Finding Motivation after Stroke or Brain Damage

picture courtesy of rewalk.us
picture courtesy of rewalk.us | Source

Research study after research study finds that a stroke survivor’s motivation is a critical factor in his or her recovery. After acute care in hospitals, rehabilitation relies on various therapies such as speech-language pathology, physical therapy, occupational therapy, cognitive therapy, and life skills training. Once the patient is medically stable, his or her recovery relies more and more on what they do to regain skills and independence. While medical doctors stabilize the stroke patient, therapists help the patient help themselves. Since the patient’s success in rehabilitation largely is largely dependent upon his or her motivation to participate and follow through with therapies, increasing motivation becomes more of a focus.

Most studies highlight how not only how important it is for stroke survivors to have comprehensive inpatient and outpatient rehabilitation resources soon after stroke but studies also show that the patient’s motivation to engage in rehabilitation is significant. Realizing a loved one who has suffered a stroke is unmotivated, depressed and uncooperative with rehabilitative efforts can leave family members feeling helpless. They are left wondering how to motivate their loved one.

When it comes to increasing motivation, there is not one simple answer. Studies are clear that one does not fit all when it comes to motivating an individual. If you speak with caregivers you will hear they tried many different approaches- some out of desperation. If you speak with more than one you will quickly realize what works for one will not work with another and what did not work for one may not mean it will not work for another. The key to increasing someone’s motivation is to know the person and what drives them.

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Finding Motivation in Hobbies

 People of all ages tend to have one or two activities they love and enjoy.  These hobbies could be physical- gardening, running, biking, fishing, etc.  They could also be sedentary activities that require more cognition power such as reading, crafting, carpentry, puzzles, etc.  It is best to select one hobby from each category but it is not necessary.  If you find a person loved gardening and is frustrated and depressed he/she can no longer do this, you can use this to motivate the individual to continue to activitely engage in the rehabilitation process.  They  need hope and they also need to see the prize (in this case- the hobby they will slowly regain the ability to enjoy again).

The gardener can begin to pick out the necessary items needed to garden and plant something of their choosing.  They will need a helper with the understanding that the person in recovery needs to participate as much as possible in the task.  Individuals struggling with cognitive deficits may need the helper to narrow down the choices to two or three items.  Individuals struggling with more physical deficits may need the helper to do most of the physical work but may verbally guide the helper or finish smaller, easier steps and allow the helper to finish the rest.

At the end of the task, it should be reinforced that this is an activity that can be shared in the future.  The helper should identify areas of improvement, no matter how small, to help the person notice what they are achieving and what they can achieve in the future if they continue with rehabilitation.

Finding Motivation in Work

 Many individuals love work for many reasons.  They may love their actual work, the feeling of financially supporting themselves and their family, or the feeling of achieving something.  It is saddening to most individuals after suffering a brain injury or stroke to learn they may not ever return to their career in the same capacity.  This person needs someone to help them see what they still can do and understand what they will be able to do in the near future after continued rehabilitation.

Aspects of their jobs may help them connect their activities in rehabilitation to working.  Finding books about their occupation, connecting them to coworkers, getting them to perform one activity they used to at work may spark some motivation.  For example, a teacher may find it motivating to work towards reading a book to either children or other patients at the hospital.  Asking the therapists to list what exercises and what small goals the person would need to achieve to meet this goal may be helpful.  Doing this with a helper first is motivating.  The patient should always do as much as they can even if it is just reading a book without holding it or holding a book as a helper reads depending upon their deficits.  The patient will begin to connect small gains in therapy with performing this task more independently.

Finding Motivation in Social Relationships

 Perhaps you were unable to connect your loved one to a hobby or activities of work successfully.  Most people find motivation in being able to interact with the people they love again.  What does the person miss most from their life before their disability? It could be playing with their grandkids, going out to dinner with their spouse, watching movies with their friends, playing cards with neighbors, etc.

You could begin to connect simple gains in rehabilitation to the patient getting closer to being able to socialize more independently.  Bring their loved ones around to motivate the individual.  Humans are social creatures.  We always find a way to socialize even if someone has physical limitations, speech limitations or memory issues.  The patient with impaired speech will be more motivated to talk to an old friend or may begin to write things down to express themselves.  The patient with physical limitations may be more motivated to sit in a chair or move to another room so the setting is more social as they interact with their visitor.

Finding Motivation in the Negatives

 Perhaps this particular patient is very hard to reach and you were unable to connect a meaningful activity to their rehabilitation progress or you are at a point where they are losing motivation and need a new angle.  People who are frustrated, depressed, and defeated may feel validated if you acknowledge all that is frustrating them and all that they simply hate about the rehabilitation process.

The new motivation can be directed at achieving a few small goals that will lead to greater independence from all of the therapists and helpers in their lives.  It is very frustrating never to be able to be left alone.  It is also rather humiliating to depend on others to go to the bathroom and bath.  Identifying these areas as the most upsetting for the individual and connecting some of the rehabilitative activities to being able to be more independent from caregivers may motivate the individual to re-engage with therapy.

Perhaps the individual may be far from using a toilet by himself but he may not be far from using a urinal in his hospital bed.  This small step towards independence and finding a small moment of privacy during these activities of living may foster more motivation to work harder in physical therapy so he can eventually walk to the toilet.

Some patients have such physical and cognitive needs that they are not left alone and have 24-hour oversight.  Allowing the person to have as much time away from caregivers (or at a safe distance) while still perserving their health and safety is incredibly meaningful.  Patients often develop a learned dependence with their caregivers.  Some autonomy may help the individual consider what they need to do to gain further independence.

A simple goal of watching a television show alone may be incredibly motivating for someone.  Therapists can outline what specific small steps to take in order to achieve this small goal.  Perhaps realizing that regaining the ability to use the phone (physically pick up the phone, speak in the receiver) may create more independence and autonomy for this individual that they had ever considered themselves.

Using Real-Life Goals and Working with Natural Consequences

 There is nothing more unmotivating then finding yourself completely removed from the real world without any hope of living your life exactly how you were living it before you suffered a serious injury or medical condition.

Humans are complicated creatures.  Whereas dogs and other animals may learn things with rewards and punishments, people easily become more depressed and question the meaning of their life if they find themselves only striving for tokens, stickers, a special dessert, etc.

The smaller goals they person needs to achieve needs to be linked to a meaningful real-life goal they have set for themselves.  We don't want to work on goals someone else has for us, we want to work on our own.  Therapists and caregivers and help the individual connect the dots between the smaller goals of therapy and their bigger goals.

Consequences to not following doctor's orders or choosing not to practice therapeutic exercises at recommended have natural and logical consequences.  Besides being abusive, people do not want to feel controlled or manipulated by someone else who has decided it is best to assign unnatural consequences to not following through with their rehabilitation regimen.  This is punishment and it does not work.  There are natural consequences to not doing what is recommended that has an incredible motivating power over us all.  Not following through with physical therapy will set the individual back.  Not taking medication may result in negative side effects or continued medical issues and setbacks. When we begin to learn we have a small degree of control over our lives we find ourselves striving  to  overcome temporary obstacles in our way, avoiding natural consequences, and ultimately achieving real-life goals.

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Finding Motivation after Rehabilitation

The above suggestions and interventions assist caretakers to motivate the individual who has suffered a stroke or brain damage and motivate them to engage in the rehabilitation process. Making progress through rehabilitation often is enough of a motivator for an individual to continue.

Other times, this is not enough. There are medications an stroke or brain injury survivor can discuss with a neuropsychiatrist. Since the stroke/brain injury survivor may lack motivation, it is a catch-22 to expect this person to be motivated enough to research the top and self-initiate interventions. This is why this article speaks to the caregivers.

Motivation -vs- Lack of Initiative

There are many reasons why a stroke/brain damage survivor may appear to be unmotivated. This may be due to depression which is a normal and typical reaction to the abrupt physical and cognitive changes they have faced. These individuals may not only have depressed mood but may be lacking the cognitive ability to initate tasks. It is important to understand the difference. The individual may not be "lazy", and calling them this is demeaning and offensive, but rather may have lack of initiative as an effect from frontal lobe damage.

The human brain is a complex structure we do not fully understand yet. It controls all we do. When we have damage in an area and lose a part of functioning in either a physicial, psychological, cognitive, or emotional area, we begin to understand how much our brain does for us and how much is "going right" each day.

Being able to initiate new tasks is a cognitive function- a function of thinking and decision making. After stroke, a person may want to do something, know they need to do it and be at a loss for how to start. They lost that "get up and go" factor they once had.  The key to regaining motivation or self-initiation is staying in the rehabilitation process.  Time and practice will allow the individual to slowly improve in this area.  There is no "MAGIC BULLET" to increasing ones motivation or initative unfortunately.

It is times like this that the individual needs support around them to help prompt them into doing what they need or want to do. Although some medication is shown to improve lack of initiative, there are studies showing that music therapy is having a positive effect as a supplemental therapy to traditional rehabilitation.

Music Therapy

There has been increased studies on the effects music therapy has on individuals with disabilities.  One study's findings suggest that music therapy may be effective in decreasing agitation and anxiety, overcoming initiation difficulties, and promoting positive behaviors in populations with neuro-behavioural disorders.  Each study used various methods.  What appears to be common is that the music therapy was used both alone and in groups and was interactive.  Music therapy is not just listening to music- it is about creating music and being allowed to express your creative self through a medium anyone even with very limited functioning and use.

Ways Music Therapy can be used:

  • An individual can listen to music of their selection or a caregiver's selection and pick music that matches a mood or brings back memories.  This may be useful for individuals who are unable to make their choices known and are unable to physicially participate in music.  Finding music that would trigger memories for the individual is instrumental in cogntiive rehabilitation.
  • A caregiver can either make a sound or sing a simple song and the individual can attempt to repeat it back.  This can also be done with musical sounds such as drumming.  This technique may benefit someone with language difficulties as well as coordination issues.
  • Over time, music therapy can become more and more complex and can follow the individual throughout the rehabilitation process and through life as they slowly make progress and improve.  Music therapy can become as complicated as composing music, working in harmony with others, and using both long-term and short-term memory to successfully create music and sing or play a complete song.

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Comments 5 comments

Vickiw 3 years ago

Hello Sue B. I started reading some of your hubs today, and find them very interesting. This one is of interest to me as I facilitated a stroke survivors group, and can really agree with your view on this. I appreciate the research that goes into your articles, and think your dream interpretations are very well thought out, and have a comforting aspect to them. Great work.


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Sue B. 4 years ago Author

Larry Wall,

Thank you for commenting and sharing your personal experience with traumatic brain injury. I think it is very helpful for loved ones to read the stories of others and understand both the reality of traumatic injuries as well as realize just how much of the future outcome is undetermined and can be influenced by how much the patient is motivated and is determined to regain independence and strength.


Larry Wall 4 years ago

My son suffered a traumatic brain injury in a car accident, where he was a passenger and the driver tried to do the right thing. The car causing the accident never stopped and was never found.

We were told my son would not live through the night--he did. They said he would be in intensive care for months, he was there less than two weeks. The regular hospital room was supposed to be for two months, it was two weeks and the stay at the rehab hospital was a month and not six.

He is recovered. However, while he is 28 he will always be 17. He knows that. On that of the injury, he is legally blind (20/400 and 20?200 with no central vision.)

He finished vo-tech school in graphic design. He is active in the local rap music scene (cannot say I enjoy that) but he does not give up.

When he was in the rehab hospital, he decided he did not want to stay any longer than he had too. He walked the halls for hours to build up strength. He cooperated with the therapist. After the first week of being there, I was playing a game of Scrabble with him, I won the game, but he was able to keep the running score without any errors. He is a real fighter.


mcts2005 4 years ago

I enjoyed your article. Motivation is my biggest downfall. I was hurt resulting with TBI in 2005. After 6yrs I realize this! Part of my motivation problem is lack of energy. I take meds for this ...but it's not enough. I'm lost. What do I do? I don't want to live the rest of my life like this. Can anyone help? Thx for giving me the opportunity to vent...


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Sue B. 5 years ago Author

Thanks for your feedback. I added a lot more content and also addressed the cognitive deficits associated with lack of initiative which are different from the lack of motivation individuals experience from depression.

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