Fatigue

Some stroke survivors label fatigue as their greatest obstacle to recovery.  It can often limit one’s ability to participate in rehab activities, and promote inactivity and subsequent “learned non-use” of the involved arm or leg.  The causes of fatigue after a stroke can be many, and research is ongoing to discover and counteract the primary causative factors.  Likely contributing factors are:  all daily activities and movements require increased oxygen consumption after a stroke, disruptions in the sleep-wake cycle,  sleep-disordered breathing, stress causing sustained excessive releases of hormones (corticotrophin and ACTH) which can lead to symptoms of depression and fatigue, effects of some medications like anticonvulsants and pain meds.

Many stroke survivors will lose motivation to participate in activity because of the increased energy expenditure required, the fear of falling, embarrassment about the appearance of their movements, and other factors.  A snowball effect ensues, in which the decreased activity causes further decline in endurance and strength, which makes any activity more difficult, awkward, and filled with fear of falling.

Ideas for treatment:

• Energy conservation techniques – these are specific ways of making your daily tasks less strenuous and energy-zapping.  Maybe pacing yourself with dressing in the morning, or using an assistive device for getting your socks on, etc.  Occupational Therapists are wizards at finding ways to make your life easier and less energy consuming.
• Structured routines – scheduled rest times throughout the day.  Try to get up at the same time, and go to sleep at the same time every day.  Your body has a natural circadian rhythm, and many chemicals are released according to this rhythm while you sleep.  These chemicals (or hormones) help to regulate your body’s energy level.  If you are constantly altering your sleeping cycle, then your body’s release of energy-regulating hormones gets thrown out of wack.  (more info on this in my article:  “Sleep is Important!”)
• Short Naps – If you take naps, make them short naps, so that you will be able to sleep through a more complete night-time cycle.
• Social Interaction – some stroke survivors overlook the importance of this part of life.  Embarrassment, change in available social activities, and even fatigue itself can lead to decreased social interaction…..which can in turn lead to more fatigue.  Try to schedule yourself time for planned social interaction.  If you are having trouble finding social interaction, look into support groups in your area.
• Nutritional evaluation – for correction of any anemia or electrolyte imbalances.  Some foods are also better at supplying your body with energy than others.  The time and expense of seeing a nutritionist might pay off in so many areas of your life, since every part of your recovery depends on your energy level and your body’s supply of nutrients!