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Objective Measurement of Fatigue Following Traumatic Brain Injury

Ashman, Teresa A. PhD; Cantor, Joshua B. PhD; Gordon, Wayne A. PhD; Spielman, Lisa PhD; Egan, Matthew BS; Ginsberg, Annika BA; Engmann, Clara BA; Dijkers, Marcel PhD; Flanagan, Steven MD

The Journal of Head Trauma Rehabilitation: January-February 2008 - Volume 23 - Issue 1 - p 33–40
doi: 10.1097/01.HTR.0000308719.70288.22

Objectives To quantify posttraumatic brain injury (post-TBI) mental fatigue objectively by documenting changes in performance on neuropsychological tests as a result of sustained mental effort and to examine the relationship between objectively measured mental fatigue and self-reported situational and day-to-day fatigue.

Participants The study included 202 community-dwelling individuals with mild-severe TBI and 73 noninjured controls.

Measures Measures included Cambridge Neuropsychological Test Automated Battery, Global Fatigue Index, and situational fatigue rating.

Method Subjects were administered a 30-minute computerized neuropsychological test battery 3 times. The second and third administrations of the battery were separated by approximately 2 hours of interviews and administration of self-report measures.

Results The neuropsychological test scores were factor analyzed, yielding 3 subscales: speed, accuracy, and executive function. Situational fatigue and day-to-day fatigue were significantly higher in individual with TBI group than in individuals without TBI and were associated with speed subscale scores. Individuals with TBI evidenced a significant decline in performance on the accuracy subscale score. These declines in performance related to sustained mental effort were not associated with subjective fatigue in the TBI group. While practice effects on the speed and accuracy scores were observed in non–brain-injured individuals, they were not evidenced in individuals with TBI.

Conclusions Findings were largely consistent with previous literature and indicated that while subjective fatigue is associated with poor performance in individuals with TBI, it is not associated with objective decline in performance of mental tasks.

From the Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York.

Corresponding author: Teresa A. Ashman, PhD, Department of Rehabilitation Medicine, Mount Sinai School of Medicine, One Gustav Levy Place, Box 1240, New York, NY 10029 (e-mail:

The authors gratefully acknowledge the important contributions of current and past New York TBI Model System and Research and Training Center staff members who administered the neuropsychologic assessment battery and self-report measures (Alexis Kramer, Sarah Schiavetti, Reneé Morrison, Angie Ortiz, Colette Seter, Evelyn Segura, David Arvidsson, and Brady Bernert) and assisted with the completion of this article (Guido Mascialino and Theodore Tsaousides). This study was supported in part by grant #H133A020501 from the National Institute of Disability and Rehabilitation Research, US Department of Education.

© 2008 Lippincott Williams & Wilkins, Inc.