Fatigue, pacing and the boom-and-bust cycle
Why a good day followed by several bad ones is a pattern rather than bad luck, and how pacing is built into the programme.
The most common self-inflicted setback in rehabilitation is doing too much on a good day. It has a name and a predictable shape.
The cycle
Energy improves, the patient does everything that was postponed, and the following days are lost to exhaustion. Average output falls even though the effort felt like progress.
The alternative is unglamorous: a consistent daily amount that is sustainable on a bad day, increased slowly rather than opportunistically.
How the programme handles it
Rest is scheduled between therapy blocks rather than taken when someone collapses, and the weekly review adjusts load against what the patient actually tolerated rather than what the plan assumed.
This is why a timetable that looks light in week one is not a sign of a weak programme. Tolerance is built, and building it is therapeutic work.
Taking it home
The same rule governs the home programme, where there is no therapist to stop an ambitious week. Much of the ground lost after discharge is lost this way.
A home programme should state a daily amount and a rule for bad days. If it does not, ask for one before you leave.
Topic
More in Recovery and aftercare
- How progress is measured during a programmeNamed instruments at admission and discharge, scored the same way both times — so the result can be checked by someone who was not there.
- When a second block of rehabilitation makes senseRepeat programmes work when there is a defined goal left to reach — and we will say when there is not.
