Post-Stroke Fatigue

Post-stroke fatigue is a common but often under-recognised complication after stroke. It causes overwhelming physical and mental exhaustion that is out of proportion to effort and does not fully improve with rest or sleep. It can affect thinking, mood, mobility and participation in day-to-day life, even when other stroke symptoms are relatively mild.

Studies suggest that around half of all stroke survivors experience significant fatigue at some point in their recovery, and for some people it can persist for months or years.

At The Royal Buckinghamshire Hospital, we provide consultant-led inpatient neurorehabilitation for adults living with post-stroke fatigue alongside weakness, cognitive change, pain or emotional difficulties. Our multidisciplinary approach is designed to help patients understand their fatigue, manage their energy and rebuild independence.

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What Is Post-Stroke Fatigue?

Post-stroke fatigue is more than just feeling tired after a busy day. It is a persistent sense of exhaustion that:

• May appear even after small physical or mental tasks
• Doesn’t fully resolve with sleep or a short rest
• Can suddenly “wipe out” your energy, forcing you to stop what you are doing
• Affects both body and mind – movement, thinking, speech and emotional control

It can occur after any type of stroke – ischaemic or haemorrhagic, large or small – and may affect people regardless of their level of physical disability. Even people who have made a good recovery in strength and movement may still experience severe fatigue.

Post-stroke fatigue is a genuine neurological symptom, not a sign of laziness or lack of effort. Recognising it early and managing it proactively can make a significant difference to long-term recovery.

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Symptoms of Post-Stroke Fatigue

Symptoms vary from person to person, and may fluctuate throughout the day. Fatigue often worsens in the afternoon or after activity.

Physical Fatigue

• Feeling drained, heavy or “wiped out” after minimal activity
• Reduced stamina – needing frequent rests or naps
• Slower walking or movement, difficulty keeping up with others
• A sense that your body “hits a wall” and cannot push through

Cognitive Fatigue

• Difficulty concentrating or multitasking
• Slower thinking, decision-making or reaction times
• Struggling to follow conversations, particularly in noisy environments
• Increased forgetfulness or “brain fog”

Emotional and Behavioural Impact

• Feeling frustrated, irritable or tearful when tired
• Losing motivation to engage in therapy, social activities or hobbies
• Withdrawing from friends and family to conserve energy
• Worrying that fatigue means you are “getting worse” or will never recover

Post-stroke fatigue often interacts with other stroke effects, such as weakness, spasticity, pain, communication or vision problems, making daily tasks feel much harder than before.

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Why Does Post-Stroke Fatigue Happen?

The exact mechanisms of post-stroke fatigue are still being researched, but it is thought to result from a combination of biological, psychological and social factors.

Contributors may include:

• Changes in the brain itself
  • The stroke can disrupt networks involved in attention, effort and arousal, making thinking and moving more energy-demanding.
  • Ongoing neuroinflammation and changes in brain chemistry may play a role.
• Sleep disturbance
  • Insomnia, frequent waking, sleep apnoea or hospital-related disruption can all reduce restorative sleep.
• Mood and emotional factors
  • Depression and anxiety are common after stroke and are strongly linked with higher levels of fatigue, although fatigue can also occur without depression.
• Medication side effects
  • Some drugs used after stroke (for example, certain blood pressure medicines, anti-epileptic drugs, sedatives) may contribute to tiredness.
• Physical deconditioning and pain
  • Spending time in bed or moving less can quickly reduce fitness and muscle strength.
  • Pain, spasticity and effortful movement all increase energy demand.
• Cognitive load and effort
  • Everyday tasks – reading, planning, conversation – may require much more concentration after stroke, leading to mental exhaustion.

Post-stroke fatigue is not your fault and does not mean you are “not trying hard enough”. It reflects how your brain and body are recovering and adapting.

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How Is Post-Stroke Fatigue Diagnosed?

There is no single blood test or scan for post-stroke fatigue. Diagnosis is based on:

• A careful clinical history of your tiredness
• How long it has been present and how it is affecting daily life
• Discussions about sleep, mood, pain, medication and other health conditions

Clinicians may use standardised questionnaires, such as the Fatigue Severity Scale (FSS or FSS-7) or similar tools, to help measure how severe fatigue is and track changes over time.

It is also important to rule out other causes of fatigue, such as:

• Anaemia or thyroid problems
• Infections
• Heart or lung disease
• Medication side effects

Once these have been addressed, and the pattern fits with post-stroke fatigue, the focus moves to management and rehabilitation, rather than more testing.

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Post-Stroke Fatigue and Recovery

Research consistently shows that post-stroke fatigue is linked with:

• Reduced participation in rehabilitation and daily activities
• Slower or less complete functional recovery
• Lower quality of life and life satisfaction
• Difficulties with work, driving and complex tasks, even when basic mobility is good

However, early recognition and structured management can reduce the impact of fatigue and support better long-term outcomes.

Addressing fatigue is therefore a core part of stroke rehabilitation, not an optional extra.

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Managing Post-Stroke Fatigue

There is no single medication that “switches off” post-stroke fatigue, but a combination of strategies can make a real difference. Recommendations from stroke and rehabilitation guidelines emphasise:

Education and Understanding

• Clear explanation that fatigue is a common, recognised stroke symptom
• Reassurance that fatigue does not mean you are not recovering
• Involving family and carers so they understand why you may need pacing, rests and support

Pacing and Energy Management

• Identifying personal triggers (e.g. busy environments, multitasking, long conversations, stairs)
• Balancing activity and rest, avoiding “boom–bust” cycles where you do too much on good days and crash afterwards
• Prioritising tasks and planning rest breaks before fatigue becomes overwhelming
• Structuring the day so that most demanding activities happen when you have more energy

Optimising Sleep, Mood and Physical Health

• Improving sleep habits and treating conditions such as sleep apnoea where present
• Screening and treatment for depression and anxiety, which often coexist with fatigue
• Reviewing medication with your medical team for drugs that may worsen tiredness
• Addressing pain, spasticity and other symptoms that drain energy

Graded Physical and Cognitive Activity

• Physiotherapy to gradually rebuild strength, stamina and confidence
• Occupational therapy to help you structure your day, simplify tasks and build sustainable routines
• Neuropsychology and speech and language therapy (where needed) for cognitive fatigue, “brain fog” and communication difficulty

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How We Can Help at The Royal Buckinghamshire Hospital

At The Royal Buckinghamshire Hospital, post-stroke fatigue is a core focus within our inpatient stroke and neurological rehabilitation programmes. We support adults recovering from:

• Ischaemic stroke
• Haemorrhagic stroke and intracerebral haemorrhage
• Lacunar stroke syndromes
• Cerebral venous sinus thrombosis and other complex cerebrovascular conditions
• Hypoxic brain injury and neuroinflammatory conditions with stroke-like features

Our consultant-led multidisciplinary team includes rehabilitation medicine, neurophysiotherapy, occupational therapy, speech and language therapy, neuropsychology and specialist nursing. Therapy is delivered within a structured daily schedule, up to 7 days a week, with built-in pacing and rest.

Our Approach to Post-Stroke Fatigue

We tailor each rehabilitation programme to your specific needs, but support for fatigue often includes:

Occupational Therapy

• Fatigue education and energy mapping – understanding your unique fatigue pattern
• Developing pacing strategies and realistic daily routines
• Task simplification, environmental adaptations and assistive equipment where helpful
• Planning graded return to self-care, hobbies, work and family roles

Physiotherapy

• Graded physical reconditioning – starting at your current ability and building up gradually
• Strength, balance and endurance training without overloading the system
• Breathwork, posture and movement efficiency to reduce unnecessary energy expenditure

Neuropsychology and Psychology

• Support for frustration, low mood, anxiety or trauma related to the stroke
• Cognitive strategies for managing concentration, memory and mental fatigue
• Behavioural techniques to break unhelpful patterns (e.g. boom–bust activity cycles, avoidance)

Speech and Language Therapy (Where Needed)

• Strategies for communication-related fatigue, such as pacing conversations and managing noisy environments
• Support with cognitive-communication tasks (e.g. following complex information)

Specialist Nursing and Medical Oversight

• Review of medications, sleep, pain and general health that may influence fatigue
• Monitoring for complications and coordinating investigations where necessary
• Liaison with community teams, GPs and stroke services to ensure joined-up care

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Who We Help

We welcome adult patients (18+) who:

• Are experiencing persistent fatigue following stroke or complex cerebrovascular events
• Find that fatigue is limiting participation in therapy, work, family life or hobbies
• Have plateaued in outpatient rehabilitation and need structured inpatient support
• Want to regain independence, confidence and quality of life despite ongoing fatigue

Our admissions team can help determine whether an inpatient stay at The Royal Buckinghamshire Hospital is suitable, or whether you might be better supported through community or outpatient services.

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When to Seek Medical or Urgent Help

This page offers general information and does not replace individual medical advice.

You should speak to your GP, stroke team or rehabilitation specialist if:

• Fatigue is persistent or worsening, and is affecting your ability to manage at home
• You are struggling with low mood, anxiety or loss of motivation
• You are unsure whether your tiredness is typical post-stroke fatigue or something else

Seek urgent medical help (999 / emergency department) if fatigue is accompanied by:

• New or sudden neurological symptoms – weakness, numbness, facial drooping, speech difficulties, sudden vision problems
• Chest pain, shortness of breath, palpitations or feeling faint
• High fever or signs of infection
• Thoughts of harming yourself or ending your life

Your medical team can assess for new stroke, heart or lung conditions, infection, and other urgent problems, and then work with you on a longer-term fatigue management plan.