Fatigue After Stroke

Abstract

Fatigue is common and persistent in stroke survivors, yet it is not known how mobility deficits, fitness, or other factors, such as social support, relate to fatigue severity, or whether subjective fatigue contributes to reduced ambulatory activity. The severity of fatigue in a sample of 53 community-dwelling subjects with chronic hemiparetic stroke was examined, and relationships among fatigue and mobility deficit severity, cardiovascular-metabolic fitness, ambulatory activity, social support, and self-efficacy for falls were identified. Measures included the Fatigue Severity Scale, timed 10-meter walks, the Berg Balance Scale, submaximal and peak VO2, total daily step activity derived from microprocessor-linked Step Activity Monitors, the Medical Outcomes Study Social Support Survey, and the Falls Efficacy Scale. Forty-six percent of the sample had severe fatigue. Fatigue showed no relationship to ambulatory activity. Fatigue severity was associated with the Berg Balance Scale (p < .01) and falls efficacy (p < .01), but not with cardiovascular fitness variables. Patients with elevated fatigue severity scores had lower social support (p < .05) and poorer falls efficacy scores (p < .05) than patients reporting less fatigue. Only falls efficacy was predictive of fatigue severity (r2 = 0.216, p < .01). Further studies are needed to evaluate whether rehabilitation strategies that include not only fitness and mobility interventions, but also social/behavioral and self-efficacy components, are associated with reduced fatigue and increased ambulation.

Model of Understanding Fatigue After Stroke

“…One (n=84) found that higher level of fatigue was associated with less standing and stepping but more sitting and lying during the day in patients 1 month after stroke. 46 Another (n=32) found no significant difference in scores of daily activities between fatigued and nonfatigued patients 3 months after stroke. 47 …”

“…Michael 2006 (n=46) 46 : higher level of PSF was associated with lower level of social support in patients who were at least 6 months after stroke.…”

Prevalence and Predictors of 6-Month Fatigue in Patients With Ischemic Stroke

“…11 Poststroke fatigue often poses a barrier to return to work and reduced physical function, daily activities, quality of life, and rehabilitation potential. 2,3,9,[12][13][14][15][16][17] Fatigue is associated with profound deterioration of several aspects of everyday life 1,18 and poor poststroke neurological recovery. 19 In a populationbased Swedish 2-year stroke follow-up study, 18 fatigue independently predicted decreased functional independence, in-stitutionalization, and case-fatality.…”

Blood pressure and heart rate adjustment following acute Frenkel’s ambulatory exercise in chronic hemiparetics stroke survivors: a comparative study

“…The concept of Frenkel's exercise is to compensate for that loss with the visual system which can update the central nervous system about the position of the limbs in space and their direction of movement, thereby, contributing to balance and improving gait pattern. Detailed administrative protocol of the exercise has been explained elsewhere 15,18 . The ambulatory part of the exercise is the most advanced stage of the exercise and it is characterized by a well-coordinated exercise, with patients required to place their feet in marked footprints as they advance in walking.…”