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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.

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.

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

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.

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

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

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.

How did you handle that?

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.

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.

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.

Fatigue/Loss of Stamina

Fatigue is a common complaint among people with TBI. The body needs a vast amount of energy for healing after traumatic injuries. Sleep is often disrupted in the hospital.

Usual patterns of rest and activity are often very different for many weeks to months after TBI. Confusion can make fatigue worse.

Central fatigue is the major type of fatigue in TBI patients. Central fatigue affects thinking. Working harder to learn and stay focused can make your family member mentally tired. In some people, central fatigue causes them to be irritable or have headaches.

Peripheral fatigue or muscle fatigue is also reported by many. Peripheral fatigue is physical. It can make pain, thinking, and mood worse.

Fatigue reduces the speed and quality of rehabilitation. Fatigue can also slow down the return to normal life activities, such as school or work.

For most people, fatigue gradually lessens over time. Stamina and endurance improve. However, some people with TBI say that for the rest of their lives, their endurance is just not what it used to be. They have to pace themselves more than they used to.

What you might see:

  • Frequent comments about being tired 
  • Need for sleep after a short activity, lack of energy 
  • Poor stamina 
  • Extreme fatigue after a busy stretch of hours 
  • Slurred speech 
  • Irritability 
  • Slower thinking speed

How you can help:

  • Set up a daily schedule for your family member. Make sure it includes enough rest/sleep. Use a calendar to help your service member/veteran follow the schedule.
  • Reduce family and social demands. 
  • Help your family member to pace him or herself. 
  • Ask your family member to conserve energy for important tasks in the day.
  • Help your family member to have an active lifestyle. Regular exercise increases stamina. The physical therapist can develop a safe exercise program.
  • Allow time for undisturbed rest during the day. A nap is usually 30-60 minutes.
  • Schedule important appointments for times of the day when your family member is most awake.
  • Learn the signs of fatigue in your service member/veteran. Ask him or her to do the same. Make a list of the signs and keep it in his or her calendar/memory notebook.
  • Inform the health care team about changes in sleep patterns or stamina.
  • Ask the health care team to rule out other causes of fatigue. Common causes of fatigue are endocrine abnormalities, sleep disorders, mood disorders, diabetes, substance abuse, electrolyte imbalances, and nutrition deficits.
Related Information:
Fatigue/Loss of Stamina
Other Physical Effects
Frequently Asked Questions
"It had been 15 months and he had slowly improved. But he couldn’t talk. He’d kind of start trying to mouth words, but he just couldn’t talk. And so, on October 21st, 2005, I’ll never forget that morning. I came in to the bedroom and I said, Fred, how are you doing?’ And he said, ‘Fine.’ Okay. I think he just talked to me. So I just turned around and went back into the kitchen, got his breakfast, came back in and thought, okay, let me try this again. I said, ‘Fred, how are you doing?’ And he said, ‘Fine.’ It wasn’t a lot at first, but he could talk." -  Denise G.



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