Article

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: 3). 01/2008; 23(1):33-40. DOI: 10.1097/01.HTR.0000308719.70288.22
Source: PubMed

ABSTRACT 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. Method: Twenty-four patients with persistent cognitive symptoms after mild traumatic brain injury (mTBI), (aged 18-51 years) and 31 healthy controls (aged 20-49 years) underwent neuropsychological testing measuring three cognitive fatigability domains: Attention fatigability was assessed using the Ruff 2 & 7 Selective Attention Test, executive fatigability using the Color Word Test (Stroop), and psychomotor fatigability using the Digit Symbol Substitution Test from the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III). Subjective fatigue was measured using the Fatigue Severity Scale and a questionnaire of everyday consequences of fatigue. Depression was screened using the Hospital Anxiety and Depression Scale and sleep disturbances using the Pittsburgh Sleep Quality Index. Results: The patients reported significantly more mental fatigue and performed worse on tests of psychomotor and executive fatigability than the healthy controls. Furthermore, the cognitive fatigability measures were not influenced by depression or sleep disturbances, as was the case in self-reported fatigue. Conclusion: Tests demanding executive or simultaneous processing of several neuropsychological functions seem most sensitive in order to capture cognitive fatigability. Clinical tests that can capture fatigability enable a deeper understanding of how fatigability might contribute to cognitive complaints and problems in maintaining daily activities.
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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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    • "A generally accepted universal definition of fatigue does not exist, nor is there any conceptual framework for studying fatigue in TBI. Nevertheless, discussions in the literature make a distinction between central fatigue (due to the dysfunction of supratentorial structures involved in mentation) and peripheral fatigue (of physical, metabolic, or muscular origin) [5]. The number of studies including post-TBI fatigue as an outcome measure has rapidly increased over the past decade. "
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