Motivation and initiation (Adynamia)

Our ability to initiate activities and see them through to completion is an important skill for everyday life. This lack of motivation, also called adynamia, is common with injury to the frontal lobes that occurs after a traumatic brain injury (TBI). It is also one of the most debilitating parts of depression, and can last for months after the other symptoms of depression (e.g., low mood, sleeping changes, eating changes, apathy) have improved. It may be difficult to determine if the cause is the brain injury or depression, so discussing it with a psychologist or psychiatrist is a good idea.

Initiation is an important part of motivation – it is our ability to get started on a task and something we all take for granted. In some cases, a person with brain injury needs verbal reminders and prompts to begin an activity. Further reminders are often needed to see the task through to completion.

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 can be a common outcome due to impacts on motivation to participate in activities or contact friends and family.

It is important for friends and family to have an understanding of what adynamia is – and isn’t – in order to help. People experiencing adynamia as a result of brain injury are not lazy and can feel quite motivated. They might be clear about what they want to do and talk about their plans, yet not know how to actually start an activity.

Lack of initiation should not be confused with other aspects of TBI that appear similar, such as fatigue and depression. Fatigue easily sets in when people with brain injury push themselves too hard. Similarly, the feeling of apathy associated with depression is a common and understandable reaction to changes brought about through brain injury, yet is distinct from adynamia, but as mentioned above, adynamia can be a part of depression.

Break tasks down into easily managed steps and write a checklist. Tick these off when completed. This can be used to re-establish normal daily activities.

Structure and an uncluttered environment will help a person feel less 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 possible.

Prompts and positive reinforcement need to be given regularly. Give encouragement when the person initiates or sees activities through to completion. Where possible make activities fun so they seem less of a chore. Having to constantly give prompts may feel frustrating at times, but is an important part of helping a loved one manage adynamia.

Mental health needs must be considered. As motivation is closely associated with mood, appropriate treatment should be provided for depression, anxiety or any other psychological problems.

A healthy lifestyle is important for managing fatigue and general wellbeing. Encourage your loved one to:

• sleep well
• get regular exercise
• avoid alcohol or limit intake
• eat a healthy diet
• learn stress management techniques
• maintain contact with friends and family.

It is natural for families and partners to find it difficult when the lively person they once knew seems uninterested in activities or other people.