How to cope with fatigue after brain injury or stroke

There are many challenges that may arise after a stroke, brain injury, or when you’re dealing with a neurological condition. While difficulties with speaking or walking are often the first to come to mind, fatigue is a common and complicated symptom that impacts many. However, this is not the same type of tiredness that follows a poor night’s sleep, nor can it easily be fixed with a cup of coffee or a quick nap. This fatigue is often described as flu-like and debilitating, when simply getting out of bed can feel impossible.  

It may at times feel frustrating or isolating when others try to relate their normal, everyday tiredness to this level of exhaustion experienced by those who have sustained a stroke or brain injury. However, learning more information can help those in recovery learn to cope with these symptoms and assist their loved ones in understanding and providing support when fatigue arises.

What is causing my fatigue?

While the exact causes of post-stroke fatigue are not fully understood, there are several areas that could be involved:

Physical factors

• After a stroke or brain injury, the body is healing. This healing process can use up a lot of energy and lead to fatigue. Additionally, brain injury can impact physical ability, leading to some newfound limitations. This means that completing daily activities like moving around and doing chores requires more effort. The combination of these factors can cause increased fatigue in both the early and late stages of recovery.

Mental factors

•  It is common to have trouble with cognitive processes such as memory, attention, planning, organization, and language processing after a stroke or brain injury. As a result, completing daily tasks such as focusing on a conversation or planning out the day can require significant amounts of effort and energy. This may quickly lead to feelings of fatigue.

Emotional factors

• Due to the often life-changing nature of a brain injury or stroke,  during the recovery process many people experience emotional changes. Changes in functioning and level of independence catalyze questions around how we view ourselves, the expectations we have about what we can and cannot do, and thoughts about how quickly we should be improving. Additionally, anxiety and depression are common in those who have experienced a stroke or brain injury. These emotional changes create feelings of fatigue and exhaustion.  

Other factors

•  After a stroke or brain injury, common factors such as difficulty sleeping, reduced physical activity, and side effects of medications can also contribute to fatigue. Additionally, recovery often involves many types of therapy (e.g., speech therapy, occupational therapy, physical therapy, counseling). While beneficial, participating in these therapies can be physically and mentally tiring and lead to fatigue.

What can I do to feel better?

Fortunately, there are many things you can do to limit fatigue and increase energy levels during your recovery. 

• Talk to your doctor: They can monitor medications that may be contributing to your fatigue. Additionally, they can rule out other medical conditions that may be playing a role and provide suggestions for ways to improve diet and physical activity for increased energy.
• Take breaks: When you are experiencing fatigue, your body is likely telling you that it needs a rest. Take a moment to sit or lie down when you feel tired. Breaks can help prevent fatigue. Set timers or alarms throughout the day (e.g., every hour) to remind yourself to rest so that you can maximize your energy.
• Pace yourself: It is important to be realistic during your recovery. Things that used to be easy may take more effort for a while. Be patient with yourself. Give yourself extra time to complete tasks and build up your stamina. For example, if you are returning to work, start with just a few hours a day and work up to a full schedule when you feel ready. If you are having trouble reading the newspaper, start with one page and take a break before continuing.
• Consider psychological counseling: Anxiety, depression, stress, and other forms of emotional adjustment are extremely common post-stroke or brain injury. This can be a result of both chemical changes in the brain as well as trauma associated with the experience of a major medical event. Recovery can be supported through mental health counseling. Identifying these mental health conditions early on can reduce fatigue and allow for improved energy in other areas of rehabilitation.
• Celebrate your progress: Recovery is a long process, and it is important to recognize the improvements you make along the way. Can you say ‘hello’ to your family on the phone even though it was difficult before? Are you able to stay focused and cook simple meals in the kitchen after having trouble following a recipe a few weeks ago? Were you able to sign your name on a form despite having to use your non-dominant hand? These are all amazing accomplishments that should be celebrated. Focusing on what you cannot do can cause feelings of frustration and make you push yourself too hard, leading to added emotional distress and fatigue.
• Keep your family and friends in the loop: Signs of fatigue are not always obvious to others. Share this article with your loved ones so they can better understand brain injury fatigue and better support you in your recovery.

Marissa is a practicing speech-language pathologist clinical fellow serving English and Spanish-speaking patients at Northeast Rehabilitation Hospital. She is also a Clinical and Scientific Consultant for Constant Therapy Health, where she is involved in content development, advisement on product features, and other app-related clinical support.

References and Further Resources

American Stroke Association. Fighting Through Fatigue. https://www.stroke.org/en/about-stroke/effects-of-stroke/physical-effects-of-stroke/physical-impact/fighting-through-fatigue

Bell, MD, K. R. Fatigue and Traumatic Brain Injury. Model Systems Knowledge Translation Center (MSKTC). https://msktc.org/tbi/factsheets/fatigue-and-traumatic-brain-injury

Fatigue and tiredness. (July 2020). Stroke Association UK. https://www.stroke.org.uk/effects-of-stroke/tiredness-and-fatigue

Puchta, A. E. (2008). Why am I so tired after my stroke?. Journal of vascular and interventional neurology, 1(2), 63.