Fatigue in Transverse Myelitis
Kerry MutchNMO Advanced Nurse Practitioner
Walton Centre Foundation TrustLiverpool
Benefits of Drinking Water• You can’t live without it!• Reduces Fatigue• No calories• Stops headaches• Reduces urine infections• Helps relieve
constipation• Gives skin a healthy
glow• Gives energy• It’s Free
• Reduces Fatigue
Affects quality of life and functional ability Adversely affects
◦ ability to self manage symptoms◦ ability to cope ◦ mood and self esteem
Can aggravate other TM symptoms
Depression Fatigue
Impact of Fatigue
Sleep
Diet
Medications
Mood
Stress
Exercise
Disability
Symptoms
Fatigue in NMO
Person with TM
Fatigue affects different people in different waysThere are many factors that contribute to fatigue
◦ Primary: related to disease process Probably related to the underlying pathologic alterations in TM such
as demyelination, inflammation and axonal injury The inability of a muscle or group of muscles to sustain the required
or expected force
◦ Secondary: associated with disease related factors Walking difficulties Sleep disturbance Pain Spasms Bladder symptoms Breathing difficulties
o ‘Normal’ activity related fatigue
Fatigue Types in TM
Trigger Factors of Fatigue Not drinking water Poor diet – wrong food Poor Posture
seating/bedding Poor sleep patterns Temperature heat/cold Infection/Virus Emotions mood/stress
Other medical conditions Anaemia Doing too much Excessive exertion De-conditioning Taking insufficient breaks Medications
Medications side-effects that can cause fatigue; Analgesics Anti spasticity Anti convulsants Anti hypertensives Anti depressants Anti histamines
Medications and Fatigue
Because of my fatigue during the past 4 weeks....
Modified Fatigue Impact Scale
Never Rarely Sometimes Often always
1. I have been less alert. 0 1 2 3 4
2.
I have had difficulty paying attention for long periods of time.
0
1
2
3
4
3.
I have been unable to think clearly.
0
1
2
3
4
4.
I have been clumsy and uncoordinated.
0
1
2
3
4
5.
I have been forgetful.
0
1
2
3
4
6.
I have had to pace myself in my physical activities.
0
1
2
3
4
7.
I have been less motivatedto do anything that requires physical effort.
0
1
2
3
4
61 people with NMO completed MFIS
Never/rarely Sometimes Often Almost alwaysPhysical fatigue 0-36
0
2
4
6
8
10
12
14
16
18
20Pts
Never/Rarely
Sometimes Often Almost always
Cognitive fatigue 0-40
0
5
10
15
20
25
30
Pts
Never/Rarely Sometimes Often Almost always
Psychosocial fatigue 0-8
0
2
4
6
8
10
12
14
16
18
Pts
Physical Fatigue
Never/Rarely
Sometimes Often Almost always
Total fatigue 0-84
0
5
10
15
20
25Pt Nos
Total Impact of Fatigue
Cognitive Fatigue Psycho social Fatigue
Priciples of Managing Fatigue
Ensure the best levels of energy Using Energy Available in Most
is available Productive Way
Planning – Efficient use of energy supplies means more can be achieved.
Prioritising – Better to complete smaller tasks than try everything and complete nothing.
Pacing – more beneficial rather than continuing to point of exhaustion and being forced to rest.
Delegating – Many people feel guilty about asking people to do jobs they previously did.
Using Energy in Most Effective Way
Motto- I Can if I Plan
Increase your fluid intake!! Make life as easy as possible for yourself Use labour saving equipment Do things differently Organise work area to avoid unnecessary
bending, reaching or walking Activity and exercise benefits Relaxation, deep breathing, yoga, pilates Sleep patterns and routine
Energy Effectiveness Strategies
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