Traumatic Brain Injury A to Z - Spasticity

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Fatigue

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Patients and caregivers can sometimes suffer from fatigue during TBI recovery. The group discusses this challenge, along with some tips on how to recognize and manage fatigue.
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Fatigue

Julie
At first, when Sam wasn’t sleeping much, we were just all so exhausted. I worried about how the fatigue would affect Sam’s healing. He was just so agitated, and he… he didn’t understand what was happening to him. The fatigue was literally etched onto his face.

Tracy
That’s a good point. Yeah fatigue is a common complaint among people with TBI. Just like the body, the brain needs a huge amount of energy for healing after a traumatic injury. And, as we’ve just learned, sleep patterns can be totally disrupted, especially in the first weeks and months after the injury.

For most people, fatigue gradually lessens over time while stamina and endurance improve. And for others, their endurance is just not what it used to be so… so they have to pace themselves more than they did before the injury.

Megan
So when the time comes, will there be anything I can do to help Clay with that?

Tracy
Oh well, sure. You can help him pace himself. You can encourage him to conserve energy for those important tasks of the day, like physical therapy. Setting up a daily schedule can be a huge help. 

Now since regular exercise will increase stamina, his physical therapist will work with you to develop a safe exercise program, based on his abilities of course.

Megan
Yeah it’s just hard to imagine him exercising right now. I just want him to wake up.

Tracy
I know... it just takes time.
 
Julie
Well, Sam had a lot of problems with fatigue. Even before he would say anything, we could tell that he was tired.

Carl
Yeah, he would be so irritable and angry. He’d start to yell, and sometimes his face would even start to droop. His confusion would be so much worse when he was fatigued.

Tracy
How did you handle that?

Carl
Well it helped to make a list of Sam’s signs of fatigue, and when they happened. That way, we could work his schedule around it, like setting important appointments for times when he was the most awake.

Julie
And based on that list, we noticed there were particular times of day when he was most fatigued, so we blocked those times out for rest.

Michelle
That’s a great idea. Now that Tom’s awake more, and he showing more signs of fatigue, I’m gonna start keeping a list.

Spasticity

An injury to the brain can cause an abnormal increase in muscle tone called spasticity. A spastic muscle does not easily relax the way a normal muscle does.

This effect is most common with a severe and/or penetrating brain injury.

Regular stretching, splints to keep limbs in proper position, and medications are common treatments.

Severe spasticity can be painful so pain management may be in order.

What you might see:

  • Involuntary muscle tightness and stiffness 
  • Muscle contractions 
  • Decreased range of movement and abnormal posture

How you can help:

  • The physical therapist will develop a stretching program for your family member. Ask the physical therapist to teach you this program.
  • Post diagrams of the stretches. Help your family member do the recommended stretches.
  • If splints are used, learn how to apply them. Find out how long they are to be worn each day.
  • Monitor your family member’s skin for pressure points from the splints. Alert nurses to areas of redness and breakdown.
  • Tell the health care team if the spasticity gets worse. This could be a sign of an underlying problem.
  • If spasticity is so severe that it interferes with comfort, positioning, and general functioning, ask the doctor about treatment options. These include implanting a muscle relaxant pump.
Related Information:
Fatigue/Loss of Stamina
Other Physical Effects
Glossary
Frequently Asked Questions
"In the very beginning, I didn’t want to know anything because I was so scared. But a little while later… the doctors would throw out tidbits to me, like he might never speak again and he might never walk again… but I couldn’t understand why. So then I wanted to understand the part of the brain that was injured and why he was having these symptoms or why he was having this diagnosis." -  Patty H.

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