FATIGUE MANAGEMENT

DOWNLOADABLE INFORMATION

SPECIFIC MANAGEMENT OF MS RELATED FATIGUE

Managing Fatigue in MS

http://www.nationalmssociety.org/keepsmyelin/resources/adobe/Issue-12.pdf

Energy Saving Tools for MS

http://www.nationalmssociety.org/keepsmyelin/resources/adobe/Issue-6.pdf

National MS Society Fatigue Management Guidelines

http://www.nationalmssociety.org/Brochures-FatigueMain.asp

Fatigue in MS: Current Understanding and Future Directions

http://www.mult-sclerosis.org/news/Jul2002/JRRD6FatigueInMS.html

Villamartelli Recommendations: Improved Fatigue Management (Included in this handout)

http://villamartelli.com/P_FatigueMgmt.htm

SOME ASSISTIVE DEVICES AND ENERGY SAVING TOOLS

ABLEDATA
Information on assistive technology and rehabilitation equipment.
www.abledata.com

Disabled Online
Resources for the disabled community and their families and friends, including news stories, message boards, disabled topics and chat rooms
www.disabledonline.com

The Home Wheelchair Ramp Project
Manual of design and construction for modular wheelchair ramps
www.wheelchairramp.org

Project Link
"Your connection to assistive devices."
www.phhp.ufl.edu/ot/projectlink

Villamartelli Links: Accessibility/ Assistive Devices

http://villamartelli.com/#ACC

RECOMMENDATIONS FOR IMPROVED FATIGUE MANAGEMENT

Michael F. Martelli, PhD: mfm.villamartelli@gmail.com

Specific Habit Training Should Include the Following General Goal Directed Strategic Interventions:

„ Pacing (as a general relaxation procedure and a pain prophylactic), including enhanced discrimination and proactive management of fatigue via segmenting activities into steps and taking frequent brief relaxation breaks.

„ Energy Conservation Strategies that emphasize early discrimination of fatigue (e.g., irritability, frustration, decreasing strength, speed or endurance, decreased cognitive efficiency), modifying activity and schedule to promote rest breaks before fatigue progresses, with gradual increases in length of activities to maximize energy level and peak performance on functional activities and vocational or educational pursuits.

„ Task Analyses and other Organization Strategies that not only enhance automatic performance, but significantly decrease energy requirements for task performance. Task Analysis involve breaking tasks into single, logically sequenced steps and recording the steps in a Checklist that can be followed and checked off as completed. Task analyses always make task initiation, completion and follow through easier. They also greatly improve ability to perform tasks in persons with limitations in energy, initiative, ability to sustain performance, memory, organization, etc. Task Analyses/ Checklists are extremely useful in minimizing fatigue by reducing the demand for, and fatigue produced by reasoning and problem solving associated with planning, organizing. Most importantly, with repeated completion, they allow retraining of efficiency habits.

„ Time Management Strategies

Concussion Care Center of Virginia

Medical Psychology & Rehabilitation Neuropsychology Service

Chronic Progressive Disorders

Developmental and Reactive Stresses

‰ Generalized Declines in Control and Coping Resources

w Declines in Physical Ability

w Declines in Activity

w Declining Independence

w Decreased Self-Esteem and Self-Confidence and Sense of Purpose secondary to decreased involvement in activities & pursuits that allow fulfillment of needs to feel useful, productive & worthwhile

w Declining Friends and Social Outlets and enjoyments

w Decreases in Cognitive Abilities

w Declining Energy & Endurance / Increasing Fatigue

Developmental Factors that Increase Functional Decline

w Fatigue related decreases in physical, cognitive, emotional & social functioning

w Cognitive & Social Understimulation related increases in cognitive deficits, rustiness, atrophy, depression, etc.

w Depression related reductions in physical, cognitive & social functioning, and motivation

w Misunderstanding of symptoms by others (e.g., laziness, selective memory, manipulation, etc.)

w Beating-up on Self (Guilt, Frustration, Anger --> SelfAbuse)

w Learned Helplessness (i.e., difficulty making continued effort given past failures/expectation of future failures / belief that efforts will not work / over-reliance on others & external help)

Interventions For primary problems of Decreased Initiation/Endurance/Energy

(i.e., fatigue), Decreased Physical Capacity, Depression, Declines in Cognition and Problem Solving, and Social Isolation

‰ Use Compensatory Strategies as Equalizers:

Patience, Persistence, Coaxing and Self-Cuing of memories and efforts (promotes exercise & adaptation vs atrophy); successive approximations

Self Pacing & Activity Planning to control fatigue (see self-control procedures)

w Internal & External Attention, Memory & Organization Strategies (see cognitive rehabilitation outline, related chapters)

wa. Internal Aids (e.g., "Who, what, when, where & why?"; "Three-peat", "Bottom Line"or "One Thing at a Time"etc.)

b. External Aids (e.g., well designed memory log, outline strategies; alarm watch; etc.)

w Task Analyses to Counter Fatigue & Decreases in Organization & Energy (and memory, etc.) - breaking a chore or task into single, logically sequenced steps and recording the steps in a Checklist that allows checking off when completed, always makes the task easier

w Assertiveness: educating others; requesting accommodations (e.g., extra time, breaks, etc.); expressing thoughts, desires

w Set incremental, step-wise goals, build self up for what can be accomplished despite obstacles, and celebrate each tiny step of progress (Nurse it, don't curse it; build yourself up instead of beating yourself up)

w Adjust Standards & Expectancies to Fit Limitations (make accurate comparisons vs inaccurate ones to healthy others, premorbid self)

w Set Modest, Incremental Goals to Allow Control & Minimize Interference Caused by Symptoms

w Employ Accurate Self-Expectancy, Self-Monitoring & Self-Evaluation and, finally

w Appropriately Self-Reinforce for Accompishment Despite Odds, Obstacles

w Identify & Engage in alternative activities that allow feeling worthwhile & useful (including social activities & involvements)

w Dispute Myths:

1. "Why me...? (vs "What contract did I sign that said this would never happen to me?")

2. Grass is always greener

3. Use "5 Commandments of Rehab", "Caregiver Rules", "Rules of Conflict", "Ideas to Help You Function" & Other Self-Help Tools, for patient, family, staff

Concussion Care Centre of Virginia

Medical Psychology / Rehab Neuropsychology Service

Task Analysis (TA) Protocol

TA involves breaking any task, chore or complex procedure into single, logically sequenced steps & recording the steps in a Checklist. The list can be checked off as completed. TA’s always make task initiation, completion & follow through much easier. Performing a TA and generating a checklist can greatly improve ability to perform tasks in persons with limitations in memory, attention, energy, initiative, ability to sustain performance, organization, etc.

Task Analysis Checklists are also extremely useful in minimizing fatigue by reducing energy demands required by memory, planning, organization, prioritizing and deciding the sequences for a task. Task analyses are useful for both basic and complex behaviors. Once completed, task analyses allow performance of tasks or routines without assistance from others. Most importantly, through repetition and relearning, they re-establishing the efficient routines that make up normal everyday human activity. When the procedures assisted by Task Analyses are repeated consistently, they eventually become automatic [habits] and become as automatic and effortless as tying a shoe.

The ingredients for rebuilding these automatic habits are the 3 P’s: Plan, Practice, Promotional Attitude. The result is rehabilitation, or replacing obstacles with efficient habits that increase independence.

Several samples of different types of activities (tasks, cleaning routines, daily schedules) follow:

TA Samples: Single Tasks

Weekly Shopping Checklist

z MILK

z PAPER PLATES/CUPS

z HAND LOTION

z CHEESE

z NAPKINS

z CHAP STICK

z BUTTER

z PAPER TOWELS

z SHAMPOO

z EGGS

z PLASTIC WRAP

z AFTER SHAVE

z FRUIT

z TRASH BAGS

‘Making A Bed’ Cheatlist

z1. Strip sheets, blankets and pillow cases

z2. Put blankets and pillows on table

z3. Take break

z4. Get sheets and pillow cases from closet At This time doing with Mom:

z5. Put on fitted sheet

z6. Put on top sheet, evening it out

z7. Put on blankets and tuck in corners

z8. Put pillow cases on pillow

z9. Put comforter on bed

Vacuum Cleaning Task Analysis

1. Remove Cleaner and Parts From the Closet

_ canister _ handle _floor brush _hand brush, _crevice

2. Unwind Power cord

3. Decide task

__ carpets

__ wood/vinyl floors

__ hand dusting

__ change dust bag

4. For Carpets

__ attach power handle

__ adjust carpet level on canister

__ turn on power

__ vacuum first in main traffic paths and then to the sides

__ turn off power

5. For Hard Floors

__ attach long handle brush

__ turn on power

__ vacuum from the center outward

__ turn off power

__ removee handle

__ clean brush head with vacuum power

6. For Hand Dusting

__ attach brush head to hand grip

__ turn on power

__ carefully dust all surfaces

__ turn off power

__ remove brush and clean it with vacuum handle

7. Change Dust Bag

__ when red light on canister comes on, or check monthly

__ when bag supply is low, purchase more at Sears. Bring code# to store.

__ open canister, carefully pull bag off attachment.

__ place dirty bag carefully into the trash

__ put new bag following reverse procedure

8. After Cleaning

__ recoil power cord into canister

__ store all parts in the closet

TA Sample: Daily Habits & Routines

AT's Initiative/Energy Retrainer

MORNING

z Wash Face

z Shave

z Apply medication to face if needed

z Brush Teeth

z Comb Hair

z Dress before "morning" nap

z Check finger nails & toe nails; trim when needed

z Check hair length and get a haircut as needed

z Shower and wash hair

z Perform an Activity/Chore (Choose from Menu)

z Check Schedule (e.g., M,W,F=Y; Tues=RedX)

z Check your appearance before leaving the house

AFTERNOON

z Fill Out Chart (Behavioral Activity Monitor & Points)

z Eat Lunch

z PowerRelaxationNap (PRN; Use Tape)

z Perform Activity or Chore (Choose from Menu)

EVENING

z Eat Dinner

z PRN (PowerRelaxationNap; Use Tape)

z Engage in Evening Activity

z 10:00pm: Complete Chart (Behavioral Activity Monitor & Tally Pts)

z Shower (if not done in am; or, again?)

z Watch TV News

z Prep for Bed (PJ's, Brush Teeth, etc.)

z BedTime

TA Samples: Cleaning Routines

TB’s Bachelor Pad Cheat Sheet

‰ 1. CLEAN APARTMENT:

A. KITCHEN:

z CLEAN COUNTERTOPS DAILY

z SWEEP FLOOR DAILY

z ORGANIZE CABINETS &WIPE OFF ICE BOX

z EVERY WEDS MOP FLOOR & WIPE WALLS

B. BEDROOM

z FOLD CLOTHES OR HANG THEM UP AND STORE WHERE APPROPRIATE.DAILY

z SWEEP AND VACUMN FLOORS WHEN APPROPRIATE OR PRN

z ORGANIZE COMPUTER AREA

z EMPTY CAT BOX DAILY

z MOP FLOORS WHEN APPROPRIATE PRN

C: DEN:

z SWEEP FLOOR

z VACUUM DAILY

z DUST DAILY

z STRAIGHTEN UP DAILY

z VACUUM UP

z MOP

D. LIVING ROOM

z DUST DAILY

z STRAIGHTEN UP DAILY

z SWEEP DAILY

z VACUUM ONCE A WEEK

z MOP ONCE A WEEK

z USE A CHECKLIST TO ENSURE DOING ALL

‰ 2) SET A CLEANING SCHEDULE:

z A: DAILY DUTIES DUST, SWEEP, STRAIGHTEN UP EACH ROOM

z B: EVERY WED MOP ALL ROOMS AFTER A IS COMPLETE

Single Doctor

Chores CheatList

BATHROOM

z Dust around the Mirror and Light and Window, including the tops of the light and mirrors and window sills.

z Dust, with a damp cloth, around the windowsills, on the front of the blinds and the back (reverse sides by adjusting slats up and down), and along the tile division.

Tub and Toilet

z Wipe down the bathtub walls, going to the ceiling.

z Use cleanser and a brush to quickly wipe grime in the tub, and scum stains on the wall.

z Use soapy brush to quickly wash and rinse the inside shower curtain.

z With a soapy disinfectant, clean the toilet top, seat, behind the seat, and under the seat, along the walls to the floor

z Fold all tiles neatly on the tile racks

Floor

z Sweep the floor, including behind the toilet.

z Take out the rug and shake it off of the porch vigorously to remove dirt and dust.

z Remove and empty the garbage can.

z Mop the floor, using ammonia or Clorox and be sure to get behind the toilet.

z Use a rag to get the floor behind the toilet. Be sure to get in all the nooks and crannies along the edges of the floor, near the tub, etc.

LIVING ROOM

z Dust Furniture, including all shelves

z Use broom/duster to dust along all baseboards, window sills, ceiling molding & fireplace mantle

z Sweep and Vacuum Under Rugs

z Sweep and Vacuum Floors

z Vacuum the couch, love seat, and chair

KITCHEN

z Empty Trash Can

z Clean Top of Refrigerator and Microwave (Wet Soapy Cloth)

z Clean Inside Refrigerator and Microwave

z Wash Any Dishes and Clean Sink with Cleanser

z Clean Sink and Surrounding Countertop

z Sweep, and then Mop Floor

STUDY/OFFICE

...

DINING ROOM

...

BEDROOM

z Dust dresser tops, around doors and windows, and along baseboard and ceiling molding

LAUNDRY

z 9:00am Saturday: Take Clothes to Dry Cleaners before 10:am

z 5:00pm Saturday: Pick up clothes from Dry Cleaners and Arrange in closet

z 10:00am Sunday: Launder socks, underwear, bathroom towels, bed sheets, etc.

z 11:00am Sunday: Use Dryer & Fold & replace clothes when done. Hang Dry other clothes

z 11:20am Sunday: Steam mist to refresh any pants, shirts in need

z Sunday 9:00pm: Fold, hang, put away dry clothes

TA Samples: Daily Activity Trainers

DH's Daily Plan Checklist

MORNING

z Wake 6:00 AM to the Alarm Clock

z Take Medication

z Make Bed

z Shower

z Get Dressed

z Comb Hair

z Make and eat breakfast

z Clear, rinse, stack breakfast dishes (for pm wash)

z Wipe counter, table stovetop if needed

z Feed animals

z Brush teeth

z Gather items to take for the day

z Leave house at 7:00; go to Grandma's

REHAB CENTER

z Arrive between 7:30-8:00Am by van

z Follow Morning Schedule (In Rehab SchedBook)

z Lunch at 11:30, Take medication

z Follow Afternoon schedule

z Leave for Grandma's between 3:30-4:00

LATE AFTERNOON

z Dinner at Grandma's & take medication

z Home between 6:00-7:00PM

z Get mail, read & sort; put bills on microwave

EVENING: PREPARE FOR THE NEXT DAY

Laundry if needed (clothes, sheets,bath/kit towels)

z separate colors and whites

z set water level

z put soap in

z put clothes in

z turn on

z put clothes in dryer - set timer for 45min

z Listen for Buzzer - fold when dry

z PUT CLOTHES AWAY: Drawers/Closets

Kitchen

z wash dishes

z wipe off countertops, stovetop;

z rinse out sink

z sweep floor; mop if needed

z Change or empty cat litter if needed

z Vacuum Carpet/Rugs if needed

z Dust Furniture if needed

Bathroom if needed

z clean sink, tub, countertop

z put toilet cleaner in toilet

z clean floor, mirror

z wash toilet inside and out

z change towels, mat, washcloths

z Check off things needed on list; write out list when going shopping -Keep list in kitchen drawer

z Pick & lay out clothes to wear for the next day

Relax/Free Time

Prepare for Bed

z Floss/Brush Teeth

z Wash Face

z Shave

z Put away clothes (in hamper or drawer/closet)

z Set Alarm for 6:00AM

DG's Daily Checklist

MORNING

_____WAKE 5:30 AM TO THE ALARM CLOCK

_____ TAKE A SHOWER-Wash and condition hair

_____ SHAVE

_____ PUT COLOGNE ON

_____ COMB HAIR

_____ PUT DEODORANT ON

_____ BRUSH TEETH

_____ GET DRESSED

_____ MAKE BED

_____ AT 6:00 AM TAKE MEDICATION

_____ MAKE AND EAT BREAKFAST

_____ CLEAR, RINSE, STACK BREAKFAST DISHES TO PREPARE FOR PM WASHING

_____ WIPE COUNTER, TABLE, STOVE TOP IF NEEDED

_____ BRUSH TEETH

_____ GATHER ITEMS TO TAKE FOR DAY - including medication

_____ AT 7:00 AM LEAVE HOUSE &GO TO PICK-UP POINT FOR SHELTERING ARMS

_____ LOCK DOOR

REHAB CENTER

_____ ARRIVE 8:00-8:30 AM BY THE VAN

_____ FOLLOW MORNING SCHEDULE

_____ LUNCH AT 11:30, TAKE MEDICATION

_____ FOLLOW AFTERNOON SCHEDULE

_____ LEAVE BETWEEN 3:30-4:00 PM TO GO TO THE PICK-UP POINT

LATE AFTERNOON

_____ TAKE MEDICATION AT 6:00 PM

_____ GET MAIL, READ & SORT, PUT BILLS IN APPT BOOK TO GIVE TO MY SEC.

_____ BUSINESS RELATED ACTIVITIES

_____ CHECK FOR MESSAGES

_____ RETURN CALLS

_____ MAKE DINNER

EVENING: PREPARE FOR THE NEXT DAY

_____KITCHEN

_____ wash dishes

_____ wipe off countertops, stovetop

_____ rinse out sink

_____ sweep floor, mop if needed

_____ CHANGE /EMPTY TRASH CAN - If Needed

_____ LAUNDRY IF NEEDED (CLOTHES, SHEETS BATHROOM& KITCHEN TOWELS)

_____ separate colors and whites

_____ set water level _____ put soap in

_____ put clothes in _____ turn on

_____ put clothes in dryer

_____ fold when dry

_____ PUT AWAY CLOTHES: DRAWERS/ CLOSET

_____ VACUUM CARPET/RUGS IF NEEDED

_____ DUST FURNITURE IF NEEDED

______BATHROOM IF NEEDED

_____ clean sink, tub, countertop

_____ put toilet cleaner in toilet

_____ clean floor

_____ wash toilet inside and out

_____ change towels, mat, washcloths

_____ WATER PLANTS ON FRIDAY IF SOIL DRY

_____ CHECK OFF THINGS NEEDED ON LISTS, WRITE OUT LIST WHEN GOING SHOPPING - KEEP LIST ON KITCHEN COUNTER

_____ PICK AND LAY OUT CLOTHES TO WEAR FOR NEXT DAY

_____ GATHER AND ORGANIZE ITEMS TO BRING FOR NEXT DAY

RELAX/FREE TIME

PREPARE FOR BED

_____ BRUSH TEETH

_____ WASH FACE

_____ SHAVE

_____ PUT AWAY CLOTHES (in hamper or drawer)

_____ PUT ON SWEATS

_____ SET ALARM FOR 5:30 AM

L's Automatic Habit Retrainer

MORNING

z Get up When Awakened

z Take Morning Medications, with Water

z Go to Bathroom

z Wash Face

z Go to Kitchen

z Drink Coffee and

z Eat Breakfast

z Go back to Bathroom and Brush Teeth

z Go to Bedroom and

z Remove Nightie

z Put on Panties & Bra

z Look on Bed and Put on Clothes that have Been Laid out

z __Put Top on __Put Bottom on _Put Socks on __Put Shoes on

z Get Hairbrush and Brush Hair (with help)

z Finish any Remaining Milk or Coffee

z Get Memory Book

z Check for Pen - get one from kitchen table if needed

z Go To DayCenter

z Take Memory Logbook and Pen

z Go out Front Door and Go To Car

z Open Car Passenger Door

z Get in Car

z Shut Car Door

z Leave for DayCenter

z Arrive at DayCenter

z Go to Activity Board

z See Daily Scheduled Events

z Participate in Activities

z Write down in log book each activity

LUNCHTIME

z Eat Lunch at Lunchtime

z Take Medication with Lunch

z Participate in Afternoon Activities

z Write down in log book each activity

z Leave DayCenter to Return Home

EVENING

z Listen to Music Tapes

z Go to Mom's Bedroom and Get Music Tapes from Table

z Return to Rec Room

z Choose and Play a Tape

z When Finished Return Tapes to Mom's Bedroom Table

z Dinner Time

z ___Go To Kitchen ___ Eat Dinner

z Work on Memory Book and Complete for Day

BEDTIME

z Get Nightie From Bed

z Go To Bathroom

z Shower

z Take Clothes Off

z ___Turn Water On ___Get in Shower

z Pick up Soap

z Put Soap on Scrubber

z Wash Self with Scrubber

z Wash Soap Off

z Wet Hair Thoroughly

z Put Shampoo On

z Make Sure There is Plenty of Shampoo

z Shampoo Hair Thoroughly

z Rise Hair Thoroughly

z Shut Water Off

z ___Get Towel ___Dry Off

z Get out of Shower

z Put on Nightie

z Put on Face Lotion and Rinse

z Brush Teeth

z Go To Bedroom

z Get HairDryer from Bed

z Plug in and Turn on

z Take Evening Medication

z Floss Teeth

z Set Alarm Clock for 7:30

z Go To Bed

Kevin's Daily Task Initiatives

MORNING

z 6:00am - Rise to Alarm

z Go To Bathroom - Toilet and Wash Hands

z Prepare Breakfast

z 6:30am - Eat

z Put Dishes in Sink and Clean Counter

z 7:00am - Dress

z Brush Teeth

z Brush Hair

z Pack Book bag - Lunch Tickets, Keys, Schedule

z 8:00am, Get Ready to Catch Bus

CIVITAN

z 8:30 - Bathroom - Toilet, Wash Hands

z 9:00 - Check Productivity

z 10:30 - Check Productivity

z 12:00 - Bathroom - Toilet, Wash Hands

z 12:30 - Eat Lunch

z 1:00 - Clean Up

z 2:00 - Bathroom - Toilet, Wash Hands

z 2:30 - Break

z 3:00 - Check Productivity

z 4:00 - Get Ready for Bus

EVENING

z 4:30 - Bathroom - Toilet, Wash Hands

z 4:45 - Prepare Dinner

z 5:00 - Eat Dinner

z 5:30 - Clean Table

z Prepare Lunch for Next Day

z Clean Dishes in Sink

z Clean Counter

z Bathroom - Shower and Clean Tub

z Dress

z Pick up Bedroom - Put Clean Clothes in Drawer/ Dirty Clothes in Basket

z Make Bed

z Free Time

z 9:30 - Prepare for Bed - Toilet, Wash Hands, Brush Teeth & SET ALARM

z 10:00 - In Bed - Sleep

Kevin's Special Duties

Automatic Habit/Energy/Initiative Retrainer

ONCE PER WEEK:

DAY/Time:__________________________

z Change Bed

z Vacuum Floor

z Dust

z Wash Kitchen Floor

z Wash Bathroom Floor

z Scrub Bath Tub

z Scrub Bathroom Sink

z Scrub Kitchen Sink

THREE WASH LOADS PER WEEK

DAYS/Time: ________________________

z Gather Clothes

z Take to Basement

z Sort Clothes

z Load Washer and Start

z Load Dryer

z Fold Clothes (with help)

z Take Clothes Upstairs (with help)

z Put Clothes in Drawer (with help)

Strategies for Energy Conservation*

When considering ways to conserve energy, remember to prioritize, delegate, pace yourself, and plan high-energy activities at times of peak energy.

Activities of Daily Living

• Sit down to bathe and dry off. Wear a terry robe instead of drying off.
• Use a shower/bath organizer to decrease leaning and reaching.
• Install grab rails in the bathroom.
• Use extension handles on sponges and brushes.
• Use an elevated toilet seat.

Organize time to avoid rushing

• Lay out clothes and toiletries before dressing.
• Minimize leaning over to put on clothes and shoes.
• Bring your foot to your knee to apply socks and shoes. Fasten bra in front then turn to back.
• Modify the home environment to maximize efficient use of energy. Example: Place chairs to allow rest stops (e.g. along a long hallway).
• Wear comfortable clothes and low-heeled, slip on shoes. Wear button front shirts rather than pull-overs.

Housekeeping

• Schedule household tasks throughout the week.
• Do housework sitting down when possible. Use long-handled dusters, dust mops, etc. Use a wheeled cart or carpenter's apron to carry supplies.
• Delegate heavy housework, shopping, laundry, and child care when possible.
• Drag or slide objects rather than lifting. Use proper body mechanics. Use your leg muscles not your back when working.
• Sit when ironing and take rest periods.
• Stop working before becoming tired.

Shopping

• Organize list by aisle.
• Use a grocery cart for support.
• Shop at less-busy times.
• Request assistance in getting to the car.
• Purchase clothing that doesn't require ironing.

Meal Preparation

• Use convenience foods/easy-to-prepare foods.
• Use small appliances (they take less effort to use).
• Arrange the preparation environment for easy access to frequently used items.
• Prepare meals sitting down.
• Soak dishes instead of scrubbing and let dishes air dry.
• Prepare double portions and freeze half.

Child Care

• Plan activities to allow for sitting down (e.g., drawing, pictures, playing games, reading, computer games).
• Teach children to climb up on the lap or into the highchair instead of being lifted.
• Make a game of the household chores so that children will want to help.
• Delegate childcare when possible.

Workplace

• Plan workload to take advantage of peak energy times. Alternate physically demanding tasks with sedatory tasks.
• Arrange work environment for easy access to commonly used equipment and supplies.

Leisure

• Do activities with a companion.
• Select activities that match energy level.
• Balance activity and rest (don't get overtired).

Adapted from: Donovan, E. (1995). Energy conservation." In Fatigue Initiative through Research and Education (FIRE^®). Educational program sponsored by Oncology Nursing Society and Ortho Biotech Inc., Phoenix, AZ.