Donna Malley is specialist OT at our Rehabilitation Centre (www.ozc.nhs.uk). This poster was prepared for a CLAHRC conference and builds on earlier (very good) work she has done on this topic. Part of an ongoing interest in our work to provide rehab for the 'invisible' consequences of brain injury.

1. CLAHRC East of England
Collaboration for Leadership in Applied Health Research and Care
This is a summary of independent research funded by the National Institute
for Health Research (NIHR)’s CLAHRC EoE Programme.
views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the
Department of Health.
Cambridgeshire and Peterborough
NHS Foundation Trust
AIMS
BRIEF FORMULATION
Hypothesis: Application of a clinical model of fatigue has value in facilitating self-management of fatigue following brain injury.
Participant: Woman with history of chronic fatigue, presenting to brain injury services after 10 years following Traumatic Brain Injury.
Participant’s Goal: “Identify ways to make the best use of the resources I have got”
Intervention: A shared understanding was developed with the participant through creating a personalised formulation of fatigue, including self-management
strategies via a series of 6 individual sessions with an Occupational Therapist. Intervention was based upon a clinical model developed from clinical practice
(Ref: Malley, Cooper & Gracey (2014) Fatigue after ABI: a model to guide clinical management. ACNR. V14(2);17-19).
Ethics: Permission obtained from Trust Research and Development department.
METHODOLOGY
Facilitating self-management of fatigue requires personalisation in terms of timing, content of intervention and evaluation of outcomes, as no one tool captures it’s
complexity and subjective experience.
People describe emotional, mental and physical fatigue which are experienced and responded to in different ways.
Use of a clinical model to support an individual to make sense of their fatigue experience and to personalise assessment and intervention is recommended.
Further development and evaluation of materials to facilitate self-management is the next stage in the research process.
REFLECTIONS
Donna Malley 1 & Andrew Bateman 2
1)Occupational Therapy Clinical Specialist and NIHR CLAHRC EoE Research Fellow;
2)Clinical Service Manager and Affiliated Lecturer Dept. of Psychiatry
1 & 2 The Oliver Zangwill Centre for Neuropsychological Rehabilitation, Ely, Cambridgeshire, UK
Fatigue is a commonly reported and frustrating consequence of many long-term neurological conditions, including stroke and acquired brain injury.
Fatigue impacts rehabilitation, levels of independence achieved and quality of life yet the evidence base for intervention remains limited. Development
and evaluation of clinical resources to support self-management is required. This case report aims to demonstrate how a clinical model can be applied
to guide clinical intervention and facilitate self management.
RESULTS
ACKNOWLEDGEMENTS With many thanks to the participant who consented for her information to be shared and NIHR CLAHRC EoE
Improved awareness and understanding of fatigue
demonstrated on personalised scales
Prior to intervention:
“[Fatigue] feels like a monster that has taken over my life”
“I have to prove to others I am fatigued as others can’t see
it”
“Fatigue is very lonely and very scary”
Following intervention: Goal achieved
“Fatigue is part of who I am and the life I want to lead”
“It’s about changing my thoughts and behaviours”
About the process:
“Never just give questionnaires and walk away as they
take you back to a dark place” [as previous clinicians have
done]
“Pacing is a word no-one likes whether you have had a
brain injury or not!”
[Therapy role] “Being alongside someone” [to make sense
of their fatigue]