Fatigue following TBI

What is Fatigue?

Fatigue can be defined as the decreased capacity for physical or mental activity due to an imbalance in the resources needed to perform an activity.1 In other words it’s a feeling of tiredness, lack of energy or exhaustion which can be hard to shake.

Fatigue following TBI

Fatigue is one of the most common symptoms following TBI of all severities. At 5 years post-injury, fatigue can still affect up to 73% of people with TBI.2

It is thought that fatigue following TBI may be due to the extra energy that is needed to complete everyday tasks, given that underlying brain damage may remain.3

Additionally, fatigue is a symptom of disorders, including TBI, which affects the basal ganglia and interrupts the connection between the prefrontal cortex and the thalamus.4 The basal ganglia plays a major role in motor activity and motivation, and if this has been damaged by the injury, then fatigue may be a consequence.

Following a TBI there are three main types of fatigue. These include:

Mental Fatigue – not being able to concentrate or stay focused.5
Physical Fatigue – being physically tired and needing to rest.5
Psychological Fatigue – feeling a lack of motivation to do anything.5

Types of Fatigue

Mental Fatigue
Mental fatigue can be caused by spending too much time on an activity without taking appropriate breaks or pacing yourself. When recovering from a TBI it’s important to make sure that you take enough breaks from activities that require you to think, so that you don’t overdo it. Your GP can give you individual advice on pacing your activity to reduce mental fatigue.

Physical Fatigue
Physical fatigue can stem from muscles becoming weaker following a TBI, due to inactivity. As the day progresses physical fatigue will gradually become worse but after a good night’s sleep, it is likely to improve. As an individual recovers from a TBI and gradually increases their daily amount of physical activity, physical fatigue is likely to decrease. If physical fatigue persists, speak to your medical professional.

Psychological Fatigue
Psychological fatigue following TBI can be related to other TBI symptoms such as anxiety, depression, stress and sleep disruption.

Tips for managing fatigue following a TBI

There are a number of strategies that can be used for managing fatigue following a traumatic brain injury.6

  • Rest: Make sure you are getting enough sleep, as well as taking regular rest breaks when you begin to feel mental/physical/psychological fatigue.
  • Exercise: Once you have been given the OK to exercise from your medical professional, exercise is an important part of TBI recovery. It will give you an endorphin boost, relieving some of the symptoms which may be associated with psychological fatigue, as well as giving your brain a cognitive boost. It is important to remember however to stop if you feel that TBI symptoms are returning.
  • Nutrition:  Make sure that you are getting a well-balanced and nutritious diet to help your body recover.
  • Ask for help: There is no shame in asking for help when you feel fatigued. Seek medical advice regarding the support services that may be available to you and ask your friends and family for help if that is an option for you.
  • Pacing: Pacing is a way of balancing the activities you have to do each day. Make sure you don’t have too many tasks to complete each day, and take regular rest periods so that fatigue does not become overwhelming.

*Disclaimer: Please note that these tips are not medical advice. It is recommended that patients consult their medical professional for individual medical advice relating to TBI and fatigue.

Pacing – what it is and why you need to practice it

Pacing is a key skill in learning to manage fatigue, triggers and your energy levels. Pacing is the skill of managing your daily and weekly activity so as not to overload your mental, physical and psychological capacity, causing your fatigue to worsen.

Key tips to introduce pacing into your day to day routine:

  • Set goals in terms of mental and physical activity. The end goal may be to walk to the local shops five kilometres away. To reach this goal begin by doing pacing exercises such as walking for 5 minutes, then the next week walk for ten minutes, until you reach the point where your end goal is within reach.
  • Don’t try to increase your level of activity too quickly. Stick with the same level for a period of time (such as a week) before trying to increase.
  • Spread your tasks out over the course of a week so that you don’t overload yourself and increase fatigue. Make sure that you have appropriate rests.
  • If you are back at work and using a computer, it’s very important to make sure you take regular breaks. Gradually increase the amount of time you spend in front of a screen each day as screens can contribute to other symptoms such as headaches.
  • Even though you may have days where you don’t feel as fatigued, it is valuable to stick to your pacing activities so that you don’t overload and increase your symptoms of fatigue.7



1. Aaronson, L.S., Teel, C.S., Cassmeyer, V., Neuberger, G.B., Pallikkathayil, L., Pierce, J., Press, A.N., Williams, P.D., & Wingate, A. (1999). Defining and mea-suring fatigue. Image—The Journal of Nursing Scholarship, 31, 45–50.
2. Olver, J.H., Ponsford, J., & Curran, C. (1996). Outcomes following traumatic brain injury: A comparison between 2 and 5 years after injury. Brain Injury, 10, 841–848.
3. van Zomeren, A.H. & Brouwer, W.H. (1994). Clinical Neuropsychology of Attention. New York: Oxford University Press.
4. Chaudhuri, A., & Behan, P. O. (2000). Fatigue and basal ganglia.Journal of the Neurological Sciences, 179(S 1-2), 34-42.
5. https://msktc.org/tbi/factsheets/fatigue-and-traumatic-brain-injury 
6. Ingles JL, Eskes GA, Phillips SJ (1999) Fatigue after stroke. Archives of Physical Medicine and Rehabilitation, 80(2), 173-78
7. www.headway.org.uk