Beyond Tired: Post Stroke Fatigue Part 1

2022-05-17

OVERVIEW: Tracy: My understanding is that not a lot of people understand post-stroke fatigue. Are we mislabeling it? Are we saying it’s more of a cognitive problem? Are we saying it’s more of a muscle strength problem? I’m just wondering if we’re mislabeling it…especially when we’re talking about it down the road. I’m really hung up on these individuals who are functioning well…so these are the individuals who no longer qualify for home care services, and have really graduated beyond outpatient, but they’re still not able to...

OVERVIEW:

Tracy: My understanding is that not a lot of people understand post-stroke fatigue. Are we mislabeling it? Are we saying it’s more of a cognitive problem? Are we saying it’s more of a muscle strength problem? I’m just wondering if we’re mislabeling it…especially when we’re talking about it down the road. I’m really hung up on these individuals who are functioning well…so these are the individuals who no longer qualify for home care services, and have really graduated beyond outpatient, but they’re still not able to get back to their role as an employee…back to those desired occupations they want to get to…because of the post-stroke fatigue.

EPISODE SUMMARY: In this episode of NOGGINS & NEURONS: Brain Injury Recovery Simplified: Post-Stroke Fatigue, with occupational therapist and educator Tracy Bentley-Root, and occupational therapy students Alyssa Brockmann and Sarah Battaglia, we talked about:

Post-stroke fatigue (PSF) - General symptoms, occupational impacts, timeline, recovery process, and intervention ideas for post-stroke fatigue. Alyssa and Sarah share their experiences with post-stroke fatigue through different lenses. Alyssa explains her fieldwork from an acute care standpoint, whereas Sarah shares her experience with the population through an outpatient or chronic lens. Alyssa discovered that she witnessed post-stroke fatigue on more of a cognitive level in the early stages of stroke recovery. Post-stroke fatigue in the chronic stages after stroke (3-6 months or longer) has a different effect on the individual.
PSF is extremely difficult to research. The definition of post-stroke fatigue also varies through the timespan of recovery. It was found that up to 50% of stroke patients report post-stroke fatigue as their worst symptom. Alyssa reports her definition of PSF, statistics of the phenomenon, and prevalence rates of the phenomenon that were found in the literature. Debra notes how common and debilitating PSF can be. There are few evaluation methods specific to stroke, they are broad evaluation methods. PSF is dependent on a number of factors before and after the injury occurs. It affects a variety of areas in your brain and translates into how the patient acts following the incident.
Real experiences of patients and their concerns entering the workforce after stroke and what can be done to support fatigue in their roles. Alyssa explores the need for healthcare practitioners to be providing patients and caregivers with hard copies of resources prior to discharge from acute care to be referenced throughout their recovery journey. Tracy and Sarah support Alyssa’s point in saying maybe healthcare practitioners need to use unified language to describe post stroke fatigue to reduce the unknown factors, and related post stroke fatigue in the group of cognitive deficits.
Interventions including journaling were found to be effective in literature examining that caregiver and patient journaling can be brought to occupational therapists to determine patterns. Such patterns can be used to design individualized care plans and reduce fatigue based on the performance patterns present. Debra then explores educating fatigue management from sleep, exercise, and nutrition from a group process standpoint to enhance the social support of fatigue. Sarah further supports this idea and describes the central adjustment to stroke by re-establishing a self identity through confidence, occupational management, and seizing control. Energy conservation, routine planning, pacing, alternating physical and mental activities, gradual grading of exercise, meditation and more are touched on to manage fatigue.

Stroke manifests in various ways that are individualized to each patient and caregiver. It is important to note that stroke recovery is an adjustable and continually changing journey where each day will present differently. A decrease in performance does not mean patient regression, rather an occupational performance area strengthened, leaving another area open for improvement. Being aware of one’s symptoms, including fatigue, as well as understanding why fatigue manifests post-stroke is important to then advocate on behalf of yourself to health care practitioners for adequate resources and sports needed to move forward in one’s re-establishment of routine, identity and occupational performance.

As always, we want to hear your top takeaways!

LINKS TO ARTICLES, BOOKS AND OTHER IMPORTANT INFORMATION:

Factors associated with post-stroke depression and fatigue: lesion location and coping styles

Managing post-stroke fatigue: A qualitative study to explore multifaceted clinical perspectives

Occupational Therapy - Energy Conservation Booklet Patient Information Leaflet

Post-stroke fatigue: a deficit in corticomotor excitability?

Post-stroke fatigue: a review on prevalence, correlates, measurement, and management

Poststroke Fatigue | Stroke

Review article Lack of content overlap and essential dimensions – A review of measures used for post-stroke fatigue

Social Support as a Predictor of Community Participation After Stroke

As always, we want to hear your top takeaways!

Questions and Comments about the podcast: NogginsAndNeurons@gmail.com

Donate to The Noggins And Neurons Podcast using your PayPal app:

Donate to Noggins And Neurons and get an Allstar Pete Trading Card

PETE’S RESOURCES:

Pete's book
Pete's blog

DEB’S OT RESOURCES:

The OT's Guide to Mirror Therapy
Tri-Fold Mirror (US addresses only)
- https://creativeconceptsot.gumroad.com/l/trifoldmirror
Occupational Therapy Intervention: Scavenger Hunt Visual Scanning for Adults
- https://creativeconceptsot.gumroad.com/l/scavengerhunt

REQUEST TO BE A GUEST ON NOGGINS & NEURONS. If you’re passionate about stroke recovery and have information or a story you believe will help others, we’d love help you share it on the show. Complete the guest request form below and let’s see if we’re a good fit!