Fatigue Flashcards
1
Q
Define fatigue
A
- Overwhelming sense of tiredness, weakness, lack of energy, and exhaustion (subjective fatigue);
- or as a mismatch between expended effort and actual performance;
- or as a reduction in the capacity to either initiate or sustain voluntary activities (objective fatigue)
- Potential causes relate to the neurological damage (central or primary fatigue) or the consequences of the damage (peripheral or secondary fatigue)
2
Q
Incidence of fatigue in neurological conditions
A
- Fatigue is an overwhelming symptom common to many neurological conditions
- Incidence of fatigue can be as much as 80% in people with neurological conditions
- Stroke - 43% to 57% of the stroke population
- MS – approx. 40%
- PD – 33 – 81%
- TBI – 21 – 73%
- SCI – 57%
- related to poor neurological recovery, reduced functional ability, decreased quality of life and, possibly, high mortality
3
Q
Central causes of fatigue
A
- CNS (primary in MS, Stroke, TBI, PD)
- Endocrine dysfunction
- Immunological
- Autonomic Nervous System
4
Q
How may CNS cause fatigue
A
- dysfunction in premotor cortex, limbic system, basal ganglia and brainstem.
- reduced frontal lobe activity and deficits in perfusion and glucose uptake shown on PET scans but not MRI. Lesions in Basal ganglia on MRI associated with increased fatigue
- dysfunction in areas related to hypothalamus and endocrine system (see endocrine dysfunction)
5
Q
How may endocrine system cause fatigue
A
Endocrine dysfunction
- hypothalamic-pituitary-adrenal (HPA) axis
- Normally stress leads to release cortisol which reduces stress response. In abnormal systems – low levels of cortisol so highly sensitive to stress. In fatigued people with MS often abnormally high level of ACTH.
- role of hypothalamus and neurotransmitters – dopamine, histamine and serotonin – with widespread actions in the brain
- interaction between neuroendocrine and neurotransmitter systems
6
Q
How may the immune system and ANS cause fatigue
A
- Immunological - Cytokines (cell signaling) action is increased in neurological conditions (MS, GBS) and do not work effectively e.g. Interleukin-2 and interferon induce fatigue and T lymphocytes and tumor necrosis factor (TNF-α) affect sleep.
- Autonomic Nervous System – reduced activity, particularly sympathetic system, leads to fatigue due to affect of lowering BP.
7
Q
How may peripheral neuromuscular cause of fatigue
A
- 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 and metabolism (mitochondria).
- Fall in muscle PCr, leading to accumulation of H+ ions (lactic acid) and reduced pH.
- Spasticity
- Damage
8
Q
Other secondary causes of fatigue
A
- Hypothyroidism or other gland disorders
- Anaemia
- Medications - muscle relaxants, pain relief, sedatives
- Psychological - stress association of higher fatigue in people with depression/anxiety – cause or contributing factor? Interactions with endocrine system or immunological responses unclear
- Sleep - many people with neurological conditions have disrupted sleep patterns.
- Vitamin deficiency/poor nutrition
- Cardiovascular fitness
9
Q
How can reduced CR fitness lead to fatigue?
A
- Contributes towards weight reduction, increased ability to use insulin, increased chronic anti-inflammatory effect, decreased anxiety and depression, - all of which contribute to fatigue.
- CV causes increased efficiency of the heart, blood cells and lungs to supply oxygen-rich blood to working muscles and tissue and the ability of muscles to use oxygen to produce energy for movement – increased efficiency in the CV system reduced fatigue
CV exercise evidence shows it can reduce fatigue in those with:
- MS
- CVA
- TBI
- Less evidence for SCI and PD
- BUT NOT people with MYALGIC ENCEPHALOMYELITIS (ME)
10
Q
List fatigue management strategies (10)
A
- Balance and pacing
- Prioritise
- Rest and relaxation
- Sleep
- Food and nutrition
- Emotional health
- Cognition
- Leisure time
- Pain management
- Physical activity and exercise
11
Q
What is included in balance, pacing, prioritising and planning management strategies
A
- Pacing is all about balancing activity and rest to bring about improvements in the way you feel - use of fatigue diary to try and fit in rest, social activities, sleep daily
- The word ‘activity’ is not just physical it includes mental and emotional activity as they all take energy
- The four key elements of pacing are: activity, rest and relaxation, establishing a sustainable baseline and increasing your activity as you are able without causing increase in fatigue
- Prioritising – do you really need to do it, can you delegate.
- Plan - thinking about what is achievable and not making unrealistic demands on energy levels by trying to tackle too much
12
Q
What is included in rest and relaxation advice
A
- Short, regular rest periods throughout the day are essential to give you time to recharge your batteries.
- For your mind and body to get real benefit you need to be fully relaxed and properly resting your brain.
- For healing rest, you may now find you have to be quiet and still, both physically and mentally – but don’t feel guilty if you do still find TV relaxing. It is highly individual!
- better to avoid sleeping during the day, as this may disrupt your night time sleep cycle.
13
Q
What is included in sleep advice
A
- At least 7 hours per night
- Stick to a calm routine
- Avoid getting overtired
- Avoid caffeine
- Resolve pain
- Positioning for relaxation and pain
- If struggling to sleep Instead of lying in bed awake, after 15 minutes of not sleeping get out of bed and do something
- Melatonin – released about 9pm as gets dark
- Amitriptyline – sedative and helps with neural pain
- Magnesium - muscle relaxant for those with leg restlessness
14
Q
What is included in food and nutrition advice
A
- Avoid junk food
- 1 – 1.5 l water per day
- Healthy diet includes:
- 5 – 7 portions of fruit and veg a day
- Low animal fats
- High omega-3 fats – fish and plants
- Low sugars/carbohydrates (<50g/day)
- Low salt (<2g/day)
- Calcium, magnesium
15
Q
What is included in emotional health advice
A
- Doing more enjoyable things as long as paced effectively (fatigue diary), such as taking regular exercise or a new activity
- talking issues through with others - whether with a professional, a support group or just somebody to whom you feel able to open up
- actively seeking out information and advice about issues that are worrying you, commonly financially
- finding ways to think more positively, whether informally or by following approaches such as mindfulness or CBT (cognitive behavioural therapy) - very useful to reduce stress levels and help those with anxiety and depression.
- Relaxation techniques - help reduce fatigue through anxiety, high tone
