Facing Fatigue with Jenn Freeburn, Cognitive Therapist

Making Headway

What is one symptom all brain injury survivors have in common? No, the answer we’re looking for is not our overwhelming awesomeness--although that’s also true! It’s FATIGUE. There are several different types of fatigue and many ways to manage it. Join Jenn Freeburn, MS, CCC-SLP as she schools us on the hows and whys of cognitive fatigue. She’ll help us strategize our way through the fog, no loud fog horn necessary.

Covered in this episode:

• Types of fatigue
• Physical fatigue- the body being tired and needing rest
• Psychological fatigue- lack of motivation, trouble starting anything
• Cognitive fatigue (mental fatigue)- brain fog, not being able to attend or focus
• Theories for brain fatigue
• The brain is trying to heal and has less energy for other things. Tasks feel more taxing
• The brain is less efficient after injury possibly due to:
• the healing process or
• additional attentional resources are being put towards other aspects of life and those resources drain energy leading to fatigue
• After a brain injury, the brain is more sensitive to things in life that cause tiredness. You used to be able to push through and now your brain can’t
• Your brain is healing! And that can make you feel tired
• Managing fatigue: it's not just about today; there is a cumulative effect. If you drain your daily “battery” and dip into your reserve battery, it will take more than a good night’s sleep to recover from the cognitive fatigue. When you are running low, you have to be gentle with yourself and not schedule a lot when you are drained
• Examples of cognitive demands:
• Sensory heavy environments: crowds, bright lights, stores, noisy, socializing
• Prolonged attentional tasks: reading especially nonfiction, anything that requires a lot of processing, taking in a lot of information. Tasks where you need to focus in and wouldn’t do with someone watching TV in the background.
• Mixing physical, cognitive, and psychological demands
• Laundry: has lots of steps mixing physical movement with cognitive aspects
• Times when your attention is pulled multiple directions: example parties and conversations
• Multi-step processes:
• Cooking: lots of steps and movement
• What’s one to do?
• Understand yourself
• What triggers fatigue for you?
• Plan your day around those:
• know what is going to cause fatigue and be nice to yourself after so you can rest
• Do the hardest tasks during the time of day you are feeling your best
• Don’t schedule hard/high stakes things during your times of higher fatigue
• Structure your day around your fatigue patterns with breaks interspersed throughout the day
• What does fatigue look like for you?
• Brain fog
• Not being able to pay attention
• Irritability, everything is annoying or frustrating.
• Self judgment i.e. negative self talk
• Making errors
• Emotionality
• Try not to ignore your triggers
• What are your early indicators that fatigue is setting in? It’s important to understand these so you can slow down and not hit the wall
• Check in with yourself to see where you are rather than pushing through
• Fighting to complete tasks isn’t beneficial for your brain
• How do I figure out my patterns?
• Keep a simple journal/log of what you do throughout the day and when
• Rate how fatiguing each thing was on a scale of 1-5
• Look for patterns
• Build your day around your patterns
• Increase routine
• Especially important when you are recovering at home and don’t have much of a schedule or structure to the day
• Establish some regularity, especially around sleep
• What is restful?
• What restores you? I.e. what recharges the battery; how can we make deposits to our energy bank? (rather than constantly drawing from it)
• Breaks are something that provides cognitive rest and is pleasurable
• What actually restores your energy? Mindless scrolling is not cognitively restful
• Identify what gives you back mental energy
• Physical movement or “active rest” is activity for your body and rest for your brain
• stretching, taking a walk, going outside,
• Activities with low cognitive engagement are most restorative--something gentle you can follow along with (not an intensive class with lots of directions)
• “Rather than focusing on the negative, ‘what am I doing that is exhausting me? I’m clearly doing too much every day’. Try to focus on how you can do more of these things that give you something back. This is a nice way to flip the script and offer yourself gentleness. This puts the focus on adding something relaxing and pleasurable rather than taking away something that feels productive” (32:40)
• Need to set good expectations. Don’t set the bar too high. Need to have a gradual return to activity. You don’t go out and run a marathon without training first
• When setting expectations, find someone to talk to that understands brain injury
• Other examples of restful activities:
• Music
• Art
• Meditation
• Restful activities are highly individualized. What gives back to you and makes you feel good?
• Be on the lookout for patterns
• Boom or bust: going too far into the overdoing it camp which will lead to needing a lot of rest to restore
• Would I benefit more from just taking a break?
• Find balance
• Is there a way to schedule your day so that you aren’t hitting the wall but having a reasonable amount of fatigue that you can recover from?
• Building a strong brain. Brain health activities:
• Sleep
• Healthy eating: know what works for your body. A colorful plate. Less sugar. Moderation.
• Staying hydrated
• Is this more than brain fog:
• depression (not wanting to do anything)
• vitamin deficiencies, low B12
• There may be other reasons beyond cognitive fatigue that are causing your symptoms. Talk to your healthcare provider
• What are you asking your brain to do?
• You may need to say no to things
• It’s not that you can’t do something. But it is for how long and at what cost.
• You might have to reprioritize to be able to do what is important
• Your self-expectations may need to change. Would you have the same expectations of a friend with a brain injury as you would on yourself?
• Recovery requires you to take care of yourself and prioritize yourself at the top
• If you are struggling with extended fatigue after your injury, bring it up with your neurologist, speech therapist, mental health professional, occupational therapist
• Find a knowledgeable thought partner to use as an outlet to discuss your fatigue with, to build strategies with, and to have accountability
• You are not alone
• Fatigue is very common
• You are not weak or doing something wrong if you are feeling fatigued. It might mean you need to shift how you are doing things--you don’t need to do it alone; there’s lots of help out there
• How to find help:
• Brain Injury Association in your state
• Ask your medical team
• Be your own self-advocate
• Use hospital connections or academic medical institutions

Questions for Jenn:

• Shoot us an email at [e-mail]
• DM us on Instagram or Facebook.
• Find your local Brain Injury Association at: https://www.biausa.org/

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