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Awareness of Subjective Fatigue After Moderate to Severe Traumatic Brain Injury

Chiou, Kathy S. PhD; Chiaravalloti, Nancy D. PhD; Wylie, Glenn R. DPhil; DeLuca, John PhD, ABPP; Genova, Helen M. PhD

Journal of Head Trauma Rehabilitation: May/June 2016 - Volume 31 - Issue 3 - p E60–E68
doi: 10.1097/HTR.0000000000000161
Original Articles

Objective: As measurements of subjective fatigue after traumatic brain injury (TBI) rely on self-assessment, deficits in self-awareness after TBI may distort subjective fatigue reports. This study investigates awareness of subjective fatigue after TBI using self- and informant reports.

Participants: Fourteen adults with moderate to severe TBI and 7 healthy controls (HCs).

Measures: Modified Fatigue Impact Scale (MFIS) and battery of cognitive and emotional tests. Informants completed an “other-report,” rating their perception of participant's fatigue. Subjective fatigue awareness was defined as discrepancy between self- and other-MFIS scores.

Results: Adults with TBI showed greater discrepancies between self- and other-MFIS scores than did HCs. Negative relations were found between fatigue awareness and symptoms of depression, but there were no relationships between fatigue awareness and cognitive performance.

Conclusions: Results indicate that adults with TBI have poorer awareness of subjective fatigue than HCs. Correlations between subjective fatigue awareness and depression support existing literature implicating strong emotional components in the experience of subjective fatigue postinjury. Findings suggest cautious interpretation of subjective fatigue, as responses may not reflect fatigue symptoms exclusively.

Traumatic Brain Injury Research (Dr Chiou), Neuropsychology/Neuroscience Research & Traumatic Brain Injury Research (Dr Chiaravalloti), Neuroscience (Dr Wylie), Research and Training (Dr DeLuca), and Neuropsychology/Neuroscience Research (Dr Genova) Kessler Foundation, West Orange, New Jersey; and Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, New Jersey (Drs Chiou, Chiaravalloti, Wylie, DeLuca, and Genova).

Corresponding Author: Kathy S. Chiou, PhD, Traumatic Brain Injury Research, Kessler Foundation, 300 Executive Dr, Ste 70, West Orange, NJ 07052 (

This research was supported by funding from The New Jersey Commission for Brain Injury Research (10.005.BIR1).

The authors thank Andrew Genualdi, Christine Broderick, Elizabet Santana, and Allison Binder for their assistance with this research.

The authors declare no conflicts of interest.

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