Energy Pie & Neurofatigue Strategies 

Throughout my education process as an occupational therapy student I have been aware of the term neurofatigue. Neurofatigue, as it was described in our readings in a quick brush, is when the brain/mind becomes tired from overuse, just as the body endures physical fatigue from overuse.


From my own personal experience, after a long day when I have a lot on my mind, not slept the night before, have been forced to focus for prolong periods of time, this will leave me feeling in a “Fog” or like a “Zombie.”  I am more prone to forget things, and have less control over my emotions. The effects of neurofatigue are much more complex than a tired brain/mind, especially if an individual has experienced a brain injury.


“Energy Pie”


Dee Cassidy introduced me to the visual conceptual model of the “Energy Pie.” 


The “Energy Pie” is comprised of four components: (1) Physical Energy; (2) Cognitive Energy; (3) Emotional Energy; and (4) Reserve Energy.   Reserve Energy provides key support to the three other areas of our “Energy Pie” once they begin to deplete from mental exertion.


After an individual has experienced a brain injury the Reserve Energy portion of the “Energy Pie” is significantly smaller, thus depending on the demands of the task, will require more strain and pull more energy from any given area of their Pie.




Neurofatigue Strategies:      The Four P’s


Occupational therapists look at strategies to manage neurofatigue and ways to assist a person increase function in their home, community and social environment when the “Energy Pie” is being depleted.  The Four P’s (1) Prioritize; (2) Plan; (3) Pace; and (4) Position can be helpful strategies to manage neurofatigue.




Use a Daily Planner; a daily planner can be a calendar on the wall, on a phone, monthly planner, etc. When we get confused it causes us to get frustrated, thus decreasing our neuro-energy leading to neurofatigue; Decide what is most important; For example: Going to a doctor's appointment would take priority over dusting the living room.




Plan Activities First to Avoid Extra Trips; Gather supplies and equipment you need before task; Example: Before you begin to garden, gather all your garden supplies; Plan Alternative Heavy and Light Tasks; When physical energy is lowered, this will lead to neurofatigue; Example: Plan your tasks so your aren't trying to do too much all at once; Plan Good Night's Rest; Sleep will replenish our energy; Example: Limit electronics in bedroom; Have a routine for relaxing before sleep; Use Family, Friends or Caregivers When Needed For Assistance; It's better to ask for help than to suffer from neurofatigue; Asking for help is not a sign of weakness.




Maintain a slow steady pace. Never rush; the faster we rush, the quicker our energy will decrease and will lead to confusion and fatigue; Rest often. Rest before you feel tired; Used Pursed Lipped Breathing; Breath through your nose and then out through your mouth. Think of it like smelling the flowers and blowing out the candles on a cake.



Avoid Excessive Bending; too much bending and reaching can cause fatigue and shortness of breath. When we are out of breath this effects are focus on the task at hand and leads to frustration; Use adaptive equipment to help avoid bending, this will make the task easier and lead to increased energy; Maintain Upright Position; maintaining an upright position when sitting and standing. This will increase oxygen that will increase our focus during a task; Sit When You Can - Sitting increases energy during task performance.




I would like to thank Dee Cassidy for helping my education process and introducing a new concept that I can share with others as I proceed with my education. She was so kind by taking the time to teach me about the concept of the “Energy Pie” as well as allowing me to be part of her “Energy Pie” presentation and give the OT perspective and share some intervention strategies that can assist with neurofatigue.


Guest blog author: Brady Handlon, written March 2, 2018, as a Level II OT fieldwork student at O’Connor Occupational Therapy Services, PLLC, while attending Eastern Michigan University to obtain a combined Bachelor of Science and Master of Occupational Therapy degree. His graduate research study “The Study of a Novel Occupation: The Culture of Table-Top Roleplay Gaming” was disseminated as a poster presentation at Eastern Michigan University’s Graduate Research Conference as well as the Lyla M. Spelbring Endowed Leadership and Conference in 2017.


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