Monday, April 15, 2024

Fatigue After Stroke The Patient’s Perspective

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Tiredness Like No Other: A Legacy Of Stroke

SRABC Ask an Expert Series: Fatigue After Stroke

A number of forum users discussed the features of PSF itself. It was described as a fatigue like no other and a neurological tiredness . There were multiple references to the idea that stroke can and does cause fatigue and that fatigue is a feature of our affliction , and some took this further, characterising PSF as a distinct problem, a thing in itself, aside from chronic fatigue syndrome . Furthermore, fatigue was repeatedly expressed by forum users as a legacy of stroke or a typical post-stroke legacy , encapsulating survivors experiences of a long-lasting fatigue directly linked to the stroke.

Get Support From Family And Friends

Ask questions about events, activities and tasks. Let them know your limits. See if together you can make it work. Let them know fatigue can be unpredictable and that you may need to change plans.

Fatigue can make it difficult to get everything done. If someone offers you help, take them up on it.

Connecting with peers can also help talking with people who get it and sharing what youve learnt.

Time Course Of Fatigue And Influence On Outcome

In a Danish study analysing the course of fatigue over a two-year follow-up after first-ever stroke, the post-stroke fatigue level was seen to decrease during the first three months after hospital discharge. This situation remained unchanged for the next 2 years of follow-up. Different findings have come from a study by Schepers et al. who have reported an increase in the prevalence of fatigue during the first year after stroke. This difference could have been explained by the high prevalence of depression in the Schepers’s study, which could have influenced the time course of fatigue.

Regarding the duration of pathological fatigue after stroke, this could become chronic and be present several years after stroke onset-up to 40% after two years .

The initial level of fatigue is the main determinant of increasing fatigue over time and this being the case, targeting fatigue soon after stroke can help in preventing its persistence.

Several studies have reported that post-stroke fatigue is an independent predictor of shorter survival , institutionalization , poorer functional outcome and greater dependency for activities of daily living and instrumental activities of daily living . Moreover, in young patients, fatigue appears to be a determinant of not being able to resume paid work following stroke, independently of physical disability or cognitive deficit .

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Acceptance And Normalisation Of Psf: Part And Parcel

Often, stroke survivors asked other forum users is this tiredness normal? , obtaining a plethora of affirmative responses. This can be summarised by the idea proposed by one participant that PSF is a guest youre stuck with, youve just got to learn to live with it and that the feelings are normal and all stroke survivors can relate to the tiredness . Along with the reassurance that tiredness is very common post stroke , forum posters acknowledged fatigue as an after effect of stroke. One post from a survivor held that tiredness is common and can last for years post stroke . Normalisation was a recurring response to queries about PSF, demonstrated by the stroke survivor who wrote the exhaustion as other posts have said is normal .

Aggressive And Combative Behavior After Stroke

(PDF) Fatigue after Stroke: The Patient

Some survivors can demonstrate aggressive and even combative behavior after stroke. When this happens, you must seek help and talk to both a doctor and, if you experience any harm, call the domestic abuse hotline. Usually aggressive and combative behavior is the result of damage to the frontal lobe and impaired impulse control. Medication may help, and its imperative to talk to your loved ones doctor while also protecting your safety.

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Tired After A Stroke Understanding Post

Feeling tired is a normal part of life. Whether you didnt get a good night of sleep or wore yourself out with a busy day or an exerting activity, your body can only handle so much before you start to feel the physical effects of being tired. In cases like these, all you need to do is rest in order to feel re-charged and rejuvenated. But for individuals who have suffered from a stroke, its not that easy.

Fatigue after a stroke is common, and its different from simply feeling tired. Post-stroke fatigue can make somebody feel like they completely lack energy or strength, with a persistent feeling of being tired or weary. Unlike typical tiredness, a nap or sleeping longer at night wont solve things. If you are experiencing post-stroke fatigue, it is important to consult with your doctor so you can take the proper steps to start feeling better and more energized.

What You Can Do

After a stroke, you can take a number of positive steps to cope with fatigue-related issues, including:

  • Ask your physician or therapists how you can keep or regain your energy
  • Plan rest time as fatigue is a genuine stroke symptom, and you will tire more easily
  • Dont overdo it
  • Learn what foods, exercises or lifestyle habits can help you regain strength
  • Be careful to stand up or get out of bed slowly, because you can get dizzy from the sudden change in blood pressure
  • Communicate with your caregivers about your levels of fatigue, and make sure they understand how you are feeling
  • Get in touch with your local stroke advocacy group

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Baseline Variables Associated With Fatigue 3 And 12 Months Post

The multivariable linear regression model of the FAS score 3 months post-stroke is shown in Table 4. Independent variables were gender, age, prior stroke, NIHSS and mRS scores at admission, multimorbidity, prior depressive disorder, PHQ-9, EQ-5D VAS and IPAQ total MET-minutes/week assessed at baseline. The variables explained 17% of the FAS variance. Prior stroke was significantly related with more fatigue, as well as higher NIHSS scores at admission . The absence of a prior diagnosis of a depressive disorder and lacking information on a prior diagnosis of a depressive disorder in the medical chart were both significantly associated lower FAS scores indicating lower fatigue levels. In addition, higher PHQ-9 scores indicating more symptoms of depression, were significantly associated with a higher level of fatigue.

Table 4. Multivariable linear regression model of fatigue 3 and 12 months post-stroke .

The regression model of the FAS score 12 months post-stroke showed that the independent baseline variables explained 23% of the FAS variance. Similar to the regression model for 3 months post-stroke, prior stroke, NIHSS at admission, prior depressive disorder and PHQ-9 were significantly associated with the FAS score . In addition, younger age , a worse rating of general health at baseline and low pre-stroke physical activity were significantly associated with higher fatigue levels.

Fighting Psf: Unwelcome Guest

Fatigue and Energy Conservation after Stroke

In contrast, some TalkStroke forum users considered PSF to be one of those things we have to try and combat . Forum users received advice from some individuals to not give into it , to be continually fighting whats going on and to find your inner strength, let anything beat you . Forum posts of a combative nature described the tiredness as annoying, emphasising that the point is not to give into it, to find ways, little ways, to fight . Despite this, such posts acknowledged that tiredness after stroke is very common , much the same as the forum users accepting and normalising their PSF.

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Comparison With Other Literature

PSF is reported as one of the largest unmet needs in stroke survivors. Despite this, fatigue is only recently starting to be included within prominent clinical guidelines. This is largely due to the lack of high-quality studies and methodological variation evident in the PSF literature. In a report by the European Stroke Organisation on evidence-based stroke rehabilitation, although several topics are discussed, fatigue is noticeably missing. The absence of guidance for clinicians working with this population is reflected in the absence of a standardised approach as was apparent in the online forum posts.

How Survivors Cope With Psf: Pace Yourself

Forum posts discussing tiredness often mentioned or sought advice on how to cope with PSF. There was much discussion about involving healthcare professionals to assist with PSF management. Often, healthcare professionals were approached for support with the practicalities of returning to employment after stroke. For instance, one user reported that my GP doesnt really have any opinion on the tiredness . Another survivor was supported by forum users posting that just because your doctor cannot help it does not mean the be all and end all . Forum users recommended simple practical solutions such as pacing yourself rather than approaching healthcare professionals for support in managing the fatigue itself. The online community suggested a plethora of lifestyle modifications to manage fatigue including learning to live within your new limitations and taking it easy when needed .

For some stroke survivors, PSF represents an emotional struggle. One user described being pleased with his progress yet was annoyed at himself for concentrating on his physical recovery without taking his mental recovery into account. Included in his mental recovery was the idea of bouts of fatigue that knocked for six. Yet for others, overcoming the fatigue was considered part of the physical recovery from stroke. One survivor reported that apart from tiredness and intermittent vertigo the physical effects of a stroke . . . have thankfully passed .

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Behavior Changes After Stroke: Why They Happen & What It Means

Elizabeth Denslow, OTR/L Flint Rehab

Behavior changes after stroke can be a normal part of the recovery process. Some changes, however, can indicate the presence of other medical complications that require treatment. This article will explain potential changes in behavior so that you know what to expect and can seek medical attention when necessary.

Weve updated this guide to be as comprehensive as possible. To help make it easier to navigate, use the links below to jump straight to each behavior.

Types of behavior changes after stroke:

Design Setting And Sampling

Carer Training Information: Right Hemiplegia Positioning

This was a cross-sectional study. A convenience sample of stroke survivors was recruited from self-help groups in the Hong Kong Special Administrative Region from January to August 2019. The criteria for inclusion in this study were as follows: aged 55 having had a confirmed diagnosis of stroke 1year previously and residing and ambulatory in the community. People who were on drug trials, had other neurological diseases, experienced transient ischemic attacks or unstable medical conditions, or who were unable to give their informed consent were excluded. The sample size was estimated based on a rule-of-thumb approach, namely, 50+8m, where m is the number of predictors . Based on the inclusion of up to eight variables in the regression analysis, it was determined that 114 participants would be needed.

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How Do You Tell If You Have Post

Remember that theres a difference between feeling tired and having post-stroke fatigue. The latter will give you a feeling of complete exhaustion you will lack all energy and feel extremely weary. You will probably feel like you have to rest every day, or even multiple times a day. This can make it difficult to accomplish things, whether its something as simple as spending time with family, running errands, or even attending your post-stroke therapy sessions.

Until you feel the type of exhaustion that comes with post-stroke fatigue its difficult to explain, so dont feel frustrated if your friends and family dont understand why youre struggling. If you think you have post-stroke fatigue, dont hesitate to consult with your doctor.

Factors Associated With Early And Late Post

  • 1Chair of Epidemiology at the University Augsburg, University Hospital Augsburg, Augsburg, Germany
  • 2Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians Universität Munich, Munich, Germany
  • 3Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
  • 4Pettenkofer School of Public Health, Munich, Germany
  • 5Department of Neurology and Clinical Neurophysiology, University Hospital Augsburg, Augsburg, Germany

Background: Post-stroke fatigue is a common symptom after stroke. However, studies on the factors associated with early and late fatigue are scarce. The objective of this study was to identify variables associated with early and late fatigue.

Methods: In the German Stroke Cohort Augsburg study, participants were interviewed during their hospital stay and completed a postal questionnaire 3 and 12 months post-stroke. Fatigue was assessed using the Fatigue Assessement Scale . In addition, depression was measured by the Patient Health Questionnaire , general health status by the EQ-5D visual analog scale, and physical activity by the International Physical Activity Questionnaire . Multivariable regression models were used to determine the associations between FAS scores at 3 and 12 months post-stroke and demographic, psychosocial and health-related covariables.

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Psf As A Multidimensional Phenomenon

This study highlights the complexity and multidimensionality of PSF, which included closely interacting emotional, cognitive, physical and social aspects. When measuring complex constructs such as fatigue, a multidimensional measurement instrument is preferable in order to have a detailed assessment of all relevant dimensions . For example, both symptom intensity and symptom interference measures are considered vital, as stroke survivors might report fatigue as very distressing and significantly interfering with daily life, despite reporting relatively low fatigue intensity, and vice versa. This is in agreement with symptom experience in cancer patients, showing a non-linear relationship between symptom severity and symptom interference . In order to have a more comprehensive assessment of PSF that includes all relevant dimensions, there is a need for a new PSF-specific PROM.

Medicalisation Of Psf: A Classic Poststroke Symptom

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Forum participants employed language highly suggestive of medicalisation such as suffers with fatigue 4). Yet there was also much discussion about long-term effects of stroke as not understood by the profession 37). One individual reported attending two outpatient appointments following discharge from the stroke ward in which his fatigue was never addressed. This is at odds with the strongly held idea by many stroke survivors on the forum that tiredness is very much a part of stroke symptoms a classic post-stroke symptom . Notably, there is ample information about PSF available online and in booklet format from various charitable organisations such as The Stroke Association and Chest, Heart & Stroke Scotland, but these recourses do not yet appear to be included in clinical practice, and were not mentioned in forum discussions.

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Survivors Biological Explanations And Beliefs: Brain Healing

Most commonly, forum users attributed PSF to the brain healing . We identified several variations on this theme: some stroke survivors and caregivers understood it as giving the brain the time off it needs to start healing itself , while others suggested that the body is working overtime trying to make sense of what has happened and heal as fast as it can . There were also references to information about PSF provided by healthcare professionals. On one occasion, the phrase poststroke fatigue was employed, where a relative explained he was told by a healthcare professional that his father in law may have post-stroke fatigue . However, discussions usually centred around the explanation of symptoms given by healthcare professionals, that stroke causes fatigue . Forum users sought to extend such explanations using metaphor for the disease process: the clock in your head is going round at its own pace now and expressed reverence for the brain, a strange thing they could not understand.

Getting Support For Post

If you struggle with post-stroke fatigue, reach out for help from your medical team.

Your doctor may be able to adjust your medication if fatigue is listed as a side effect of any current prescriptions.

If you have demanding secondary effects, like post-stroke pain or paralysis, your therapist might be able to help. For example, they can try electrical stimulation to see if it helps accelerate recovery.

Ultimately, you should experiment with as many treatments as possible until you find something that helps you. Remember to pace yourself and rest when you need it. Good luck!

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Mood Swings After Stroke

Sometimes, mood swings are an innocent byproduct of the intense challenges of stroke recovery. Everyday activities may require more energy than normal as the brain is still healing. This can result in post-stroke fatigue and mood swings as a complication of that fatigue.

Other times, mood swings can stem from damage to the emotion center of the brain, resulting in a condition known as emotional lability or pseudobulbar affect. This can cause uncontrollable emotional outbursts like laughter or crying, even if the situation isnt funny or sad. This condition may improve on its own over time and it can also be treated with medication.

General Barriers And Facilitators

Stroke: Patient Education: Positioning for Right Hemiplegia ...

Five patients named lack of knowledge as a barrier for behavior change, in particular in relation to dietary behavior.

And furthermore they just let me find out they just let me figure it all out for myself, they do not say what you can do best.

Social support was experienced as a facilitator of physical activity. Support of spouses was named by three patients.

Yes, I do that with my husband that’s really nice I feel his support, like: together we can do this. So that’s really nice.

Some patients appear to have a low perceived severity of their ischemic stroke, which leads to the absence of an intention to quit smoking:

I simply hate it, but I also hate that nothing comes out of those investigations. And therefore I say, well if there is anything that they see, something in my brains, well if there is a bit of a scar, they can see something, then I’m like: shit. But now I just haven’t yet.

However, for one participant severity appeared to be a facilitating factor to quit excessive alcohol intake. According to this patient, it was a choice between drinking and dying or quit drinking and stay alive. Severity has not been mentioned in relation to other healthrelated behavior.

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