Fatigue after spinal cord injury.
OBJECTIVE
To identify variables increasing fatigue following spinal cord injury (SCI) and their functional consequences.


METHODS
A search of the Medline and Reedoc databases with the keywords SCI, fatigue, intrinsic muscular fatigue, chronic fatigue, aging, training, electrostimulation, quality of life and the same words in French.


RESULTS
Two kinds of fatigue are identified following SCI. Intrinsic fatigue in muscles totally or partially paralysed at the level of or below the spinal cord lesion; this peripheral fatigue is due to denervation, total or partial loss of motoneurons, or histological and metabolical changes in muscle; it is well-defined by electrophysiological technology; spasticity and spasms have little influence on its development; it is reversible in part with long term electrostimulation, but at this time, electroneuroprosthetic techniques do not reduce the excessive energetic cost to stand up and walk. Chronic fatigue appears in the long term following SCI; it is linked with aging, physiological, and psychological deconditioning; some data point to chronic fatigue after SCI similar to post-polio syndrome and chronic fatigue syndrome, which may explain the central nature of the fatigue; training programs could be useful in delaying this chronic fatigue and as a consequence, increasing the latent quality of life.


CONCLUSIONS
Muscular intrinsic fatigue after SCI is always of a peripherical nature in muscles partially or totally paralysed. Chronic fatigue during aging greatly decreases quality of life. Both intrinsic and chronic fatigue could be anticipated by electrostimulation technique on the one hand and long term training on the other.
Barat
M
M
Unité de Rééducation Neurologique, Université Victor-Segalen Bordeaux-II et Fédération des Neurosciences Cliniques, CHU de Bordeaux, 146, rue Léo-Saignat, 33076 Bordeaux cedex, France. michel.barat@chu-bordeaux.fr
Dehail
P
P
de Seze
M
M
D000203:Activities of Daily Living; D006801:Humans; D018763:Muscle Fatigue / Q000502:physiology*; D018482:Muscle, Skeletal / Q000294:innervation; D011788:Quality of Life; D013119:Spinal Cord Injuries / Q000503:physiopathology*