Skip to main content
Top
Published in: Journal of Neurology 8/2006

01-08-2006 | ORIGINAL COMMUNICATION

Recovery from mild traumatic brain injury

A focus on fatigue

Authors: Maja Stulemeijer, M.Sc, Sieberen van der Werf, Gijs Bleijenberg, Jan Biert, Jolanda Brauer, Pieter E.Vos

Published in: Journal of Neurology | Issue 8/2006

Login to get access

Abstract

Background

Fatigue is one of the most frequently reported symptoms after Mild Traumatic Brain Injury (MTBI). To date, systematic and comparative studies on fatigue after MTBI are scarce, and knowledge on causal mechanisms is lacking.

Objectives

To determine the severity of fatigue six months after MTBI and its relation to outcome. Furthermore, to test whether injury indices, such as Glasgow Coma Scale scores, are related to higher levels of fatigue.

Methods

Postal questionnaires were sent to a consecutive group of patients with an MTBI and a minor-injury control group, aged 18–60, six months after injury. Fatigue severity was measured with the Checklist Individual Strength. Postconcussional symptoms and limitations in daily functioning were assessed using the Rivermead Post Concussion Questionnaire and the SF-36.

Results

A total of 299 out of 618 eligible (response rate 52%) MTBI patients and 287 out of 482 eligible (response rate 60%) minor-injury patients returned the questionnaire. Ninety-five MTBI patients (32%) and 35 control patients (12%) were severely fatigued. Severe fatigue was highly associated with the experience of other symptoms, limitations in physical and social functioning, and fatigue related problems like reduced activity. Of various trauma severity indices, nausea and headache experienced on the ED were significantly related to higher levels of fatigue at six months.

Conclusions

In conclusion, one third of a large sample of MTBI patients experiences severe fatigue six months after injury, and this experience is associated with limitations in daily functioning. Our finding that acute symptoms and mechanism of injury rather than injury severity indices appear to be related to higher levels of fatigue warrants further investigation.
Literature
1.
go back to reference Cassidy JD, Carroll LJ, Peloso PM, Borg J, von Holst H, Holm L, Kraus J, Coronado VG (2004) Incidence, risk factors and prevention of mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med 43(suppl):28–60PubMedCrossRef Cassidy JD, Carroll LJ, Peloso PM, Borg J, von Holst H, Holm L, Kraus J, Coronado VG (2004) Incidence, risk factors and prevention of mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med 43(suppl):28–60PubMedCrossRef
2.
go back to reference Evans RW (1992) The postconcussion syndrome and the sequelae of mild head injury Neurol Clin 10:815–847PubMed Evans RW (1992) The postconcussion syndrome and the sequelae of mild head injury Neurol Clin 10:815–847PubMed
3.
go back to reference Levin HS, Mattis S, Ruff RM, Eisenberg HM, Marshall LF, Tabaddor K, High WM Jr, Frankowski RF (1987) Neurobehavioral outcome following minor head injury: a three-center study. J Neurosurg 66:234–243PubMedCrossRef Levin HS, Mattis S, Ruff RM, Eisenberg HM, Marshall LF, Tabaddor K, High WM Jr, Frankowski RF (1987) Neurobehavioral outcome following minor head injury: a three-center study. J Neurosurg 66:234–243PubMedCrossRef
4.
go back to reference van der Naalt J, van Zomeren AH, Sluiter WJ, Minderhoud JM (1999) One year outcome in mild to moderate head injury: the predictive value of acute injury characteristics related to complaints and return to work. J Neurol Neurosurg Ps 66:207–213CrossRef van der Naalt J, van Zomeren AH, Sluiter WJ, Minderhoud JM (1999) One year outcome in mild to moderate head injury: the predictive value of acute injury characteristics related to complaints and return to work. J Neurol Neurosurg Ps 66:207–213CrossRef
5.
go back to reference Ponsford J, Willmott C, Rothwell A, Cameron P, Kelly AM, Nelms R, Curran C, Ng K (2000) Factors influencing outcome following mild traumatic brain injury in adults. J Int Neuropsychol Soc 6:568–579PubMedCrossRef Ponsford J, Willmott C, Rothwell A, Cameron P, Kelly AM, Nelms R, Curran C, Ng K (2000) Factors influencing outcome following mild traumatic brain injury in adults. J Int Neuropsychol Soc 6:568–579PubMedCrossRef
6.
go back to reference LaChapelle DL, Finlayson MAJ (1998) An evaluation of subjective and objective measures of fatigue in patients with brain injury and healthy controls. Brain Injury 12:649–659PubMedCrossRef LaChapelle DL, Finlayson MAJ (1998) An evaluation of subjective and objective measures of fatigue in patients with brain injury and healthy controls. Brain Injury 12:649–659PubMedCrossRef
7.
go back to reference Paniak C, Reynolds S, Philips K, Toller-Lobe G, Melnyk A, Nagy J (2002) Patient complaints within 1 month of mild traumatic brain injury: A controlled study. Arch Clin Neuropsych 17:319–334CrossRef Paniak C, Reynolds S, Philips K, Toller-Lobe G, Melnyk A, Nagy J (2002) Patient complaints within 1 month of mild traumatic brain injury: A controlled study. Arch Clin Neuropsych 17:319–334CrossRef
8.
go back to reference King NS, Crawford S, Wenden FJ, Moss NE, Wade DT (1995) The Rivermead Post Concussion Symptoms Questionnaire: a measure of symptoms commonly experienced after head injury and its reliability. J Neurol 242:587–592PubMedCrossRef King NS, Crawford S, Wenden FJ, Moss NE, Wade DT (1995) The Rivermead Post Concussion Symptoms Questionnaire: a measure of symptoms commonly experienced after head injury and its reliability. J Neurol 242:587–592PubMedCrossRef
9.
go back to reference Ingebrigtsen T, Waterloo K, Marup-Jensen S, Attner E, Romner B (1998) Quantification of post-concussion symptoms 3 months after minor head injury in 100 consecutive patients. J Neurol 245: 609–612PubMedCrossRef Ingebrigtsen T, Waterloo K, Marup-Jensen S, Attner E, Romner B (1998) Quantification of post-concussion symptoms 3 months after minor head injury in 100 consecutive patients. J Neurol 245: 609–612PubMedCrossRef
10.
go back to reference McCullagh S, Oucherlony D, Protzner A, Blair N, Feinstein A (2001) Prediction of neuropsychiatric outcome following mild trauma brain injury: an examination of the Glasgow Coma Scale. Brain Injury 15:489–497PubMedCrossRef McCullagh S, Oucherlony D, Protzner A, Blair N, Feinstein A (2001) Prediction of neuropsychiatric outcome following mild trauma brain injury: an examination of the Glasgow Coma Scale. Brain Injury 15:489–497PubMedCrossRef
11.
go back to reference Kashluba S, Paniak C, Blake T, Reynolds S, Toller-Lobe G, Nagy J (2004) A longitudinal, controlled study of patient complaints following treated mild traumatic brain injury. Arch Clin Neuropsych 19:805–816CrossRef Kashluba S, Paniak C, Blake T, Reynolds S, Toller-Lobe G, Nagy J (2004) A longitudinal, controlled study of patient complaints following treated mild traumatic brain injury. Arch Clin Neuropsych 19:805–816CrossRef
12.
go back to reference Mickeviciene D, Schrader H, Obelieniene D, Surkiene D, Kunickas R, Stovner LJ, Sand T (2004) A controlled prospective inception cohort study on the post-concussion syndrome outside the medicolegal context. Eur J Neurol 11:411–419PubMedCrossRef Mickeviciene D, Schrader H, Obelieniene D, Surkiene D, Kunickas R, Stovner LJ, Sand T (2004) A controlled prospective inception cohort study on the post-concussion syndrome outside the medicolegal context. Eur J Neurol 11:411–419PubMedCrossRef
14.
go back to reference de Groot MH, Phillips SJ, Eskes GA (2003) Fatigue associated with stroke and other neurologic conditions: Implications for stroke rehabilitation. Arch Phys Med Rehab 84:1714–20CrossRef de Groot MH, Phillips SJ, Eskes GA (2003) Fatigue associated with stroke and other neurologic conditions: Implications for stroke rehabilitation. Arch Phys Med Rehab 84:1714–20CrossRef
15.
go back to reference Haboubi NH, Long J, Koshy M, Ward AB (2001) Short-term sequelae of minor head injury (6 years experience of minor head injury clinic). Disabil Rehabil 23:635–638PubMedCrossRef Haboubi NH, Long J, Koshy M, Ward AB (2001) Short-term sequelae of minor head injury (6 years experience of minor head injury clinic). Disabil Rehabil 23:635–638PubMedCrossRef
16.
go back to reference Seel RT, Kreutzer JS, Rosenthal M, Hammond FM, Corrigan JD, Black K (2003) Depression after traumatic brain injury: A national institute on disability and rehabilitation research model systems multicenter investigation. Arch Phys Med Rehab 84:177–184CrossRef Seel RT, Kreutzer JS, Rosenthal M, Hammond FM, Corrigan JD, Black K (2003) Depression after traumatic brain injury: A national institute on disability and rehabilitation research model systems multicenter investigation. Arch Phys Med Rehab 84:177–184CrossRef
17.
go back to reference Cicerone KD, Kalmar K (1997) Does premorbid depression influence post-concussive symptoms and neuropsychological functioning? Brain Injury 11:643–648PubMedCrossRef Cicerone KD, Kalmar K (1997) Does premorbid depression influence post-concussive symptoms and neuropsychological functioning? Brain Injury 11:643–648PubMedCrossRef
18.
go back to reference Vos PE, Battistin L, Birbamer G, Gerstenbrand F, Potapov A, Prevec T, Stepan ChA, Traubner P, Twijnstra A, Vecsei L, von Wild K (2002) EFNS Guideline on Mild Traumatic Brain Injury. Report of am EFNS Task force Eur. J Neurol 9: 207–219PubMedCrossRef Vos PE, Battistin L, Birbamer G, Gerstenbrand F, Potapov A, Prevec T, Stepan ChA, Traubner P, Twijnstra A, Vecsei L, von Wild K (2002) EFNS Guideline on Mild Traumatic Brain Injury. Report of am EFNS Task force Eur. J Neurol 9: 207–219PubMedCrossRef
19.
go back to reference Vercoulen JHMM, Swanink CMA, Fennis JFM, Galama JMD, van der Meer JWM, Bleijenberg G (1994) Dimensional Assessment of Chronic Fatigue Syndrome. J Psychosom Res 38:383–392PubMedCrossRef Vercoulen JHMM, Swanink CMA, Fennis JFM, Galama JMD, van der Meer JWM, Bleijenberg G (1994) Dimensional Assessment of Chronic Fatigue Syndrome. J Psychosom Res 38:383–392PubMedCrossRef
20.
go back to reference Steward AL, Hayds RD, Ware JE jr (1998) The MOS short form general health survey: reliability and validity in a patient population Med Care 26:724–735 Steward AL, Hayds RD, Ware JE jr (1998) The MOS short form general health survey: reliability and validity in a patient population Med Care 26:724–735
21.
go back to reference Vercoulen JHMM, Alberts M, Bleijenberg G (1999) De Checklist Individual Strength (CIS) Gedragstherapie 32:31–36 Vercoulen JHMM, Alberts M, Bleijenberg G (1999) De Checklist Individual Strength (CIS) Gedragstherapie 32:31–36
22.
go back to reference van der Werf SP, van den Broek HLP, Anten HWM, Bleijenberg G (2001) Experience of severe fatigue long after stroke and its relation to depressive symptoms and disease characteristics Eur Neurol 45:28–33PubMedCrossRef van der Werf SP, van den Broek HLP, Anten HWM, Bleijenberg G (2001) Experience of severe fatigue long after stroke and its relation to depressive symptoms and disease characteristics Eur Neurol 45:28–33PubMedCrossRef
23.
go back to reference Kalkman J, van der Werf S, van Engelen B, Schillings M, Jongen P, Zwarts M, Bleijenberg G (2002) Fatigue complaints are equally characteristic for neuromuscular diseases as for multiple sclerosis Neuromuscular Disord 12:779 Abstract Kalkman J, van der Werf S, van Engelen B, Schillings M, Jongen P, Zwarts M, Bleijenberg G (2002) Fatigue complaints are equally characteristic for neuromuscular diseases as for multiple sclerosis Neuromuscular Disord 12:779 Abstract
24.
go back to reference de Kruijk JR, Leffers P, Menheere PPCA, Meerhoff S, Rutten J, Twijnstra A (2002) Prediction of post-traumatic complaints after mild traumatic brain injury: early symptoms and biochemical markers. J Neurol Neurosurg Ps 73:727–732CrossRef de Kruijk JR, Leffers P, Menheere PPCA, Meerhoff S, Rutten J, Twijnstra A (2002) Prediction of post-traumatic complaints after mild traumatic brain injury: early symptoms and biochemical markers. J Neurol Neurosurg Ps 73:727–732CrossRef
25.
go back to reference Stalnacke B (2004) Detection and outcome of mild traumatic brain injury in patients and sportsmen: persisting symptoms, disabilities and life satisfaction in relation to S-100B, NSE and cortisol. PhD thesis, University of Umea:35 - 38 Stalnacke B (2004) Detection and outcome of mild traumatic brain injury in patients and sportsmen: persisting symptoms, disabilities and life satisfaction in relation to S-100B, NSE and cortisol. PhD thesis, University of Umea:35 - 38
26.
go back to reference Rutherford W. (1989) Postconcussion symptoms: relation to acute neurological indices, individual differences, and circumstances of injury. In: Levin HS, Eisenberg HM, Benton AL (eds) Mild head injury. New York, Oxford University Press. pp. 217–40 Rutherford W. (1989) Postconcussion symptoms: relation to acute neurological indices, individual differences, and circumstances of injury. In: Levin HS, Eisenberg HM, Benton AL (eds) Mild head injury. New York, Oxford University Press. pp. 217–40
27.
go back to reference Ingles JL, Eskes GA, Philips SJ (1999) Fatigue After Stroke Arch Phys Med Rehab 80:173–178CrossRef Ingles JL, Eskes GA, Philips SJ (1999) Fatigue After Stroke Arch Phys Med Rehab 80:173–178CrossRef
28.
go back to reference World Health Organization (1978) The ICD-9 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. WHO Geneva World Health Organization (1978) The ICD-9 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. WHO Geneva
29.
go back to reference McLean A Jr, Dikmen SS, Temkin NR. (1993) Psychosocial recovery after head. injury. Arch Phys Med Rehabil 74(10):1041–6PubMedCrossRef McLean A Jr, Dikmen SS, Temkin NR. (1993) Psychosocial recovery after head. injury. Arch Phys Med Rehabil 74(10):1041–6PubMedCrossRef
30.
go back to reference Iverson GL, Lange RT. Examination of “Postconcussion-Like” Symptoms in a Healthy Sample. (2003). Applied Neuropsychology 10:137–144PubMedCrossRef Iverson GL, Lange RT. Examination of “Postconcussion-Like” Symptoms in a Healthy Sample. (2003). Applied Neuropsychology 10:137–144PubMedCrossRef
Metadata
Title
Recovery from mild traumatic brain injury
A focus on fatigue
Authors
Maja Stulemeijer, M.Sc
Sieberen van der Werf
Gijs Bleijenberg
Jan Biert
Jolanda Brauer
Pieter E.Vos
Publication date
01-08-2006
Publisher
Steinkopff-Verlag
Published in
Journal of Neurology / Issue 8/2006
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-006-0156-5

Other articles of this Issue 8/2006

Journal of Neurology 8/2006 Go to the issue

OriginalPaper

ENS COMMUNICATIONS