Cognitive Fatigue after Brain injury

Disclaimer: This information sheet is for education purposes only. Please consult with your doctor or other health professional to make sure this information is right for your child.

What is it?

Cognitive fatigue is a common problem that can follow a mild, moderate or severe brain injury. Cognitive fatigue means that a child has reduced capacity for sustained mental effort or cognitive endurance (but NOT reduced intellectual abilities NOR reduced physical energy). Fatigue can lead to behavioural problems, educational difficulties and emotional problems.

What are the symptoms?

• Difficulty sustaining attention
• Poor endurance for thinking tasks
• Can concentrate initially but then he/she loses that concentration ability over time. Their behaviour when fresh and rested is very different to when they are fatigued.
• Child/young person "gives up" easily on thinking tasks
• Poor school performance
• Child/young person may need more sleep than usual and may need a nap at or after school to get through the day
• Behavioural difficulties including hyperactivity, irritability, tearfulness, miserable,
• Becomes muddled
• Headaches
• Children/young people tend to "soldier on" and as a result become exhausted
• Fatigue can also be associated with feelings of low self-esteem, worry, depression and anxiety over how they will perform.

Who do I see and how is it diagnosed?

Your local doctor should examine the child and exclude any other medical cause for the fatigue eg chronic infections, thyroid problems, anaemia, heart failure.

What is the treatment?

Unfortunately there is no quick fix. Understanding the problem is the first step. Knowing that your child is not lazy or naughty or lacking motivation can reduce the stress for them dealing with their fatigue. Fatigue will lessen with time as your child's brain injury stabilises. Sometimes a permanent change to the child/young person's lifestyle will be needed. A well balanced diet, good sleeping routines and regular exercise are important.

Recognition of fatigue and taking steps to minimise its effect is important.

Allowing your child to have the sleep they need

• more sleep either each night or at the weekends
• afternoon naps
• some kids need a nap at school

Allowing "down time"

• eg no assignments during holidays, this is a time for rest and relaxation
• breaks during homework time to do something physical

Managing the academic workload

• negotiating a reduced homework load, work out which homework is the most important
• negotiating a reduced school work load - eg one less subject to provide some "free" periods to recharge their "brain batteries"
• asking for additional time to complete assignments
• having assignments provided at the beginning of the term so as to be able to plan the work evenly throughout the term
• applying through the education department for concessions with examinations, eg rest breaks and extra time

Rehabilitation Department The Children's Hospital at Westmead Cnr Hawkesbury Rd & Hainsworth St, Westmead Locked Bag 4001, Westmead, 2145 Tel: (02) 9845 2132 - Fax: (02) 9845 0685 http://www.chw.edu.au/rehabilitation/