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Fatigue

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.

Swallowing/Appetite & Weight

Many people with traumatic injuries do not drink or eat for a period of time. As a result, they lose weight.

Once the person is fully awake and able to follow directions, swallowing can be evaluated. It is important to fully evaluate swallowing before the injured person drinks or eats.

The purpose of evaluating the person’s ability to swallow is to make sure that what he or she eats goes into the stomach, not into the lungs. When food or fluid slips into the lungs, it often results in pneumonia.

A speech or occupational therapist evaluates swallowing. This may be done in the person’s hospital room.

If not, the therapist may escort your family member to the x-ray department for a video fluoroscopy. Your family member will consume a barium-laced liquid or food that will light up on an x-ray. The x-ray helps the therapist to see precisely where it is going.

Once your service member/veteran is cleared to drink or eat, he or she may only be able to consume certain types of liquids and foods. Most people do best with medium consistencies, rather than thin fluid or very chewy, tough foods.

With practice, most people will return to a normal diet.

Appetite can be affected. Some people with TBI complain of a reduced appetite. Others gain weight due to boredom, memory problems, and an increased appetite.

Work with the health care team to learn how to help your service member/veteran have a healthy diet and a healthy weight.

What you might see:

  • Choking or coughing during meals
  • Pocketing of food inside the mouth and/or drooling
  • Decreased interest in eating
  • Weight loss, without trying to lose weight (possibly due to loss of taste and smell)
  • Overeating, resulting in weight gain
  • Memory problems: failure to remember when to eat or when last ate

How you can help:

  • Do not offer fluids or food until your service member/veteran has been cleared to drink and eat.
  • If on a special diet with restricted fluids and foods, work with the therapists and dietitians to learn what foods are allowed. Learn how to assist your family member to drink and eat if special strategies are needed (i.e., eat slowly, chin tuck during swallow, double swallow, follow every bite of food with fluid).
  • Short-term changes in appetite are common. Don’t worry about early weight loss. Most often, the weight is regained once the person is home.
  • Monitor your service member/veteran’s body weight and learn what his or her ideal weight range is from the dietitian.
  • Report appetite changes to the health care team. These may be a sign of depression, general emotional distress, medication problems, or other medical conditions.
  • Ask for a dietitian to review dietary intake and to learn more about meal preparation and a balanced diet.
  • It is common to have reduced taste and smell following TBI. Talk with the dietitian about how to use spices and flavorings to perk up the taste of food.
  • Weight gain following TBI is common. It is usually due to lack of physical activity. But sometimes it is due to boredom. Work with your service member/veteran to remain physically active and engaged in outside activities. Establish set meal times. Discourage overeating or too many snacks.
  • Encourage your service member/veteran to be involved, as able, in grocery shopping and meal planning/preparation.
  • Write meal times in the planner/memory book. Check off meals when finished.
Related Information:
Fatigue/Loss of Stamina
Other Physical Effects
Glossary
Frequently Asked Questions
"A really super thing for us in terms of communicating with the hospital staff—and the hospital already had this installed in the room—is a big dry erase board. Some people use it and some people don’t. We use it to make a list of all the things we want to talk about with the doctors. That way, if I’m not in the room when the doctors come by on their rotation, they’ve got the big list right there and they can see it clearly. That helps keep the communication going." -  Anna E.

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