Motivation & initiation
Some brain injuries can result in a
loss of motivation and difficulty in getting started with
Our ability to initiate activities then see them through
to completion is an important skill for everday life.
This lack of motivation, also called adynamia, is common with
injury to the frontal lobes that arise after a traumatic brain
Initiation is an important part of motivation - it is our
ability to get started on a task, something we all take for
granted. In some cases, a person with a brain injury needs verbal
reminders and prompts to begin an activity, and often further
reminders are needed to see the task through to completion.
Adynamia does not always mean the person feels unmotivated -
often they talk about their plans and activities, they know what
they want to do, but don't know how to actually start the activity.
Adynamia can easily be confused with other aspects of a TBI or
similar brain disorder. For example, fatigue lasting for several
days can result if the person pushes themselves too hard.
Depression is an understandable reaction to how life has changed
after a brain injury, and apathy is quite common when people are
The impact of reduced motivation
Difficulties with motivation can impact on many areas of life
such as rehabilitation, learning coping skills, social functioning
and a return to work or study. Social isolation is common as it can
be difficult to feel motivated or even simply call or email a
Adynamia is not laziness
It is easy to see how a person with adynamia could be seen as
lazy, apathetic, and not making an effort. Understanding these
changes may be difficult for family and friends even when they
understand how a traumatic brain injury has
caused these problems.
The situation is also difficult for partners and family members
as the lively person they once knew may now appear uninterested in
activities and other people. They can also become frustrated with
the need to keep prompting the person to start tasks, and remind
them to keep going until it's finished.
Break tasks down - Break tasks
into easily managed steps and a checklist. Tick these off when
completed. Beginning, completing and following through on a task is
less overwhelming. This can also help re-establish normal
activities of daily living.
Structure & an uncluttered
environment - It is easy to feel overwhelmed
after a brain injury. Provide a timetable of weekly events with
built in rest periods as needed. Have lists of how to
accomplish various tasks in a handy spot. Keep the
environment free of distractions and noise as much as
Prompts & positive reinforcement
- When regular prompts are needed, don't let annoyance or
exasperation show. This will be easier when you understand the
difficulties of adynamia. Encourage the person when they initiate
or see activities through to completion. Where possible make the
activity fun so it seems to be less of a chore.
Mental health - As motivation is
closely associated with mood, appropriate treatment should be
provided for depression, anxiety or any other psychological
Healthy lifestyle -
As with virtually every aspect of a traumatic brain
injury, fatigue will be less of a problem if you focus on a
- Sleep well
- Get regular exercise
- Avoid alcohol or limit your intake
- Eat a healthy diet and watch your weight
- Learn stress management techniques
- Maintain contact with friends and family.
Care for the carer - Providing care and
assistance to a person with impaired motivation can be difficult
for a carer. All efforts may seem futile and the carer may begin to
feel apathetic themselves. It is important to take breaks from the
caring role and have some time to do outside activities. These
breaks can be crucial to wellbeing and may allow you to provide a
better quality of care in the long run.
References and further information
Reber, A. S. (1995). The Penguin Dictionary of Psychology
(Second Edition). London: Penguin Books.
Marin, R. S & Chakravorty, S. (2005). Disorders of
Diminished Motivation. In J. M. Silver, T. W. McAllister, & S.
C. Yudofsky (Eds.), Textbook of Traumatic Brain Injury ( pp.
337-349). Washington, DC: American Psychiatric Publishing.
Wood, R. Ll., & McMillan. (2001). Neurobehavioural
Disability and Social Handicap Following Traumatic Brain Injury.
East Sussex, England: Psychology Press.
Rees, R. (2005). Interrupted Lives: Rehabilitation and learning
following brain injury. Melbourne, VIC: IP Communications. (IN BIAQ