Synapse - reconnecting lives

Some brain injuries can result in a loss of motivation and difficulty in getting started with activities.

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 injury (TBI). 

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 depressed. 

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 friend.

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.

Managing adynamia

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 possible. 

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 problems. 

Healthy lifestyle - As with virtually every aspect of a traumatic brain injury, fatigue will be less of a problem if you focus on a healthy lifestyle:

• 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.