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Fatigue: A Common Complaint of Individuals with TBI

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75% of TBI (n = 223) had significant fatigue as opposed to 40% of controls (n = 85) ... JFK Johnson Rehabilitation Institute. Kessler Medical Rehabilitation and ... – PowerPoint PPT presentation

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Title: Fatigue: A Common Complaint of Individuals with TBI


1
Fatigue A Common Complaint of Individuals with
TBI
2
Wayne A. Gordon, Ph.D. Jack Nash
Professor Department of Rehabilitation
Medicine Mount Sinai School of Medicine Mount
Sinai Medical Center New York, NY E-mail
wayne.gordon_at_mssm.edu Website www.tbicentral.org
This presentation is supported by Grant No.
H133A02501, National Institute on Disability and
Rehabilitation Research.
3
  • More than 70 of those studied by Olver et al,
    1996 complained of fatigue up to 5 years

4
  • LaChapelle et al, 1998 reported that many
    individuals with TBI report that fatigue is their
    most disabling symptom

5
Why are individuals with TBI fatigued?
  • It has been suggested that more mental effort is
    needed to get the job done (VonZomeron, 1984)

6
Why are individuals with TBI fatigued?
  • Zino et al, 2006 and Riese et al, 1999 have
    reported that the blood pressure of individuals
    with TBI increased while they were performing
    cognitive tasks

7
  • Given the importance of this issue in the last
    funding cycle (2002-2007) 3 TBI model
    systems independently examined Post-TBI Fatigue
    (PTBIF)
  • Santa Clara Valley Medical Center
  • Craig Hospital
  • Mount Sinai Medical Center

8
  • The findings of these research projects were
    published in the January 2008 issue of JHTR

9
Fatigue over time
  • SCVMC examined a group of individuals at 1 and 2
    years post-injury and found that levels of
    fatigue ranged between 23 and 61 depending on
    the measure used
  • These values were stable between years 1 and 2

10
Fatigue over time
  • They also reported some decrease in fatigue in
    the first year post-injury that increased again
    between 18 and 24 months post-injury

11
The Mount Sinai group examined two issues
  • The relationship between fatigue and cognitive
    performance
  • The relationship between fatigue and participation

12
Fatigue and cognition
  • The relationship between fatigue and cognitive
    performance examined by creating a cognitive
    challenge and comparing the response of
    individuals with TBI (n 202) and non-disabled
    individuals (n 73)

13
Fatigue and cognition
  • Evaluation lasted on average 4.5 hours and
    consisted of two administrations of 6 subtests
    taken from the CANTAB (double baseline)
  • Followed by a third administration about two
    hours later
  • In between the second and third administration
    the person was given paper and pencil tasks

14
Fatigue and cognition
  • Changes in performance on the CANTAB was viewed
    as a measure of objective fatigue
  • Situational fatigue was based by a 7 point rating
    of fatigue on a Likert scale
  • Day-to-day fatigue was measured by scores on
    the GAF

15
Fatigue and cognition
  • In order to reduce the number of variables CANTAB
    was factor analyzed and three factors emerged
  • Speed
  • Accuracy
  • Executive function

16
Fatigue and cognition
  • Individuals with TBI did poorer than ND on the
    CANTAB and were also more fatigued

17
Fatigue and cognition
  • On the speed factor scores the ND became faster
    indicating that they were benefiting from
    practice
  • Those in the TBI group remained stable across
    administration indicating no benefits from
    practice

18
Fatigue and cognition
  • In terms of accuracy, individuals with TBI made
    more errors over time
  • Those in the ND group remained constant
  • No change on executive function scale in either
    group

19
Fatigue and cognition
  • Speed was associated with situational fatigue at
    all points in time in the TBI group but not in
    the controls
  • Day-to-day fatigue (GAF score) was related to
    speed at T1 and T3 in the TBI group but not the
    controls
  • In the control group those who were more fatigued
    experienced a greater decline in their speed

20
Fatigue and cognition
  • These findings suggest that different patterns of
    cognitive performance are associated with fatigue
    in individuals with TBI and controls
  • Response speed decrease as the cognitive demands
    increase

21
Fatigue and participation
  • 75 of TBI (n 223) had significant fatigue as
    opposed to 40 of controls (n 85)

22
Fatigue and participation
  • The relationship between fatigue (GFI), pain,
    sleep and depression was examined by eliminating
    items from the non-fatigue scales that overlap
    with the GFI, i.e., fatigue
  • TBI had higher levels of depression, pain, poorer
    sleep quality and health related quality of life

23
Fatigue and participation
  • In predicting fatigue it was found that sleep
    quality, pain and depression accounted for 58 of
    the variance in the controls and 23

24
Fatigue and participation
  • GFI scores were not correlated with measure of
    participation
  • Fatigue did not appear to limit what folks were
    doing

25
Fatigue and treatment
  • The group at Craig examined the utility of
    modafinil as a treatment for fatigue defined as
    daytime sleepiness
  • There was no clear benefit of the drug over
    placebo!

26
Future plans
  • Collaborative study on post-TBI insomnia
    involving four other TBI model systems
  • Carolinas Rehabilitation
  • JFK Johnson Rehabilitation Institute
  • Kessler Medical Rehabilitation and Research
    Center
  • Santa Clara Valley Medical Center

27
Future Plans
  • Study will examine insomnia in individuals at 1
    and 2 years post injury and 2 and 5 years
    post-injury

28
Future Plans
  • Mount Sinai is also studying the utility of
    exercise as a treatment for post-TBIF

29
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