Measurement of physical performance and objective fatigability in people with mild-to-moderate traumatic brain injury

Abstract

The aims of this study were to objectively measure the physical performance and physical endurance of patients with traumatic brain injury with minimization of cognitive and psychological fatigue, and to compare the physical performance of brain injured patients with that of healthy controls. This was a nonrandomized partially blinded controlled study. The study setting was the Outpatient Multidisciplinary Brain Injury Clinic in the Department of Physical Medicine and Rehabilitation of a tertiary care university teaching hospital. Participants included an experimental group that comprised independently ambulant men (age 18-55 years) with mild-to-moderate traumatic brain injury (n = 24) who complained of greater fatigue than before their injury and an age-matched and sex-matched control group (n = 24). The intervention included the Six-Minute Walk Test. The primary outcome measures were the Six-Minute Walk Distance, the Fatigue Severity Scale, Addenbrooke's Cognitive Examination, and the Fatigue Visual Numeric Scale; the secondary outcome measures were the Physiological Cost Index of Walking and the Borg Scale of Perceived Exertion. The Six-Minute Walk Distance of the experimental group (452.33+/-68.816) when compared with that of the control group (518.08+/-92.114) was reduced by 12.7 and 30.5%, respectively, when compared with the predicted Six-Minute Walking Distance (650.04+/-79.142) for the same age and sex. The mean Fatigue Severity Scale values were 2.51 and 1.62 for the experimental and control groups, respectively. The mean Addenbrooke's Cognitive Examination Score for the patients was 85.5+/-7.265. In conclusion, the Six-Minute Walk Test is useful in segregating physical fatigue from cognitive and psychological aspects of fatigue when cognitive and psychological dimensions are known. The Six-Minute Walk Test can be used as a tool for exercise intensity prescription in men with mild-to-moderate brain injury, to avoid the deleterious effects of fatigue.

Exercise Intolerance in Individuals With Postconcussion Syndrome

“…The literature contains discrepancies regarding the perceived exertion reported by participants with and without brain injury. [33][34][35] Similar to our findings, Dawes et al 34 reported that individuals with brain injury had shorter exercise tests; however, they found no differences in ratings of exertion. This inconsistency may be due to differences in brain injury between studies because Dawes et al 34 evaluated participants with TBI and stroke.…”

Understanding the interplay between mild traumatic brain injury and cognitive fatigue: models and treatments

“…However, this may be due to poor study design and/or poorly defined fatigue outcome measures. For example, the Six-Minute Walk Test was found to be a useful instrument in segregating physical fatigue from cognitive and psychological aspects of fatigue [119], but this test has not been consistently used to asses fatigue in studies of physical activity. More recently, vigorous aerobic exercise training has been shown to reduce physical fatigue in some individuals with TBI [120].…”

What is post TBI fatigue?

“…The experience of PTBIF can be both physical and cognitive (Elovic et al, 2005;Levine & Greenwald, 2009;Merritta, Cherian, Macaden, & John, 2010;Olver et al, 1996). It is often associated with a felt sense of disproportionate exertion and associated mental or physical exhaustion and inability to perform.…”

“…There is limited evidence linking physical performance and self-reported fatigue in individuals with TBI (Merritta et al, 2010). Furthermore, there is little relationship between self-reported fatigue and frequency of participation in diverse daily activities such as work, family, recreation, etc (Bushnik, Englander, & Wright, 2008a;Cantor et al, 2008).…”