Motivation in rehabilitation and acquired brain injury: can theory help us understand it?

Abstract

Background: In acquired brain injury (ABI) populations, low motivation to engage in rehabilitation is associated with poor rehabilitation outcomes. Motivation in ABI is thought to be influenced by internal and external factors. This is consistent with Self-determination Theory, which posits that motivation is intrinsic and extrinsic. This paper discusses the benefit of using Self-determination Theory to guide measurement of motivation in ABI.

Methods: Using a narrative review of the Self-determination Theory literature and clinical rehabilitation research, this paper discusses the unique role intrinsic and extrinsic motivation has in healthcare settings and the importance of understanding both when providing rehabilitation in ABI.

Results: Based on the extant literature, it is possible that two independently developed measures of motivation for ABI populations, the Brain Injury Rehabilitation Trust Motivation Questionnaire-Self and the Motivation for Traumatic Brain Injury Rehabilitation Questionnaire, may assess intrinsic and extrinsic motivation, respectively.

Conclusion: Intrinsic and extrinsic motivation in ABI may be two equally important but independent factors that could provide a comprehensive understanding of motivation in individuals with ABI. This increased understanding could help facilitate behavioural approaches in rehabilitation.

Implications for Rehabilitation

• Conceptualization of motivation in ABI would benefit from drawing upon Self-determination Theory.

• External factors of motivation such as the therapeutic environment or social support should be carefully considered in rehabilitation in order to increase engagement.

• Assessing motivation as a dual rather than a global construct may provide more precise information about the extent to which a patient is motivated.

Keywords:

• Motivation
• Self-determination Theory
• acquired brain injury
• traumatic brain injury
• measurement

Acknowledgements

The authors would like to thank the rehabilitation staff at the Hamilton Health Sciences Regional Rehabilitation Centre in the Acquired Brain Injury inpatient and outpatient programs for their support of this study .

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The present research was supported by the Toronto Rehab Scholarship in Rehabilitation-related Research for Graduate Students with Disabilities, awarded to the first author. Funding for study-related expenses was provided by McMaster University. Acquired Brain Injury inpatient and outpatient services for their support of this study.