- as a reduction in the capacity to either initiate or sustain voluntary activities
possible causes of fatigue
central= CNS/ endocrine dysfunction/ immunological/ ANS
peripheral- neuromuscular
other- hypothyroidism/ anaemia/ medication/ psychological, sleep, diet, CV fitness
possible causes of fatigue- CNS causes
dysfunction in the premotor cortex, limbic system, basal ganglia and brainstem. Reduced frontal lobe activity adn deficits in perfusion and glucose uptake show on PET scans. Lesions in basal ganglia on MRI= increased fatigue. dysfunction in hypothalamus and endocrine system
possible causes of fatigue- endocrine dysfunction
hypothalamic-pituitary adrenal axis, normally stress causes release of cortisol which reduces stress response. in abnormal systems= low level of cortisol so highly sensitive to stress. Role of hypothalamus and neurotransmitters (dopamine, histamine and serotonin), interaction between neuroendocrine and neurotransmitter systems
possible causes of fatigue- immunological and ANS
cytokines (cell signalling) e.g. interleukin-2 and interferon induce fatigue and T lymphocytes and tumour necrosis factor (TNF-a) affect sleep (increased in MS and GBS), ANS- reduced activity leads to fatigue due to affect of lowering BP
possible causes of fatigue-sleep and psychosocial causes
sleep= many people with neurological conditions have disrupted sleep patterns- anxiety/ pain/ spasticity, psychosocial= association of higher fatigue people with depression/anxiety. Interactions with endocrine system or immunological responses unclear
PNS- neuromuscular causes
axonal damage/ peripheral nerve dysfunction, changes in the Na pump at the nodes of ranvier can result in nerve conduction block, impaired muscular excitation/ contraction/ metabolism, fall in muscle PCR/ accumulation of H+ ions and reduced pH, spasticity, damage
Reduced CV fitness
the ability of the heart, blood cells and lungs to supply oxygen to the working muscles and tissues. The ability of the muscles to use oxygen to produce energy for movement.
what can CV exercise lead to
weight reduction, reduced BP, reduced LDL and increased HDL, increased ability to use urine, increased chronic anti-inflammatory effect, reductions in vascular adhesions, decreased anxiety and depression, reduced all-cause mortality, most of which influenced by fatigue
assessment- subjective
rest and relaxation, sleep, diet, mental health, leisure time, cognitive activities, physical activity and exercise, pain
keep diary
fatigue measurements
VAS for fatigue, modified impact scale, the fatigue scale, fatigue assessment instrument, fatigue descriptive scale, multidimensional fatigue symptom inventory
fatigue management- balance and pacing, prioritising
balance- pacing is all about balancing activity and rest to bring about improvements in the way you feel- includes mental and emotional activity as well as physical, the 4 key elements to pacing are: activity, rest, relaxation
prioritising- delegate tasks
fatigue management- rest and relaxation
short, regular rest periods throughout the day are essential to give you time to recharge. Need to be fully relaxed and resting brain. Hor healing rest- need to be quit and still both physically and mentally, better to avoid sleeping during day= night sleep cycle
fatigue management- sleep
need atleast 7 hours sleep, stick to calm routine, avoid getting overtired and caffeine, resolve pain, positioning for relaxation, melatonin- released about 9pm as it gets dark, amitriptyline- sedative, magnesium
