Objective Measurement of Fatigue Following Traumatic Brain Injury

Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
Journal of Head Trauma Rehabilitation (Impact Factor: 2.92). 01/2008; 23(1):33-40. DOI: 10.1097/01.HTR.0000308719.70288.22
Source: PubMed


To quantify posttraumatic brain injury (post-TBI) mental fatigue objectively by documenting changes in performance on neuropsychological tests as a result of sustained mental effort and to examine the relationship between objectively measured mental fatigue and self-reported situational and day-to-day fatigue.
The study included 202 community-dwelling individuals with mild-severe TBI and 73 noninjured controls.
Measures included Cambridge Neuropsychological Test Automated Battery, Global Fatigue Index, and situational fatigue rating.
Subjects were administered a 30-minute computerized neuropsychological test battery 3 times. The second and third administrations of the battery were separated by approximately 2 hours of interviews and administration of self-report measures.
The neuropsychological test scores were factor analyzed, yielding 3 subscales: speed, accuracy, and executive function. Situational fatigue and day-to-day fatigue were significantly higher in individual with TBI group than in individuals without TBI and were associated with speed subscale scores. Individuals with TBI evidenced a significant decline in performance on the accuracy subscale score. These declines in performance related to sustained mental effort were not associated with subjective fatigue in the TBI group. While practice effects on the speed and accuracy scores were observed in non-brain-injured individuals, they were not evidenced in individuals with TBI.
Findings were largely consistent with previous literature and indicated that while subjective fatigue is associated with poor performance in individuals with TBI, it is not associated with objective decline in performance of mental tasks.

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    • "By comparing neuropsychological tests with different test characteristics, it is possible to investigate crucial properties in tests sensitive to cognitive fatigability . Since several studies show that fatigability reveals itself in decreased processing speed and sustained attention, these measures should be included as basic test attributes (Ashman et al., 2008; Bleiberg, Garmoe, Halpern, Reeves, & Nadler, 1997; Gronwall & Wrightson, 1974; Johansson et al., 2009). However, it is not yet clear whether speed and attention demands are sufficient to elicit cognitive fatigability in clinical populations. "
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    ABSTRACT: Objective: Self-perceived mental fatigue is a common presenting symptom in many neurological diseases. Discriminating objective fatigability from self-perceived mental fatigue might facilitate neuropsychological diagnosis and treatment programs. However clinically valid neuropsychological instruments suitable for assessment of fatigability are still lacking. The prime aim of the study was to investigate aspects of cognitive fatigability and to identify properties of neuropsychological tests suitable to assess fatigability in patients with persistent cognitive complaints after mild brain injury. Another aim was to investigate whether cognitive fatigability captured by neuropsychological measures is influenced by depression or sleep disturbances.
    Journal of Clinical and Experimental Neuropsychology 06/2014; 36(7):1-14. DOI:10.1080/13803395.2014.933779 · 2.08 Impact Factor
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    • "The fundamental and most susceptible cognitive functions after a brain trauma include information processing speed and attention, also found to be connected to the development of mental fatigue (Ashman et al. 2008; Johansson et al. 2009; Ziino and Ponsford 2006). Information processing speed is "
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    ABSTRACT: Abstract Mental fatigue is, for many, a very distressing and long-term problem after a traumatic brain injury (TBI) or stroke. This will make it more difficult for the individual to return to work and resume social activities, and it can take several years to find the right balance between rest and activity in daily life, to find strategies and to accept the new situation. The aim of this study was to evaluate the effect of an advanced mindfulness program following a MBSR program, designed for subjects suffering from long-term mental fatigue after a brain injury. The advanced program was based on The Brahma Viharas, meditative practices known for cultivating four mental states: compassion, metta, appreciative joy, and equanimity. Fourteen participants followed the 8-month advanced mindfulness program, with group visits once a month and a final all-day retreat. All the participants were suffering from mental fatigue at least 1 year after a brain injury following a stroke or a TBI. The assessments after the advanced program showed a significant and sustained positive effect on mental fatigue and on tests measuring information processing speed and attention. With mindfulness practice it was possible to improve wakefulness during meditation and, above all, improve the mental fatigue levels. We propose that mindfulness is a promising treatment for mental fatigue after a stroke or TBI.
    Mindfulness 10/2013; 6(2). DOI:10.1007/s12671-013-0249-z · 3.69 Impact Factor
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    • "They found that non-concussed athletes reported significant increases in subjective fatigue, and evidenced declines in performance on cognitively challenging tasks and changes in EEG activity while performing these tasks. Their results, taken in tandem with those of Ashman et al. (2008) suggest that fatigue effects manifested on sustained neuropsychological tasks may be task dependent and are not specific to concussed individuals (Barwick et al., 2012). There is limited evidence linking physical performance and self-reported fatigue in individuals with TBI (Merritta et al., 2010). "
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    ABSTRACT: Fatigue is among the most common sequelae of traumatic brain injury (TBI). To summarize the empirical and theoretical literature on Post TBI fatigue (PTBIF) and identify some of the challenges that continue to confront clinicians, researchers and individuals with TBI. Qualitative literature review. The epidemiology, characteristics, and correlates of PTBIF are described. Challenges in the operational definition and measurement of fatigue are discussed and the empirical literature on measurement of PTBIF and theoretical models of the potential etiology of PTBIF is summarized. Existing treatments of PTBIF and the research supporting them are reviewed. Future directions for clinical research are presented. Although PTBIF is a high incidence condition after TBI that is related to significant suffering and reduced quality of life, it remains inadequately measured and treated. Its etiology and precipitants are poorly understood and intervention research is inadequate. Further research is necessary to develop psychometrically-sound objective and subjective measures of PTBIF and examine the efficacy of treatments for fatigue. Interventions shown to improve fatigue in other populations should be considered in treating PTBIF.
    Neurorehabilitation 07/2013; 32(4):875-83. DOI:10.3233/NRE-130912 · 1.12 Impact Factor
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