Fatigue after mild traumatic brain injury

Fatigue is an often reported symptom by patients after a traumatic mild brain
injury ( TMBI). This fatigue is months (> 6 months; van der Naalt 1999,2001)
after the accident still present and deteriorates the patients well- being.
Sensation of fatigue is often measured with questionnaires (eg. fatigue
severity scale, FSS).
In patients with multiple sclerosis fatigue is also an often reported and
debilitating symptom. In this patients group we demonstrated that fatigue has
both motor as well as mood related characteristics (Steens et al, 2012a en b;
METc 2008-003). By performing the same experiments in patients with MTBI and to
compare the data with control subjects and with data obtained in MS patients we
hope to get more insight in the mechanisms that are responsible for the
increased feeling so fatigue in different patients groups.

Naalt van der J (2001). Prediction of outcome in mild to moderate head injury:
a review. J Clin Exp Neurophychol 23: 837-851.

Naalt van der J, van Zomeren AH, Sluiter WJ, Minderhout JM (1999). One year
outcome in mild to moderate head injury: the predictive value of acute injury
characteristics related to complaints and return to work. J Neurol Neurosurg
Psychiatry 66:207-213.

Steens A, de Vries A, Hemmen J, Heersema T, Heerings M, Maurits N, Zijdewind I
(2012a). Fatigue perceived by Multiple Sclerosis patients is associated with
muscle fatigue. Neurorehab Neural Repair 26: 48-57.

Steens A, Heersema T, Maurits N, Renken RJ, Zijdewind I (2012b). Mechanisms
underlying muscle fatigue differ between multiple sclerosis patients and
controls: a combined electrophysiological and neuroimaging study. Neuroimage
59: 3110-3118.

How important is fatigue in patients with MTBI? What are the mechanisms
underlying the decline in force during a fatiguing task? Which changes in brain
activation take place during the fatiguing task?

This research comprises experiments in which brain activation, force, muscle
activity and muscle activation by the brain is studied. During the experiments
subjects are asked to fill out 3 questionnaires (2 fatigue-related and 1 mood
related questionnaire). During the first session in the Dept Neuroscience
subjects are asked to produce a force with their hand muscles. Simultaneously
with the voluntary activation the nerve is stimulated with a short electrical
pulse.
The second session takes place in an 3-Tesla MR scanner. Subjects are in the
and produce again force with their handmuscles. The force and muscle activity
are measured with MR compatible force transducer and electrodes. The nerve is
stimulated with MR-compatible surface electrodes.

By combining all the data information is obtained about changes in the brain
during fatiguing contractions/

No risk; short painful sensation during electrical stimulation of the nerve.
During the MR session subjects have to lay still for one hour in the scanner.
Total time investment 2* 2 hours.