Source: Definition of Mild Traumatic Brain Injury Developed by the Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine.
J Head Trauma Rehabil 1993:8(3):86-87
Contact the Brain Injury Law Group
Call 800-992-9447
Many sources talk about fatigue as an issue in brain injury. Gronwall and Wrightson in Mild Head Injury say it has a greater direct impact on a patient's life than any other factor. The universally recognized treatise by Muriel Lezak, Neuropsychological Assessment, ©1995 Oxford University Press, at page 183 contains the following outstanding explanation of fatigue:
As a result of the slowed processing resulting from many microscopic sites of damage diffusely distributed throughout cerebral white matter and the upper brain stem, activities that were automatic now may only be accomplished with deliberate effort.
The activities that are normally automatic but become effortful after the injury, particularly during the first weeks or months, include many that are performed frequently throughout a normal activity day, such as concentrating, warding off distractions, reading for meaning, doing mental calculations, monitoring ongoing performances, planning the days activities, attending to two conversations at once or conversing with background noise, etc. ... It is little wonder that by late afternoon, if not by noon, many of these patients are exhausted. Making matters worse, as they get fatigued their efficiency plummets to even lower levels so that activities that were difficult when they were most rested and competent become extremely labored and even more error prone; e.g., they become more distractible, make more mistakes when speaking, become more clumsy, etc.
Wrightson and Gronwall in Mild Head Injury, ©1999, Oxford concur.
In most cases, fatigue is brought on most quickly by cognitive effort, desk work, reading, or any activity that needs attention. Physical effort does have some effect, particularly in early stages when it may bring on somatic symptoms, but later it is better tolerated.
Characteristically, providing their sleep has not been disturbed, the patients starts the day with some feeling of energy. Then, fairly suddenly, often they say like a curtain falling down, they find they are struggling to keep going; and can't make sense of what they're doing. If they recognize this warning and rest for an hour or two they may recover and be able to start again for another period. If they neglect the warning and go on working until they can cope no longer they bring on a state of severe fatigue which will stop them doing anything productive for the rest of the day; often it will persist and prevent useful work the next day, or even longer.
Comments by the family or pressure at work can make the situation worse. It is difficult for others to understand the limitations imposed by the fatigue and they can encourage or embarrass the patient into continuing in spite of it. When a patient who has been improving starts to regress, this sort of situation will often be uncovered.
Why subtlebraininjury.com?
subtlebraininjury.com is a website with a mission to educate with respect to the magnitude of brain injury which does not involve coma - injuries that have been labeled by names which grossly minimize their potential impact upon the life of the injured person. This site is brought to you by the advocates of the Brain Injury Law Group, a community of plaintiff's trial lawyers across the United States united by a common interest in serving the rights of persons with traumatic brain injuries and a common commitment to fully understanding the anatomic, medical and psychological aspects of TBI.
Additional Information
For a full treatment of the topic of brain injury, and recovering adequate compensation for those who have survived such injury, please visit our other pages. tbilaw.com A general treatment of all types of brain injury, including severe brain injury and concussion, with a special focus on the legal aspects of recovering full and adequate compensation for such injuries. tbilaw.com has been at the cornerstone of the web advocacy of the Brain Injury Law Group since it went online in 1996. waiting.com A page designed to assist those with issues regarding coma, especially in the acute phase when the doctors are saying "I just don't know." vestibulardisorder.com Addressing vertigo and dizziness resulting from trauma as well as information and resources for vestibular disorders.
Disclaimer:
The materials on this World Wide Web site are provided purely for informational purposes and are not legal advice. These materials are intended, but not promised or guaranteed, to be correct, complete, and current. This web site is not intended to be a source of advertising, solicitation or legal advice. Therefore, the reader should not consider this information an invitation for an attorney-client relationship. Readers should not act or rely upon any information contained in this World Wide Web site and should always seek the advice of competent counsel.
The owner of this web site is a law firm, the Johnson Law Office which organized the Brain Injury Law Group. The Johnson Law Office is licensed to practice in the States of Wisconsin , Illinois and Michigan. The Brain Injury Law Group does not wish to represent anyone desiring representation based upon their viewing any portion of this World Wide Web site that fails to comply with all legal and ethical rules in such individuals state. While not intended to do so, but in a good faith effort to comply with all rules and regulation which may be applicable to it, the Brain Injury Law Group hereby informs readers that this site may be construed as advertising and promotional materials. The Brain Injury Law Group makes no representation that it can obtain the same results as reported in this web site in other legal matters.
The transmission of an e-mail request for information does not create an attorney-client relationship, and you should not send us via e-mail any information or facts relating to your legal problem. If you are a client, remember that e-mail may not be secure. WE BELIEVE THAT THE BY FAR PREFERRED METHOD FOR YOU TO CONTACT US IS BY PHONE AT: 1-800-992-9447.
1-800-992-9447
g@gordonjohnson.com
©Attorney Gordon S. Johnson, Jr., 1997-2008.
