What is fatigue?

‍“Fatigue is the abnormal sense of tiredness or lack of energy out of proportion to the degree of daily effort or degree of disability”. Individuals can have physical fatigue, mental fatigue or a combination of both.  

Most people don’t consider the energy it takes to get dressed, have a shower, hang out the washing or make a meal and they don’t need to consider their energy levels as often as other people with a disability or certain medical conditions. Most people are able to complete all daily personal care tasks, self-management tasks and productivity tasks within a day and not once consider the amount of energy each of these tasks will require.

Individuals with certain disabilities and medical conditions are required to thoroughly plan, prioritise and pace themselves with every activity they do, each day to ensure the most important and meaningful tasks are completed.

Symptoms of fatigue may fluctuate from day to day or hour to hour, therefore it is important for people living with fatigue to plan, prioritise, and pace. Education to close family and friends on how fatigue impacts an individual’s daily life, including the ability to engage in tasks and social activities is important to bring understanding and awareness when plans may need to change at the last minute.

Christine Miserandino developed a metaphor called the Spoon Theory to help people living with chronic conditions and disabilities put their challenges into perspective. The spoon theory can be used to help participants explain to friends, family and their workplace how they need to consider their energy levels each day to participate in tasks that are important and meaningful. ‍‍

‍So, what is the spoon theory?

Spoon theory is a metaphor that is used to describe a spoon as a unit of energy and each task completed will take spoons away, while some tasks help restore spoons. Everybody wakes up with their own number of spoons and this will depend on age, medical conditions and disability. A young person with no chronic condition in their early 20s may wake up with 10 spoons and a person in their late 70s with a chronic condition may only wake up with 4 spoons. Therefore, the elderly person will need to plan the number of activities they will complete that day according to their spoons, prioritise what tasks are most important to be completed and pace by taking their time to complete the task and deciding when to complete the tasks.

How can occupational therapy help with fatigue management?

‍Occupational therapists can assist participants to overcome the barrier of fatigue to achieve their goals and increase their participation and independence in activities of daily living, instrumental activities of daily living and all other meaningful occupations. The occupational therapist will listen to the client's goals and work with the participant to identify the activities they are currently completing that use energy and activities that help restore energy. The occupational therapist will assist the participant with increasing their independence in being able to prioritise activities and estimate energy use in preparation for planning daily and weekly activities. The occupational therapist will support the participant in developing a weekly routine in consideration of their required tasks and fatigue levels and to prevent them from ‘running out of spoons’.

Fatigue varies in duration and intensity therefore it is important to regularly review daily and weekly routines to ensure participants can reach their goals and engage in meaningful activities.

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References: 

[1] KruppLB, LaRocca NG, Muir-Nash J, Steinberg AD. The Fatigue SeverityScale: Application to Patients With Multiple Sclerosis and Systemic LupusErythematosus. Arch Neurol. 1989;46(10):1121–1123.doi:10.1001/archneur.1989.00520460115022

[2] https://butyoudontlooksick.com/articles/written-by-christine/the-spoon-theory/