An objective measure of fatigue?

Brazos Minshew’s Thought For Today

An objective measure of fatigue

I recently read a systematic review of the medical literature which included a study on Biofeedback mitigating fatigue in people following a Traumatic Brain Injury (TBI). The study demonstrated statistical and clinical efficacy for biofeedback in relieving fatigue. However, the literature review graded the quality of the results “low to very low” using the GRADE system. It stated, “Although the four types of intervention … showed unequivocally effective results, the quality of evidence was low/very low according to the GRADE system.”

This made me ask the question, “Is an objective measure of fatigue desirable? Is it even possible?


Words make Worlds: Subjective vs. Objective

According to, “Anything objective sticks to the facts, but anything subjective has feelings.” goes on to suppose that Subjective and Objective are opposite concepts. In this literature review, the GRADE system used in calculating benefit and even the definition of ‘objective vs. subjective’ there seems to be an inherent bias in favor of objective ‘facts’ (?) versus the subjective experience of someone who suffers fatigue following a TBI. My personal bias is exactly opposite.  

I graduated clinical biofeedback with Jack Sandweiss, MA of UCLA and Philip Hughes, PhD in Berkeley. Thereafter, I served two three-year terms as a clinical researcher in Vancouver, BC at Occidental Institute with Walter Sturm and conducted “in-service” trainings as a guest speaker at Albert Einstein School of Medicine in Queens, New York and Yale University’s St. Raphael Hospital in New Haven, Connecticut.  I started a Stress Management program at Charter Psychiatric Hospital with Anthony Picchioni, PhD and Gary Malone, MD. I also served at the Howard Center for Mind-Body Medicine, Baylor-Irving, directed by Sally Hill, RN.  

And, I suffered disabling fatigue following a TBI in 2007.

I repaired my injuries using a multi-disciplinary approach which included biofeedback. My bias was significantly slanted toward ‘how I felt,’ as opposed to how I performed on objective metrics. My experience made me remember a time when “how do you feel?” was an important question.

We can use our Words to make a better World by remembering that how people feel matters because People Matter!  


Biofeedback therapy

Even as the literature review stated, “Conventional electroencephalographic biofeedback has the potential to improve the cognitive symptoms and problematic behaviors. In between-group comparisons, the intervention group exhibited significantly improved General Fatigue and Mental Fatigue subscale scores versus the control group, though the total Multidimensional Fatigue Inventory (MFI) score did not change significantly [Schoenberger et al. 2001].

However, let us not forget that in the art of medicine, “How people feel” is legitimately important! As we promote our profession, it is critical that we focus on illuminating the legitimacy of our craft to an increasingly skeptical world. It is also critical to the survival of our personal career that use our education and experience to relieve suffering and improve the way people feel!

Brazos G. Minshew, MS, ND


Ther Adv Neurol Disord. 2017 May; 10(5): 229–239.

Published online 2017 Feb 1.  doi:  10.1177/1756285616682675

PMCID: PMC5426526

Complementary and alternative interventions for fatigue management after traumatic brain injury: a systematic review

Gang-Zhu Xu, Yan-Feng Li, Mao-De Wang, and Dong-Yuan Cao

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