The Impact of Post Traumatic Brain Injury Fatigue on Health and Wellbeing

There are many different types of disability, and all have significant impacts on the lives of individuals with them. Disability can result from a wide range of conditions, including injury, and the disability that will be the focus of this essay is traumatic brain injury (TBI). TBI is defined as being an injury to the brain caused by trauma to the head, typically resulting from an accident such as a traffic collision, or a fall. TBI’s are classed as being severe when a period of unconsciousness follows injury which exceeds 6 hours, along with a period of post-traumatic amnesia lasting for a minimum of 24 hours (Headway, 2017). TBI has a wide range of consequences and symptoms in each case, and these can vary widely depending on the location and severity of the injury.

However, there are some effects which are commonly reported by TBI patients, one of these being fatigue. Mental fatigue, defined as feeling tired and unable to think clearly or concentrate (Brainline, 2017), has been described as one of the most common problematic symptoms of TBI, and although fatigue can improve as the patient recovers from TBI, it often persists. Fatigue could be due to the brain requiring more energy to function and heal post injury (Brainline, 2017). Research has found that TBI patients experience significantly higher levels of fatigue than those without TBI, and this finding is consistently using both subjective and objective measures of fatigue (LaChapelle & Finlayson, 1998). This essay will discuss the impact that fatigue associated with TBI can have on the health and well-being of an individual, as well as exploring attempts to define the concepts of disability, health, and wellbeing.

Disability has been defined in the UK under the Equality Act 2010 as a “physical or mental impairment that has a substantial and long-term negative effect on the ability to carry out normal daily activities” (Gov.uk, 2010). This definition is practical when attempting to classify someone as disabled, and fits with a medical model of disability. The medical model explains that individuals are disabled due to impairments or difficulties they experience, and in order for these to be overcome, any impairments need to be treated (Scope, 2017). The medical model has been criticised as having a focus on curing an individual even if the impairment is not causing any discomfort, and not considering their actual needs. This can lead to a lack of independence and a loss of control over their lives (Scope, 2017).

The second definition of disability which offers a different perspective comes from the World Health Organisation (WHO), and defines disability more generally, stating it is “an umbrella term, covering impairments, activity limitations, and participation restrictions” (WHO, 2017). This explanation removes the focus on disability being simply a health problem and fits more with a social model of disability, which states that individuals are disabled because the society they live in creates barriers to their needs. In the view of the social model, these societal barriers need to be removed or changed for limitations to be overcome, and these barriers can include physical, such as access to a building, as well as attitudes of society towards disabled individuals (Scope, 2017).

The social model has advantages over the medical model in that it considers individual needs and requires society to be accessible for everyone. However, a criticism of the social model is that it may neglect an impairment which is causing pain or difficulty and could, therefore, benefit from being treated (Shakespeare, 2016). Each definition and model of disability provides its own advantages and criticisms, and issues with defining disability may stem from attempting to define many unique experiences and difficulties under one term, when the concept of disability may be inherently subjective (Gronvik, 2009).

Since its 1948 constitution, the WHO has defined health as being “a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity” (WHO, 2006). This definition of health has been praised for not having a negative focus and encompassing many aspects of health. However, criticisms of it focus on the word “complete”, which is difficult to measure and causes individuals living with chronic conditions or disabilities labeled as always being in ill health (Huber, 2011). The WHO definition has been challenged by Huber (2011), who introduced the idea of health as an individual’s ability to cope when faced with challenges in different areas of life, such as physical, social and emotional (Huber, 2011).

Huber’s definition focuses more on how unique circumstances may impact the lives of an individual rather than purely on an absence of disease or impairments. This essay will discuss health using Huber’s definition as a reference and will discuss the social, physical and emotional aspects of health.

Many attempts at defining wellbeing have been made over many years, and these have often encompassed a feeling of fulfillment, accomplishing of goals and feelings of life satisfaction (Dodge, et al., 2012). An example of one of these definitions come from Shah & Marks (2004), who discussed wellbeing as feelings of happiness, satisfaction, and fulfillment, along with contributing to society (Marks & Shah, 2004). This definition of wellbeing, along with many others like it, have been criticised as being descriptions more than definitions, and for having a focus on many subjective dimensions which may underlie the concept of wellbeing (Dodge, et al., 2012). A definition by Dodge et al. (2012) explains the concept of wellbeing as being an equilibrium, like a homeostatic mechanism, with a set point for well-being, that can be upset by life challenges or a lack of resources, and the equilibrium is a balance between the two (Dodge, et al., 2012). This definition is simple and does not require the meeting of different dimensions criterion. Additionally, it ties in with Huber’s (2011) definition of health with its focus on overcoming and managing challenges, and wellbeing in this essay will be discussed in line with this definition.

The first aspect of health that can be impacted by post-TBI fatigue is physical health. Factors important for the maintenance of physical health include physical activity, nutrition and managing any physical symptoms of illnesses (Koshuta, 2003). Fatigue causes feelings of tiredness, and this could affect motivation to partake in factors important to the maintenance of physical health, such as exercise. Indeed, research has found that fatigue in TBI patients is associated with a lower level of physical activity (Stulemeijer, et al., 2006). Given that a lack of physical activity is linked to obesity, cardiovascular and respiratory problems, the importance of being able to be physically active is clear (Gov.uk, 2016). The reduction in physical exercise associated with post-TBI fatigue has an impact on the health and well-being of an individual, as it affects their ability to cope with physical challenges and to maintain a state of physical wellbeing. It may also impact on an individual’s ability to recover, as physiotherapy and exercise are often a part of the rehabilitation process after TBI, especially as these injuries tend to result from accidents or falls (Borgaro, et al., 2005).

A second way in which post-TBI fatigue can impact the physical aspect of health and wellbeing involves nutrition. Individual’s who feel tired and unable to concentrate are less likely to feel the motivation to cook food or shop for nutritious food. Fatigue may result in activities such as cooking taking significantly longer, difficulties maintaining focus on the task, or finding the motivation to prepare food. Individual’s who previously enjoyed cooking before TBI have reported gaining less enjoyment from it post-TBI due to problems introduced by fatigue (Cantor, et al., 2008). These difficulties may cause an individual to seek food such as takeaway food, which may be unhealthy, or to eat less frequently. Lacking proper nourishment can lead to a susceptibility to illnesses, problems with weight and further feelings of fatigue to the TBI patient (NHS Choices, 2017).

The above challenges faced by post-TBI fatigue patients can involve experiencing a reduced enjoyment from activities that may have previously been enjoyed, such as exercise or cooking. A reduced enjoyment of activities has been found amongst TBI patients, as fatigue has an impact on motivation, with patients reporting they are unable to begin or maintain activities and are unable to concentrate on them (Yudofsky, et al., 2005). As well as affecting physical health, this can impact on other areas such as returning to work or partaking in hobbies and social activities. This impacts health as individuals may feel unable to cope with challenges, whether physical or emotional and upset the balance of wellbeing by not having adequate resources to manage life challenges.

In a study conducted on employment rates and returning to work following TBI, it was found that patients who reported suffering from fatigue were less likely to return to work. Additionally, feelings of fatigue were reported as being a particular difficulty by those TBI patients who had returned to work (McCrimmon & Oddy, 2006). This could be explained by the effects of fatigue leaving individuals tired and unable to concentrate or feel motivated for work. This impacts the health of an individual as it is affecting their ability to cope with the demands of work or education, and could, therefore, limit their satisfaction and progress. To overcome these difficulties faced when returning to work, in line with the social model of disability, adjustments could be made. Patients who have returned to work following TBI and who experience fatigue stated that adjustments which were helpful in managing fatigue and encouraging motivation included only having one task at a time to focus on, having supportive and understanding employers, and flexibility surrounding working hours, such a shorter days or part-time hours (Materne, et al., 2017). If adjustments could be made in line with these, the barriers limiting the participation of the TBI patient in the workplace could be removed and result in an improvement to their health and wellbeing.

Along with impacting the physical and emotional state of TBI patients, post-TBI fatigue can also impact the social aspect of an individual’s health and wellbeing. Feeling fatigued has been found to be associated with limitations to social participation, with individuals reporting feeling too fatigued to socialize, and this can result in social isolation. Social functioning has been associated with the individual’s perception of their quality of life, therefore this could suffer if an individual feels unable to partake in social activities (Cantor, et al., 2008). To overcome the social barriers individuals may face following TBI, recovery could include tackling feelings of fatigue and emphasizing the importance of support provided by family and friends, along with addressing how to maintain social contact when a person is suffering from fatigue (Finset, et al., 1995).s

A final, important point about how fatigue post-TBI can impact the health and well-being of individuals concerns recovery from the injury. Patients who are undertaking rehabilitation after a TBI undergo many sessions of occupational therapy, physiotherapy, and psychological therapy and these sessions typically last an hour or more and can be intense and demanding. If patients are dealing with fatigue, they may feel unable to participate fully in a session, or request to finish the session early (Borgaro, et al., 2005). The social model of disability would explain that rehabilitation programmes need to account for fatigue experienced by patients, and incorporate regular breaks in sessions, or shorter sessions, as part of rehabilitation.

In conclusion, post-TBI fatigue impacts the physical, emotional and social health of individuals as it affects their ability to participate in physical activity, nutrition, workplace and social activities and their own recovery from TBI. This affects health and wellbeing as it has a negative influence on an individual’s ability to cope and adapt, and upsets the balance between resources to cope with life challenges. In line with the social model of disability, some of the difficulties created by fatigue in TBI patients could be overcome through adaptations to their environment including adjustments at work and to rehabilitation programmes to allow for and manage the problem of fatigue.