Fatigue and Lack of Motivation - Fact Sheet

Fatigue is a very common outcome after acquiring a brain injury due to the many tiny sites of damage throughout the brain. It is different to the yawning and sleepy feeling of normal fatigue. This type fogs the mind, drains all energy, dampens movement and sleep may do little to reduce it.

People with adynamia will experience loss of drive, indifference and placidity. There is usually slowed mental function, a marked decrease in ideas and activity is rarely self-initiated. There is often not only a verbal reminder needed to start a task, but further reminders required throughout the task. It is easy to see how family members could get frustrated in these situations unless they fully understand the impact of adynamia.

The activities that are normally automatic will often require effort after the injury. These activities can be concentrating, warding off distractions, reading for meaning, doing mental calculations, monitoring ongoing performances, planning the day’s activities, attending to two conversations at once or conversing with background noise. The huge effort involved for someone who has sustained a brain injury means they often need to sleep in the early afternoon due to the mental exhaustion involved in getting through the morning.

Characteristically, providing their sleep has not been disturbed, the person starts the day with some feeling of energy. Then, fairly suddenly, often they say like a curtain falling down, they find they are struggling to keep going; and can’t make sense of what they’re doing. If they recognise this warning and rest for an hour or two they may recover and be able to start again for another period. If they neglect the warning and go on working until they can cope no longer they bring on a state of severe fatigue which will stop them doing anything productive for the rest of the day; often it will persist and prevent useful work the next day, or even longer.

In social interaction the person may not appear to be interested in the conversation, with dull responses to people or given situations. Social skills are exactly that—skills. But because they become second nature for most adults it is hard to accept that someone with a brain injury may be struggling to keep up, pay attention, provide appropriate visual cues, analyse what was said, think of a response AND look interested at the same time.

An acquired brain injury is often called the hidden disability. Fatigue and adynamia are good examples of this. Often a person will have no visible scarring so all their employers, family and friends may see is an apparently lazy person who enjoys an afternoon nap, gets upset when you give them a few tasks and doesn’t give affection or take interest in what you say or do.

The cruel irony of the situation is that the individual may never have worked this hard to accomplish tasks, reaquire their social skills or achieve the simplest of goals. When the injury is ‘invisible’ it may be crucial for employers, family and friends to be fully informed of adynamia to begin the process of understanding its devastating impact.

Comments by the family or pressure at work can make the situation worse. It is difficult for others to understand the limitations imposed by the fatigue and they can encourage or embarrass the patient into continuing in spite of it. When a patient who has been improving starts to regress, this sort of situation will often be uncovered.

Task analysis is one possible strategy to combat adynamia, or problems with motivation. Tasks are broken into individual sequenced steps and formed into a checklist. Each step is then ticked as it is completed. In this way beginning, completing and following through on a task is much easier.

This reduces fatigue as it minimises the need to plan, organise, decide, prioritise, remember and put things in sequence. These are only some of the Cognitive issues required to say, cook an omelette. The person with adynamia can be exhausted by these tasks before they’ve even opened the kitchen door.
Task analysis re-establishes the routines in our activities of daily living. With the use of checklists and lots of practice it can eventually make a great improvement in terms of drive and motivation.

The ingredients for rebuilding these automatic habits are the three P’s: Plan, Practice and Promotional attitude. The result is rehabilitation, or removing obstacles to independence, and systematic achievement of incremental goals in desirable life areas.

Once you have goals in place, try building your motivation by:

A logical place to start here is to find out how social interaction has been affected by adynamia. Usually family and close friends can be relied upon to give you their honest impression if you insist on your need for accurate feedback. This should give you an idea as to which areas you need to work on, such as poor listening, or appearing vague or uninterested. Some therapists can assist in relearning skills through practice and repetition in functional situations. Alternatively you could buy books on effective communication and work on these in day-to-day situations.

In some ways the brain can be likened to a four lane freeway. The heavy traffic may be moving along rapidly but close just one lane and suddenly there is a traffic jam. The same can happen with your social interaction. You may need to avoid group situations or distracting environments as the ensuing ‘traffic jam’ will overload your ability to communicate effectively.

Sleep disorders are common after a brain injury. Lack of sleep will greatly multiply all the existing problems faced by somebody with a brain injury. Sleep can also have an impact on recovery so it is crucial to sleep well, and seek help if this proves difficult.

In some cases it can be best to inform people about problems with fatigue. Given the right information, family and true friends should be concerned enough to understand your difficulties and make allowances. This also gives you the freedom to say you are getting fatigued and need to take a break. When they understand adynamia they should realise that it is not their conversation putting you to sleep!

Sometimes a brain injury can result in difficulties in making social judgements. People can be too open and trusting particularly after a frontal lobe injury. If you are wondering whether you should tell someone about your brain injury and how it has affected you, it may be best to discuss it first with a trusted friend or family member.


Copyright Brain Injury Association of Queensland, Inc, Australia, 2007. This is one of a range of fact sheets made available by the Brain Injury Association of Queensland. While all care has been taken to ensure information is accurate, these fact sheets are only intended as a guide and proper medical or professional advice and information should be sought. The Association will not be held responsible for any injuries or damages that arise from following the information provided in these fact sheets. You can visit the Association’s website at www.braininjury.org.au or send emails to This email address is being protected from spam bots, you need Javascript enabled to view it