Introduction

Spinal cord injury (SCI) is a lesion to the spinal cord that may cause severe neurological impairment and disability (Anton et al. 2017). Consequent sensory, motor, and autonomic dysfunction is also associated with many secondary health conditions, including fatigue, that can cause distressing symptoms and increased disability for people with SCI (Anton et al. 2017).

Fatigue commonly occurs in people with neurological disorders or diseases like fibromyalgia (Overman et al. 2016), Parkinson’s disease (Barone et al. 2009), multiple sclerosis (Oliva Ramirez et al. 2021), neuromuscular disease (Lou et al. 2010), spina bifida (Lidal & Larsen 2002) or stroke (Cumming et al. 2016). In people with SCI, fatigue is one of the most common secondary conditions, experienced by approximately 30-78% of the population (Anton et al. 2017; Fawkes-Kirby et al. 2008; Nooijen et al. 2015; Lidal et al. 2013; Hong et al. 2023).

In studies including people with SCI, fatigue has been defined as feelings of tiredness, lack of energy, low motivation, difficulty in concentrating, or an increased perception of effort disproportionate to attempted activities (Anton et al. 2017; Hammell et al. 2009). Some definitions have proposed a distinction between peripheral muscle fatigue (i.e., being tired from exercise) and global fatigue (Barat et al. 2006). There is comprehensive research on the pathophysiology of peripheral muscle fatigue (Ibitoye et al. 2016), as well as interventions to reduce muscle tiredness associated with doing specific activities (Hoogenes et al. 2021). However, global fatigue remains an understudied issue in SCI and is often undermentioned and/or underestimated during medical interviews (Anton et al. 2017; Fawkes-Kirby et al. 2008; Jensen et al. 2007). Thus, global fatigue, is the focus of this chapter.

For people with SCI, living with fatigue can be overwhelming, causing a profound negative impact (Wijesuriya et al. 2012). In people with SCI, fatigue has been associated with poor social integration, less productive activity (Wijesuriya et al. 2012), less participation (Kuzu et al. 2022), lower quality of life (Christofi et al. 2023; Craig et al. 2008), and lower psychological functioning (van Diemen et al. 2016). Fatigue is also negatively associated with mobility and it may have negative effects on SCI rehabilitation (Smith et al. 2016; Saunders et al. 2013; McColl et al. 2003). Moreover, fatigue may contribute to functional decline and loss of independence in people with SCI living in the community and in those aging with SCI (Alschuler et al. 2013; Moher et al. 2009).