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  • Today’s busy day…
  • During sports, complex works, mental work like teaching, studying, computer work, and most importantly driving.
  • Generally fatigue is tiredness, drowsiness, lassitude.
  • * Here is a Shift Schedule Interaction Model.* To understand what causes fatigue, we must first become aware of the interactions between these three important areas. Your work schedule affects your job life and your home life directly. However, if your work schedule disrupts your home life, your work life can also be disturbed. Often, shift workers have stomach problems, sleep disturbances, and limited family interaction. These problems can show up at work in the form of drowsiness, “feeling lousy,” and mood changes. Likewise, an unhealthy work schedule can make the job life very difficult -- and these stresses are often brought back to the family! * Obviously, no outsider can or should control workers’ private lives. However, workers should learn how they can make their own lives (at work and at home) more safe, healthy, and satisfying. Previous studies have shown how successful shift working miners cope with the stresses brought on by their work schedules.
  • Fatigue coincides with PCr depletion.Once PCr stores depleted ATP concentration falls. Associated with fatigue during short duration, high intensity exercise.Glycogen depletion associated with fatigue during prolonged submaximal exerciseSlow-twitch fibers become glycogen depleted first, followed by fast-twitchDuring moderate-high intensity exercise lactic acid accumulates within the active muscles and blood.Lactic acid 99.5% dissociated at physiological pH.Lactic acid accumulation associated with fatigue.Lactate ion involved in fatigue. Mechanism not known.H+ ion involved in fatigue, Number of possible mechanismsH+ ion may contribute to fatigue via: Rapid depletion of PCr stores. (H+ ion involved in CK reaction and will displace reaction to favor PCr breakdown)Ca2+ released from sarcoplasmic reticulum may enter mitochondria. (Increased Ca2+ in mitochondrial matrix would reduce electrical gradient across inner membrane).Reduced ATP production.
  • Organisms have evolved to co-ordinate their activities with the day-night cycle caused by caused by the Earth's rotation. Direct responses to light or darkness are important but, in addition, biological clocks have evolved to time biological processes. "Circadian" rhythms (from 'circa'-about, 'dies'-a day) are the result of the best-characterised of these biological clocks, which times events that occur once per day. Even in the absence of environmental time cues, circadian rhythms persist with a period close to 24 hours. The circadian clock regulates many aspects of metabolism, physiology and behaviour, in humans and many other organisms.Human beings, plants and animals have a biological clock and it tells each plant, human and animal when to eat, sleep and when to wake up. In addition to this, we are able to reset this clock to fit in more usefully with our everyday life.Do you wake up early on weekends even if you don't want to? Have you ever suffered from jet lag? If so, you are probably feeling the effects of one or more of the so called biological clocks within your body. The understanding of these clocks can be very helpful to you, for by doing so you may be able to learn to "set" them to wake up at a prearranged time, remind you of appointments or even help you to return to your car before the time expires on your parking meter.If someone's daily biological clock runs fast, the person will tend to get sleepy early in the evening, but will be able to wake up in the morning with little difficulty. Exposure to the day/night cycle of the outside world will help him or her to reset his biological clock each day- humans being able to do this more easily than animals- otherwise he would go to bed earlier and get up earlier and earlier each day. Because of this need to readjust his internal clock, he is continually under pressure from the external world.Why do we have biological clocks?The reason is probably a matter of evolution. Animals are thought to have developed biological clocks because they help a species to survive. The clocks discourage activity during darkness when their owners are more vulnerable to predators because of reduced vision.Humans have retained the daily and monthly for what was probably much the same set of reasons: the clocks are more useful nowadays to use. For instance, we eat at certain times and the gastric juices flow at certain times and we digest the food at a certain time. The clock also reduces the amount of urine at night so that we're not as likely to be going to the bathroom all night.So, we all have a biological clock..it works the same way in all individuals but it can also be trained to work the way you want it to.
  • Acute fatigue: New or a significant increase in feelings of fatigue in the previous 6 weeks.
  • Management by - A= Awareness,B=Balance, C=Connections.“Compassion stress” impinges upon or breaks through normal boundariesPractice excellent self-careNurture yourself by putting activities in your schedule that are sources of pleasure, joy and diversionAllow yourself to take mini-escapes- these relieve the intensity of your work Transform the negative impact of your work (find meaning, challenge negativity, find gratitude)Talk out your stressBuild a positive support system that supports you, not fuels your stressPets accept whatever affection you are able to give them without asking for more
  • Assessment of fatigue is important before deciding any exercise schedule or duration and intensity.Finding the cause of unwillingness to exercise, days off during treatmentReduced response and prolonged progression after treatment.Further deterioration in health condition.
  • Modified Fatigue IS?FAS?Brief fatigue inventoryFatigue severity scalePearson–ByarsFatigueFeelingChecklistRhoten Fatigue ScaleChalder Fatigue ScaleFatigue Assessment InstrumentFatigue Impact ScaleFatigue Rating ScaleFatigue ScaleLee Fatigue ScalePiper Fatigue ScaleFatigue severity scale has highest citations with 239 citations.Followed by – Fatigue questionnaire – 174And Multidimensional fatigue inventory – 99.
  • It is a good idea to establish a bedtime routine. Do not take sleeping pills. Sleeping pills remain in your system many hours after awakening, may impair work performance, and can be habit-forming. Many experts recommend taking the natural hormone, melatonin, as a natural sleep inducer. However, this product should only be taken according to the directions on the label. If a person is being treated for any medical condition, the drug should be taken only with the advice of their physician.* A cool room can be important -- the drop in body temperature is a natural phenomenon related to the onset of drowsiness and sleep. An air conditioner thus helps in two ways: It cools the air and provides a humming sound that can mask outside noises. * Try to stay away from long naps -- these can disrupt your main period of sleep. Short naps, which are less than 20 minutes long, can restore alertness without disrupting your normal sleep pattern.* Relaxation tapes can be purchased at some retail outlets and medical clinics.* Don’t attempt to do strenuous exercises just before bedtime. Give yourself at least 1 or 2 hours to recover and relax following an exercise period. Exercising, in general, enhances sleep quality and quantity.Timing is important--digestive juices have circadian (daily) rhythms. Try to eat at the same times each day. If you eat late, eat light. Try low-fat foods, poultry, fish, pasta, vegetables, and fruit.If you work nights, eat light foods throughout the shift. Try yogurt, soups, toast, and fruit. Candy, pop, and chips will give quick energy, but then leave you more tired than before. Avoid heavy, greasy and spicy foods at night -- ″hold the onions.”Alcohol is a sleep robber -- don’t use it as a sleep aid. Stop caffeine consumption at least four hours before bedtime. Try to eat some meals together.Know when to confront and when not to confront--but don’t postpone indefinitely.“We’re in this together.”Role of exercise-- fights obesity, heart disease, diabetes, circulatory disease--all contribute to fatigue.helps handle job stress.should be aerobic--snowmobiling and fishing don’t count!Physical fitness can help prevent work injuries.Daily exercise enhances sleep quantity and quality.Recommended: Aerobic exercise 20-30 minutes per day, 3-4 days a week.1) Roll down the window.2) Turn up the heat or cold.2) Stick your head out the window.3) Turn up the radio.4) Sing and yell.5) Drink some DEW/COKE/JOLT.6) Sip some coffee.7) Speed up!8) Exercise in your seat.9) Have another beer--(This is WI)10) Chew gum.11) Slap yourself in the face.
  • Fatigue

    1. 1. Shrikant S. Sant. 1st yr M.P.Th Community Physiotherapy.
    2. 2. 1/26/2014 FATIGUE 2
    3. 3. DEFINITION  Fatigue Is a Complex State Characterized by a Lack of Alertness and Reduced Mental and Physical Performance, Often Accompanied by Drowsiness.1  A subjective lack of physical and/or mental energy that is perceived by the individual or caregiver to interfere with usual and desired activities. (according to Multiple Sclerosis Council for Clinical Practice Guidelines)2 1/26/2014 FATIGUE 3
    4. 4. CAUSES3 lack of sleep long work hours shift rotation noise vibration boring work too much stress alcohol drugs worries illness advancing age 1/26/2014 FATIGUE 4
    5. 5. WORK SCHEDULE Rotations Hours Off Days JOB LIFE Mood Health Safety Productivity 1/26/2014 3 HOME LIFE Eating Sleeping Family Recreation FATIGUE 5
    6. 6. SIGNS AND SYMPTOMS4  Forgetfulness  Poor Communication  Impaired Decision - Making Skills  Lack of Alertness  Slow Reaction Time  Withdrawn Behavior  Quick to Anger  No Sense of Humor  Lack of Interest  Always Tired. 1/26/2014 FATIGUE 6
    7. 7. PATHO-PHYSIOLOGY5  Depletion of –  Phosphocreatinine  Glycogen  Accumulation of –  Lactate  Calcium 1/26/2014 FATIGUE 7
    8. 8. CIRCADIAN CLOCK (BIOLOGICAL CLOCK) 6 3 - 5 am 3 - 5 pm • lowest core temperature • maximum sleepiness • poorest performance • high sleepiness • hard to stay vigilant (mental and physical) The body’s core temperature cycle 1/26/2014 FATIGUE 8
    9. 9. Hope does not take away your problems. It can lift you above them. Maya Angelou 1/26/2014 FATIGUE 9
    10. 10. CLASSIFICATION7,8,9  Physical or Mental.  Central & Peripheral  Acute Fatigue and, Chronic Fatigue Syndrome.  Compassion Fatigue. 1/26/2014 FATIGUE 10
    11. 11. PHYSICAL FATIGUE10  A Decrease in Physical Performance  A Feeling of Muscle Discomfort or Soreness  Lack of Energy. 1/26/2014 FATIGUE 11
    12. 12. MENTAL FATIGUE11  Tired and Drowsy Due to Loss of Sleep  Loss of Concentration And / Or Alertness  Diminished Levels of Creativity and Logic. 1/26/2014 FATIGUE 12
    13. 13. CHRONIC FATIGUE SYNDROME12  Fatigue that is present for any amount of time on 50 percent of the days for more than 6 weeks.  Fatigue that limits functional activities or quality of life. 1/26/2014 FATIGUE 13
    14. 14. COMPASSION 13 FATIGUE  The Effect of Secondary Stress and Vicarious Traumatization on HealthCare Professionals.  Caregiver Stress.  Clinical practice issues. 1/26/2014 FATIGUE 14
    15. 15. Chinese Proverb Equation for the value of your life Your Health = 1 Everything else in your life = 0 Put a one first, in front of all the zeros and you will have the value of your life Without your health, you have nothing. 1/26/2014 FATIGUE 15
    16. 16. WHY SHOULD WE CHECK?  Exercise schedule, duration & intensity.  Unwillingness, days-off during treatment.  Reduced response to treatment.  Further complications. 1/26/2014 FATIGUE 16
    17. 17. ASSESSMENT  Fatigue severity scale (max.- min.- )  Multi dimensional fatigue inventory (max.- min.- )  Brief fatigue inventory (max.- 1/26/2014 FATIGUE min.- ) 17
    19. 19. 1/26/2014 FATIGUE 19