This issue of the Journal of Head Trauma Rehabilitation contains 6 articles, which result from research completed by 3 of the traumatic brain injury (TBI) model systems (Mount Sinai School of Medicine, Santa Clara Valley Medical Center, and Craig Hospital), funded by the National Institute of Disability and Rehabilitation Research. The fact that 3 TBI model systems have focused their research efforts on post-TBI fatigue suggests the extent to which fatigue is a significant challenge confronting many individuals with TBI. Indeed, 50%–75% of individuals with TBI report fatigue and more than half of those with fatigue rate it as their worst symptom.1–3
The manuscripts in this issue examine the measurement of post-TBI fatigue, the frequency of post-TBI fatigue, the impact of post-TBI fatigue on cognition and participation, and the treatment of post-TBI fatigue. The article by Marcel Dijkers and Tamara Bushnik examines the utility of the Barroso Fatigue Scale, finding that, while the measure is useful to the extent that it includes items from well-known measures of fatigue, it has a limited value as a global measure of fatigue. This finding emphasizes the need to examine the psychometric properties of measures whenever they are applied to individuals with TBI and not assume that they will “work” in the same way as they do in other groups of individuals. The article by Bushnik, Englander, and Wright examines the frequency of fatigue over the course of the first 2 years postinjury. The unexpected finding of this study was that fatigue was reported less often than had been reported in the literature with only 16%–32% of the sample exceeding cutoff scores on 2 measures of fatigue. The third article, also by Bushnik, Englander, and Wright, in analyzing variables associated with fatigue during the first 2 years postinjury, finds that factors such as fatigue and sleep quality improved during the first year postinjury and remained stable thereafter. The article by Ashman, Cantor, Gordon, Spielman, Egan, Ginsberg, Engmann, Dijkers, and Flanagan reports the interesting finding that declines in performance that were the function of sustained mental effort were not related to reports of subjective fatigue. The fifth article (Cantor, Ashman, Gordon, Ginsberg, Engmann, Egan, Spielman, Dijkers, and Flanagan) finds that, although fatigue is negatively related to quality of life, it does not limit the quantity or the quality of the individual's participation. The final article (Jha, Weintraub, Allshouse, Morey, Cusick, Kittleson, Harrison-Felix, Whiteneck, and Gerber) presents findings of a randomized clinical trial examining the utility of Modafinil in the treatment of post-TBI fatigue and excessive daytime sleepiness. Unfortunately, the medication was found to be no more effective than the placebo for the treatment of these disorders.
Wayne A. Gordon, PhD
Department of Rehabilitation, Mount Sinai School of Medicine, One Gustave L Levy Place, New York, NY 10029
1. Olver JH, Ponsford JL, Curran CA. Outcome following traumatic brain injury: a comparison between 2 and 5 years after injury. Brain Inj
2. LaChapelle DL, Finlayson MA. An evaluation of subjective and objective measures of fatigue in patients with brain injury and healthy controls. Brain Inj
3. van der Naalt J, van Zomeren AH, Sluiter WJ, Minderhoud JM. One year outcome in mild to moderate head injury: the predictive value of acute injury characteristics related to complaints and return to work. J Neurol Neurosurg Psychiatry