How To Become An Energy Conservation Ninja: The Three Ps, AF

View fullsize

Post traumatic brain injury fatigue affects 70% of stroke and brain injury survivors. It should be called something other than fatigue, because it is way more insidious. It’s not just a passing moment of feeling a little tired; it is waking up tired and going to sleep tired. It is not being able to think and having trouble focusing. It is an out of control feeling, and it can send survivors into a depression faster than anything I have seen.

The only thing I can liken it to is having a baby. Those first few months you’re just trying to take a shower and save enough energy to get through dinner. Moms will talk about “dreading the night”, because how much you sleep and how well you sleep is out of your control, even though you are exhausted. Then things get a little better. Now, you are saving up energy to go on outings, while juggling the emotionally and mentally fatiguing journey of assuming a  new role while adjusting your old ones. Priorities shift, pace of life shift, and the life you planned shifts.

Sound familiar? Anyone who has post TBI/CVA fatigue is nodding their head vigorously. The tremendous difference is that instead of the fulfillment and purpose that is a natural byproduct of being a parent, a brain injury survivor does not get the same praise or empathy. Every milestone is not greeted with a cute 1 month old picture, and no-body is soothingly patting you on the back and saying your doing a good job. To make matters worse, survivors are both the parent and the child in this analogy.

We encourage our babies to sleep for 12 hours at night and to take two naps a day for the first year and then we facilitate naps up to age 5, sometimes longer. We understand that babies are integrating their sensory systems and can get overwhelmed, tired, and cranky after being in a loud place or when they are learning a new skill. We have endless love and compassion for these sweet little beings. They bring us so much joy with their development and we have more patience for them than any other humans in our lives.

This is where the TBI and stroke survivor stops nodding their heads. Survivors feel crushing guilt and depression at not being able to recover “as quickly” as their imaginary timeline and when the fatigue hits it wreaks all kinds of mental havoc.

TBI survivors mockingjay salute. I see you. You are exhausted sometimes just from getting out of bed. Emotion is fatiguing, thinking is fatiguing, moving is fatiguing, and recovery is fatiguing. This can be problematic for an alarming amount of time.

Post traumatic brain injury fatigue is complicated by depression, reduced endurance, and physical disability. In a recent systematic review, so a review of a whole bunch of studies, they suggest, that more research needs to be done. We could have deduced that on our own, but c'est la vie. The big takeaway is that post stroke fatigue is complicated by depression and in my experience these two walk hand in hand, but that is another post for another day.

I tend to talk a lot about Energy Conservation in my practice. You have all heard the THREE Ps. Prioritize, Pace, and Plan. These are the trinity of energy conservation, which is the idea that energy is no longer limitless and we need to ration it via the Ps. Here’s the deal though, you have to be in tune with your physical, emotional, and spiritual self to be good at energy conservation and most of you brain injury bad assess are NOT doing the mind body connection thing.

That is why I have come up with the Three Ps, AF. ;)

Prioritize, Pace, Plan. ACCEPTANCE FLEXIBILITY.

These concepts are iterative; meaning, if you can do the Ps effectively, then you have acceptance and flexibility. If you are fighting the fact that you have had a brain injury and trying to resume, even half of your usual work, at your “normal” pace, you may struggle.

Let’s say, you have been religiously using the Ps and have slowly resumed most of your pre stroke activities but then fatigue returns with a vengeance. Looking back you realize that you have been having relationship difficulties and that the new program at work has been draining to learn. You have two options: ignore the warning signs and wait until it worsens or prioritize your health. In prioritizing your health, you accept that you had a brain injury and have the mental and emotional flexibility to re-assess and course correct. This is not an extreme choice. This doesn’t mean you quit your job. This means you take a five minute screen free, noise free, light free few moments, before you encounter the new program at work. This means you spend more time with your partner that doesn’t have to do with medical bills or bills in general. This means you take care of yourself and never forget where you have been and why it has made you a healthier person.

Brain injury thrivers are excellent at course correction and mental flexibility. Just like a mom or dad, who sense the looming tantrum on the horizon, a brain injury survivor checks in with themselves.  Even if their fatigue seems absurd, they course correct. They are flexible like the patient who loves to go to loud concerts, but learned he could only take an hour of being in that environment. They plan and when those plans fail they are flexible. They are like energy conservation ninjas full of mind body connection. They are living and breathing examples of the three Ps, AF in action.