Donders Institute for Brain, Cognition and Behaviour
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Thesis defense Aglaia Zedlitz (Donders Series 131)

17 October 2013

Promotors: Prof. dr. L. Fasotti, Prof. dr. A.C.H. Geurts, Prof.dr. R.P.C. Kessels

Brittle Brain Power. Post-stroke fatigue, explorations into assessment and treatment

Post-stroke fatigue(PSF)  is a common and debilitating symptom after stroke affecting approximately 29-77% of stroke patients. It has been found to be persistent, have a negative impact on quality of life, rehabilitation outcome and even mortality. PSF probably has cognitive, emotional as well as physical aspects. Unfortunately there is no generally accepted definition of PSF, nor is there a biological marker or golden standard to measure it. Since PSF has only recently been identified as a core symptom after stroke, investigations of PSF and especially of treatment options are still in their infancy. The studies in this thesis thus  aimed to provide first directions for researchers and clinicians faced with patients that suffer from PSF.

That this directions for clinicians are direly needed, is shown in the first study. Many patients reported that even though they were in need of care, the information of PSF they had received was insufficient. Their fatigue could not be related to personal factors. This result was further elaborated in another study in which, out of many psychological and social factors, only cognitive and somatic complaints were associated with the fatigue. These associations were furthermore dependent on the fatigue-assessment tool used. A study into these tools then  discovered that they seem to measure entirely different constructs.

Previously the “cognitive coping hypothesis” was offered as an explanation of the experienced fatigue. This hypothesis states that patients with an injured brain have to put in more effort to accomplish tasks, than non-injured individuals. For patients this means that they tire more easily and they need longer to recuperate from fatigue then before the injury. This theory was the starting point for a treatment protocol used in the Sint Maartenskliniek in the Netherlands. Patients were taught how to use their energy more parsimoniously. A previous pilot study had indicated this protocol to be effective in alleviating PSF. In this dissertation the protocol with the adaptations to the original protocol and an added Graded Activity Training is presented. This protocol (Cognitive and Graded Activity Training: COGRAT) was examined via a randomized controlled trial in eight different rehabilitation facilities. And the results showed it to be effective: the combined COGRAT-treatment reduced fatigue in 68% of the patients with clinically significant levels.