FATIGUE ASSESSMENT

PRESENTED BY : JWANIKA VANSIYA

Fatigue is defined as the subjective complain of tiredness or diminished energy level to the point of interfering with normal or usual activities.

Fatigue can be menifested as difficulty or inability initiating activity ( perception of generalized weakness) reduced capacity maintaining activity and difficulty with concentration , memory and emotional stability.

WHAT IS FATIGUE?

Acute fatigue

Chronic fatigue

1 Local fatigue

General fatigue

2

TYPES

Lack of sleep Long work hours Shift rotation Noise Boring work Too much stress Alcohol Drugs Worries Illness Advancing age

ETIOLOGY

.

Common conditions causing Fatigue

Heart failure

.COPD

Multiplesclerosis. Myesthenia

gravis

All types of infections.

anemia

Forgetfulness Poor communication Impaired decision-making skills Lack of alertness Slow reaction time Quick of anger No sense of humor Lack of interest Always tired

SIGNS AND SYMPTOMS

FATIGUE ASSESSMENT

history

Physical examination

Laboratory studies

ID : Age, Gender, Nationality, Occupation Chief complain Onset : abrupt or gradual, related to event

or illness Course : stable, improving or worsening? Factors that alleviate or exacerbate

symptoms Impact on daily life- ability to work

HISTORY

History

Medical history

Family history

Drug history

Social history

Allergy history

When the fatigue is started, how long it lasts, and what makes it better or worse?

Symptoms or side effects, such as pain, the patient having from the cancer or the treatments.

Medicines being taken. Sleeping and resting habits. Eating habits and changes in appetite or

weight. Whether the patient has depression, anxiety

QUESTIONS????

Health habits and past illnesses and treatments.

How the fatigue affects being able to work.

Questions???

General appearance Posture patient’s walking Trouble breathing or loss of muscle strength Palpation Analogue scale: describes the fatigue on a

scale 1 to 10 1 5 10

PHYSICAL EXAMINATION

Anemia: pallor, tachycardia, systolic ejection murmur

Goitre or thyroid nodule: dry skin, delayed deep tendon reflexes, peri orbital puffiness,

Hyperthyroidism: weight loss, hyper reflexia, fine tremor, atrial fibrillation.

Addison’s disease: hypotension, scar, pigmentation in skin creases

Heart failure: elevated jugular venous pressure, ankle edema

Specific clinical signs of organic disease associated with fatigue include the following:

Systemic assessmentLocal assessment

Tests for fatigue assessment

Anaerobic fatigue:

Assessment of the fatigue during anaerobic power performance when vigorous exercises continues for more than few seconds .

Anaerobic fatigue is the percentage decline in the power output during the test.

SYSTEMIC ASSESSMENT

The various tests which are used for anaerobic fatigue are following:

.

Katch test

Wingate cycle ergometer test

Measurement of blood lactate level

Katch test

Procedure Test scores:• Peak power output = force * distance (num of revolutions*distance per revolution divided by time in minutes)(5secs=o.o83min)

• Anaerobic fatigue=high power output – low power output divided by high power output* 100

Wingate cycle ergometer test

if a man weighing 73.3 kg performs wingate test on a Monark cycle ergometer (6.0 m traveled per pedal revolution) with an applied resistance of 5.5kg (73.3*0.075=5.49 rounded off to 5.5kg), pedal revolution at 5 secs interval is 12,10,8,7,6,5 (48 total revolution in 30 seconds)

Peak power output= force*distance divided by time 5.5kg*(12*6)divided by 0.083 min 4753kg.m/min or 776.8 watts

Example

Anaerobic fatigue=high power output-low power output divided by high power output * 100 High power output is 776.8 W Low power output= force*distance divided by time 5.5 * (5*6) divided by 0.083 1980.8 kg.m/min = 323.7 WAnaerobic fatigue = 776.8-323.7 divided by 776.8*100=58.3%

.

Fatigue is reached the amount of lactate in the muscle and blood is maximum.

Measurement of lactate in blood can give an idea regarding the extent of fatigue.

Measurement of blood lactate levels

Measurement of aerobic capacity

• vo2 max = co * arteriovenous o2 diffrence

• Arteriovenous o2=arterial o2- venous o2

Measurement of energy expanditure

• Spirometry testing

.

Assessment procedure which indicate a fall in the strength or firing ability of the muscle fiber can be used to determine fatigue.

LOCAL ASSESSMENT

Decremental

studies

EMG

MMT

Brief fatigue inventory Fatigue severity scale Piper fatigue inventory

Scales

Fatigue severity scale

Depending on the findings in the history and physical examination, blood tests and other imagine studies may be ordered.

CBC (complete blood count)Blood sugarTSH Tests for deficiency in vitamin B12, D,folic

acid and ironESR

LABORATORY TESTING

1. Exercise physiology. McArdle, Katch and Katch

2. Physiology of sport and exercise. Jack H. wilmore, W. Lany Kenney.

3. Physiotherapy in neuro-condition. Glady

REFERENCE

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