There needs. This can lead to a lack of

There are many different types of disability, and all have
significant impacts on the lives of individuals with them. Disability can
result from a wide range of conditions, including injury, and the disability
that will be the focus of this essay is traumatic brain injury (TBI). TBI is
defined as being injury to the brain caused by trauma to the head, typically
resulting from an accident such as a traffic collision, or a fall. TBI’s are
classed as being severe when a period of unconsciousness follows injury which
exceeds 6 hours, along with a period of post-traumatic amnesia lasting for a
minimum of 24 hours (Headway, 2017). TBI has a wide range of consequences
and symptoms in each case, and these can vary widely depending on the location
and severity of the injury. However, there are some effects which are commonly
reported by TBI patients, one of these being fatigue. Mental fatigue, defined
as feeling tired and unable to think clearly or concentrate (Brainline, 2017), has been described as one of the most
common problematic symptoms of TBI, and although fatigue can improve as the
patient recovers from TBI, it often persists. Fatigue could be due to the brain
requiring more energy to function and heal post injury (Brainline, 2017). Research has found that TBI patients
experience significantly higher levels of fatigue than those without TBI, and
this finding is consistent using both subjective and objective measures of
fatigue (LaChapelle & Finlayson, 1998). This essay will
discuss the impact that fatigue associated with TBI can have on the health and
wellbeing of an individual, as well as exploring attempts to define the concepts
of disability, health and wellbeing.

Disability has been defined in the UK under the Equality Act
2010 as a “physical or mental impairment that has a substantial and long term
negative effect on ability to carry out normal daily activities” (, 2010). This definition is
practical when attempting to classify someone as disabled, and fits with a
medical model of disability. The medical model explains that individuals are
disabled due to impairments or difficulties they experience, and in order for
these to be overcome, any impairments need to be treated (Scope, 2017).
The medical model has been criticised as having a focus on curing an individual
even if the impairment is not causing any discomfort, and not considering their
actual needs. This can lead to a lack of independence and a loss of control over
their lives (Scope, 2017).
A second definition of disability which offers a different perspective comes
from the World Health Organisation (WHO), and defines disability more
generally, stating it is “an umbrella term, covering impairments, activity
limitations and participation restrictions” (WHO, 2017). This explanation removes
the focus on disability being simply a health problem, and fits more with a
social model of disability, which states that individuals are disabled because
the society they live in creates barriers to their needs. In the view of the
social model, these societal barriers need to be removed or changed for
limitations to be overcome, and these barriers can include physical, such as
access to a building, as well as attitudes of society towards disabled
individuals (Scope, 2017).
The social model has advantages over the medical model in that it considers
individual needs and requires society to be accessible for everyone. However, a
criticism of the social model is that it may neglect an impairment which is
causing pain or difficulty, and could therefore benefit from being treated (Shakespeare, 2016). Each definition and
model of disability provides its own advantages and criticisms, and issues with
defining disability may stem from attempting to define many unique experiences
and difficulties under one term, when the concept of disability may be
inherently subjective (Gronvik, 2009).

We Will Write a Custom Essay Specifically
For You For Only $13.90/page!

order now

Since its 1948 constitution, the WHO has defined health as
being “a state of complete physical, mental and social wellbeing, and not
merely the absence of disease of infirmity” (WHO, 2006).
This definition of health has been praised for not having a negative focus and
encompassing many aspects of health. However, criticisms of it focus on the
word “complete”, which is difficult to measure and causes individuals living
with chronic conditions or disabilities labelled as always being in ill health (Huber, 2011). The WHO definition
has been challenged by Huber (2011), who introduced the idea of health as an
individual’s ability to cope when faced with challenges in different areas of
life, such as physical, social and emotional (Huber, 2011).
Huber’s definition focuses more on how unique circumstances may impact on the
lives of an individual rather than purely on an absence of disease or
impairments. This essay will discuss health using Huber’s definition as a
reference, and will discuss the social, physical and emotional aspects of

Many attempts at defining wellbeing have been made over many
years, and these have often encompassed a feeling of fulfilment, accomplishing
of goals and feelings of life satisfaction (Dodge, et al., 2012). An example of one
of these definitions come from Shah & Marks (2004), who discussed wellbeing
as feelings of happiness, satisfaction and fulfilment, along with contributing
to society (Marks & Shah, 2004). This definition of
wellbeing, along with many others like it, have been criticised as being
descriptions more than definitions, and for having a focus on many subjective
dimensions which may underlie the concept of wellbeing (Dodge, et al., 2012). A definition by
Dodge et al. (2012) explains the concept of wellbeing as being an equilibrium,
like a homeostatic mechanism, with a set point for wellbeing, that can be upset
by life challenges or a lack of resources, and the equilibrium is a balance
between the two (Dodge, et al., 2012). This definition is
simple and does not require the meeting of different dimensions criterion.
Additionally, it ties in with Huber’s (2011) definition of health with its
focus on overcoming and managing challenges, and wellbeing in this essay will
be discussed in line with this definition.

The first aspect of health that can be impacted by post-TBI
fatigue is physical health. Factors important for the maintenance of physical
health include physical activity, nutrition and managing any physical symptoms
of illnesses (Koshuta, 2003). Fatigue causes feelings of tiredness,
and this could affect motivation to partake in factors important to the
maintenance of physical health, such as exercise. Indeed, research has found
that fatigue in TBI patients is associated with a lower level of physical
activity (Stulemeijer, et al., 2006). Given that a lack
of physical activity is linked with obesity, cardiovascular and respiratory
problems, the importance of being able to be physically active is clear (, 2016). The reduction in physical
exercise associated with post-TBI fatigue has an impact on the health and
wellbeing of an individual, as it affects their ability to cope with physical
challenges and to maintain a state of physical wellbeing. It may also impact on
an individual’s ability to recover, as physiotherapy and exercise are often a
part of the rehabilitation process after TBI, especially as these injuries tend
to result from accidents or falls (Borgaro, et al., 2005).

 A second way in which
post-TBI fatigue can impact the physical aspect of health and wellbeing
involves nutrition. Individual’s who feel tired and unable to concentrate are
less likely to feel motivation to cook food, or shop for nutritious food.
Fatigue may result in activities such as cooking taking significantly longer, difficulties
maintaining focus on the task, or finding motivation to prepare food.
Individual’s who previously enjoyed cooking before TBI have reported gaining
less enjoyment from it post-TBI due to problems introduced by fatigue (Cantor, et al., 2008). These difficulties
may cause an individual to seek food such as takeaway food, which may be
unhealthy, or to eat less frequently. Lacking proper nourishment can lead to a
susceptibility to illnesses, problems with weight and further feelings of
fatigue to the TBI patient (NHS Choices, 2017).

The above challenges faced by post-TBI fatigue patients can
involve experiencing a reduced enjoyment from activities that may have
previously been enjoyed, such as exercise or cooking. A reduced enjoyment of
activities has been found amongst TBI patients, as fatigue has an impact on
motivation, with patients reporting they are unable to begin or maintain
activities, and are unable to concentrate on them (Yudofsky, et al., 2005). As well as
affecting physical health, this can impact on other areas such as returning to
work, or partaking in hobbies and social activities. This impacts health as
individuals may feel unable to cope with challenges, whether physical or
emotional, and upsets the balance of wellbeing through not having adequate
resources to manage life challenges.

In a study conducted on employment rates and returning to
work following TBI, it was found that patients who reported suffering from
fatigue were less likely to return to work. Additionally, feelings of fatigue
were reported as being a particular difficulty by those TBI patients who had
returned to work (McCrimmon & Oddy, 2006). This could be
explained by the effects of fatigue leaving individuals tired and unable to
concentrate or feel motivated for work. This impacts the health of an
individual as it is affecting their ability to cope with the demands of work, or
education, and could therefore limit their satisfaction and progress. To
overcome these difficulties faced when returning to work, in line with the
social model of disability, adjustments could be made. Patients who have
returned to work following TBI and who experience fatigue stated that
adjustments which were helpful to managing fatigue and encouraging motivation
included only having one task at a time to focus on, having supportive and
understanding employers, and flexibility surrounding working hours, such a
shorter days or part time hours (Materne, et al., 2017). If adjustments
could be made in line with these, the barriers limiting the participation of
the TBI patient in the work place could be removed and result in an improvement
to their health and wellbeing.

Along with impacting the physical and emotional state of TBI
patients, post-TBI fatigue can also impact the social aspect of an individual’s
health and wellbeing. Feeling fatigued has been found to be associated with
limitations to social participation, with individuals reporting feeling too
fatigued to socialise, and this can result in social isolation. Social
functioning has been associated with the individual’s perception of their
quality of life, therefore this could suffer if an individual feels unable to
partake in social activities (Cantor, et al., 2008). To overcome the
social barriers individuals may face following TBI, recovery could include
tackling feelings of fatigue, and emphasising the importance of support
provided by family and friends, along with addressing how to maintain social
contact when a person is suffering from fatigue (Finset, et al., 1995).s

A final, important point about how fatigue post-TBI can
impact the health and wellbeing of individuals concerns recovery from the
injury. Patients who are undertaking rehabilitation after a TBI undergo many
sessions of occupational therapy, physiotherapy and psychological therapy, and
these sessions typically last an hour or more and can be intense and demanding.
If patients are dealing with fatigue, they may feel unable to participate fully
in a session, or request to finish the session early (Borgaro, et al., 2005). The social model of
disability would explain that rehabilitation programmes need to account for fatigue
experienced by patients, and incorporate regular breaks in sessions, or shorter
sessions, as part of rehabilitation.

In conclusion, post-TBI fatigue impacts the physical,
emotional and social health of individuals as it affects their ability to participate
in physical activity, nutrition, workplace and social activities and their own
recovery from TBI. This affects health and wellbeing as it has a negative influence
on an individual’s ability to cope and adapt, and upsets the balance between
resources to cope with life challenges. In line with the social model of
disability, some of the difficulties created by fatigue in TBI patients could
be overcome through adaptations to their environment including adjustments at
work and to rehabilitation programmes to allow for and manage the problem of