Managing Cognitive Fatigue

Cognitive fatigue is common following a brain injury and one of the challenges my clients find the most frustrating.  They create a plan for their day but by lunch, they are too exhausted to complete it.  Managing daily work and life responsibilities feels impossible.  So, what can they do?  The Cognitive Energy Rating Scale, which was developed at the Center for Head Injuries, is a tool to help clients recognize how much cognitive and emotional energy is used to complete tasks throughout the day. The rating scale uses a 10-point system divided into 3 categories-low, moderate and high energy.

The Cognitive Energy Rating Scale has multiple uses including increasing awareness, improving the ability to pace and increasing the ability to set realistic expectations. I ask clients to identify a couple of tasks that fall into each category and then have them complete those tasks to identify how accurately they were able to categorize them. Once they feel comfortable with how the scale works, we begin to implement it daily. Clients are asked to predict the energy expenditure using the 10-point scale for each task as they develop their plan for the day. They are then asked to track the actual energy expended using the same 10-point scale and this information is reviewed in the weekly sessions. As awareness increases, the difference between the predicted and actual scores begins to decrease. The next goal is to identify the number of points that can be expended and then repeated the following day. It’s not uncommon for my clients to tell me they were reallllly productive one day and then the next day they aren’t able to do half as many tasks. This roller coaster effect can be very frustrating and make it difficult to predict how much work can be completed in a day or a week.  The ratings are also used when creating the daily plan. If a client recognizes increased alertness in the morning, then their plan would include higher rated tasks in the morning whenever possible.  For someone who is more alert in the afternoon, they would schedule accordingly. The goals are consistency and sustainability. For example, if a client is able to expend 25-30 points on tasks throughout the day and get up the following day and do it again, and again and again, then we know that is their range. They recognize when they go too far above 30-closer to 35 points, their performance suffers the next day. Once we identify their ideal range, I encourage them to schedule within that range for 2-3 weeks and monitor their response.   If no difficulty is reported, they can try to increase by 5 points thus demonstrating increased endurance. It’s similar to building in a training plan-you don’t increase your mileage until you can repeat what you have already done without experiencing a significant negative response.


In addition to accurately identifying the Cognitive Energy being used, we are also looking at the factors that impact the scores. For example, a task that may be lower on the scale can be more challenging if sleep was interrupted the night before of if a headache is present. The effective use of strategies can also reduce the rating for a task or increase it if a strategy is not implemented. Note-taking is an example of a strategy than reduce the cognitive demand of a task when it’s used or increase the cognitive demand when it is not.  Environmental factors such as noise can also increase the cognitive demand of a task. The more a client is able to understand and recognize these factors, the better they are able to accurately predict and stay within their sustainable points.

Although the Cognitive Energy Rating Scale (CERS) was developed for clients with neurological challenges, the CERS can be easily adapted for everyone’s use.  It is an excellent tool to increase awareness for the energy required to complete tasks and for effective planning your day/week.

If you would like more information on the Cognitive Energy Rating scale and how you can use it to increase your consistency and productivity, contact me at doreen@thecognitivecoach.net

 

 

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328 Ace Drive Wall
Township, NJ 07719

doreen@thecognitivecoach.net
(732) 977-7381

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