Fatigue Management in Neurology. Alison Nock MS Specialist Occupational Therapist

Transcription

1 Fatigue Management in Neurology Alison Nock MS Specialist Occupational Therapist

2 Overview of Fatigue Common disabling symptom Some people rate fatigue as the worst symptom of their disease. Predominant determinants of fatigue are pain, depression and functional loss Can adversely affect mood and ability to cope with other symptoms

3 Overview of Fatigue (2) Significantly impacts on quality of life Fatigue mechanism is poorly understood No clear connection between disability and fatigue Is different for everyone Often classed as one of the invisible symptom

4 Definition of Fatigue A subjective lack of physical and/or mental energy that is perceived by the individual or caregiver to interfere with usual or desired activities (Clinical Practice Guidelines, 1998)

5 Fatigue The state of reduced capacity for work or accomplishment following a period of mental or physical activity e.g. muscle fatigue if the area called upon to repetitively work for an extended period.

6

7 Environment Physical Social Institutional Cultural Multiple Sclerosis Primary MS Fatigue Secondary MS Fatigue Pain Fatigue is identified as a significant problem Physical Health Comorbid Conditions Latrogenic Causes Psychological Health Anxiety Stress Depression Other Normal Fatigue Sleep Disorders Primary Secondary Adapted from MS Council, 1998

8 Primary Fatigue Primary fatigue is experienced as a direct result of damage or inflammation to the myelin in the central nervous system. The body responds to this damage by slowing down reactions thus causing fatigue.

9 Primary Fatigue Short Circuiting or Nerve fibre fatigue: The effort of doing something gets increasingly difficult over time until you are forced to stop. It often improves after a short rest. Herdon (1999) suggests a reduced efficiency of neural transmission. A build up of sodium ions during continued activity is thought to cause a conduction block. Rest allows the cell membrane to return to its resting state.

10 Primary Fatigue Heat Sensitivity Fatigue: The experience of worsening symptoms and fatigue in hot weather or following a bath is known as Uhtoffs phenomenon. This thermosensitivity is unique to MS fatigue. A rise in body temperature can cause fatigue due to increased ionic conduction, reducing the duration of action potential and limiting the current available for ongoing transmission.

11 Primary Fatigue Lassitude: An overwhelming sensation of tiredness that does not appear to be directly related to participation in activity or rest. Poorly understood immunological theories have been suggested.

12 Secondary Fatigue Fatigue can be experienced as a result of other factors that are not necessarily directly related to your Condition and are therefore described as secondary factors.

13 Secondary Fatigue Medication side effects of medication may cause tiredness or drowsiness,e.g. beta interferon, baclofen Infection often associated with increased tiredness. A rise in body temperature as little as 0.5 degrees may worsen MS fatigue

14 Secondary Fatigue Sleep Disturbance Need to assess the causes of sleep disturbance e.g. urgency, pain, depression or anxiety. Sleep diary can be a useful tool for assessment. Environment Need to consider environmental aspects of persons life that is impacting on energy levels.

15 Secondary Fatigue Exertion/deconditioning The increased effort required by the body if mobility or coordination are affected can cause fatigue. Reduced activity can also lead to deconditioning of both the cardiovascular system and the muscles themselves, resulting in a less efficient use of energy. Depression/low mood emotional impact of adjusting to a neurological condition or nerve damage. Low mood can effect motivation to be active and make you feel lethargic

16 Cognitive Fatigue People with cognitive fatigue have difficulties with: Learning new information Maintaining attention Concentration span Memory recall These symptoms may worsen after a mentally demanding exercise.

17 Fatigue - Impact Other symptoms Self esteem Ability to take part in day to day activities Work, leisure and social activities Relationships/Sex life Ability to cope with your symptoms Capacity for learning, memory and concentration

18 Fatigue Management a process by which the individual increases understanding of the factors which contribute to & exacerbate his/her fatigue. Then through education & adaptation, he/she learns to optimise function within the context of fatigue through goal setting & the use of energy conservation strategies (Harrison 2007)

19 How Do We Manage Fatigue? Acknowledge that it is real Consider multiple contributory factors Exercise/diet Break the boom-bust pattern Environment Medication

20 Decreasing overall level of activity The Boom-and-Bust pattern Good day Bad day Time Activity

21 Principles of Fatigue Management Take frequent rests Prioritise activities Plan Ahead Organise tools, materials and work areas Adopt a good posture Lead a healthy lifestyle and exercise

22

23 Frequent Rests Balance activity with rest Rest means doing nothing at all Take frequent short rests and rest BEFORE feeling tired Find a relaxation method that suits you

24

25 Activity Time Fdiary V S(example) Activity Comment 6:00AM 7:00AM Fixing breakfast standing 15 minutes (cool) 8:00AM Blurred vision 1-10 (1= very low; 10 = very high) F= fatigue level V= value of activity S= satisfaction you feel with your performance Comments: list all MS symptoms as they appear or worsen during the day including cognitive problems, visual problems, weakness, dizziness, dragging foot, pain, numbness, burning etc)

26 WEEKLY PLANNER MON TUES WED THURS FRI SAT SUN Before PM After 10.00

27 Prioritise Activities Consider all the jobs you do during a typical day/week Avoid jobs that could be done by other people Consider outside help Consider jobs that could be cut out of your daily routines or done less often Think about changing some of the ways that you do certain activities

28 Plan Ahead Order activities so that those that must be done are done before you run out of energy Make a daily or weekly timetable of activities that need to be done Spread heavy and light tasks throughout the day Set yourself realistic targets Break large tasks into manageable chunks

29 Organise Tools, Materials and Work Area (Ergonomics) Organise work areas, eg kitchen and computer work station Consider lighting and ventilation (heat!) Have specific area for each job, storing essential items at hand for immediate use Keep work areas as uncluttered as possible Consider heights for ease of transfers Larger grips ease of task

30 Posture Relaxed and efficient approach to carrying out activities Upright and symmetrical posture Rest and support important Avoid excessive twisting and bending Vary support surfaces during the day

31 Lead a Healthy Lifestyle /Exercise Try to keep generally fit (balance exercise and rest). Exercise strengthens the muscles around the joint Eat a well balanced diet. Avoid heavy meals or only plan a light activity afterwards Excess weight, alcohol and smoking can all have negative effects on fatigue

32 Putting It Into Practise Common sense principles but need to put theory into practise Daily/weekly record along with fatigue level Identify baseline to work from Build in routines Adopt the right attitude for change, positive self talk and acceptance important to make changes Support and communication

33 Keeping on Track

34 Fatigue research Development of a New Fatigue management Programme for people with Multiple Sclerosis. Multi-centre randomised control trial Poole, Bristol and Southampton Fatigue management v s Local best practise

35 Any Questions?

36 Resources MS Society information sheets National Association of Neurological Occupational Therapists fatigue manual for Occupational Therapists Group education programme An evidenced-based multi-disciplinary approach to manage fatigue with people who have MS University Hospital Birmingham Fatigue in Multiple Sclerosis- A guide to Diagnosis and Management. Lauren B. Krupp Modified Fatigue Impact Scale