Why fatigue matters in sessions
Many people report tiring much faster than before their stroke or injury, especially with tasks that need sustained concentration. Fatigue can make performance swing from one session to the next, and pushing through it can leave someone exhausted for the rest of the day.
For cognitive practice that has two consequences. First, the amount and difficulty of work in a session should match the person’s tolerance on that day. Second, a poor result can mean the person was tired, not that their abilities have changed, so it helps to know how tired they were.
Rating mental effort
A simple numeric self-rating, for example from 0 (no effort) to 10 (maximal effort), is quick to use and gives the person a shared language for saying how they feel. To make ratings useful:
- Explain the anchors the first time and keep them the same: what 0, about 3 and about 7 mean for this person.
- Use large, clearly labelled options for people with aphasia or limited movement; pointing works as well as speaking.
- Ask at set points, not only when the person looks tired, so the ratings are comparable.
- Treat the rating as the person’s own report: it complements observation rather than replacing it.
Several published scales rate perceived exertion or fatigue. If your service uses a specific validated scale, use it consistently and check its licensing terms.
Structuring a session
- Short blocks. Several short exercises with check-ins in between are usually easier to tolerate than one long one.
- Hardest work early. Place the most demanding tasks before fatigue builds, and finish with something familiar.
- Adjust in the moment. If effort ratings climb, lower the level, shorten the next block or switch to a less demanding task.
- Set thresholds in advance. Agreeing, for example, that a rating of 7 or more means a break takes the decision out of the moment.
Planned breaks
A break works best when it is structured and short enough not to break the session’s momentum. A minute or two of quiet, paced breathing gives a clear start and end. One commonly used pattern is “box breathing”: breathe in for a count of four, hold for four, breathe out for four, hold for four. Ask for a new effort rating after the break before deciding what to do next.
Breaks between sessions, and the rest of the person’s day, matter as much as breaks within a session; fatigue management is usually a broader conversation involving the whole team.
Recording effort with results
Writing the effort rating next to each result makes later review much more meaningful. A drop in accuracy with high effort reads differently from a drop with low effort, and a stable score achieved with less effort over several weeks can itself be useful information. In notes, summarise the range of ratings, the peak, and any breaks taken, alongside the task results.