No one thinks about traumatic brain injuries until it happens to them or someone they love. In 2016, there were approximately 55.5 million prevalent cases of traumatic brain injuries. Depending on the type of injury, its severity, the patient’s age, etc., the road to recovery may be longer or shorter, bumpier or smoother, and it may not end at the perfect destination. While there are an abundance of factors at play during rehabilitation, many of which are uncontrollable, patients have more power over their situation than is often believed. A patient’s motivation can completely alter the path that rehabilitation takes.

Motivation can be described as “‘the impetus to initiate, sustain, orientate, enliven, and move forward a goal-oriented action’”, but what impacts it and how does it present itself? There is no one answer, even amongst professionals, that determines which factors affect motivation or how it can be visualized and evaluated. In interviewing 32 stroke rehabilitation professionals, Niall Maclean and his colleagues found that the practices used to recognize, understand causes of, and change patients’ motivation all varied from person to person, seemingly with little more than a general sense of what motivation is and past experiences. With these discrepancies, there is a large margin for error in evaluating patients’ motivations and, subsequently, enlisting appropriate courses of action. Not only are the incorrect evaluations themselves harmful, but labeling patients as ‘motivated’ or ‘unmotivated’ can result in self-fulfilling prophecies: professionals see certain patients as unmotivated and do not put as much effort into the care given, resulting in the patients becoming more unmotivated.

By coding and categorizing information collected from interviews, Taiki Yoshida and his colleagues evaluated which factors influence motivation and how motivation affects behavior. Their data fell into seven core categories: “patients’ goals, experiences of success and failure, physical condition and cognitive function, resilience, influence of rehabilitation professionals, relationship between patients, and patients’ supporters.” The manifestation of these factors could be seen in the behaviors of stroke patients; when highly motivated, the majority of stroke patients would engage in “self-training, rehabilitation, and activities of daily living more actively.” As the reflection of motivation in behavior is not universally applicable, however, observational analyses of the patients should be regarded second to the patients’ narratives. In the broad sense of altering motivation in rehabilitation patients, an ideal starting point for research might be targeting one of these core factors of influence, implementing changes, and making narrative-based and observation-based theories.

Viewing rehabilitation motivation as a combination of the aforementioned components, each should be looked at critically to determine what can be targeted. Experiences of success and failure, physical condition and cognitive function, and resilience would be difficult to change, if at all. This leaves patients’ goals and relationships to be honed in on, which arguably can go hand in hand with one another. Ninuk Dian Kurniawati and her colleagues provide data that suggests that family support is one of the more influential components of motivation; there is nothing quite like the support of family and friends, people who knew the patient as a person, outside of and before their injury or illness. That being said, familial support is not easily manipulated, especially from within a hospital or rehabilitation center (not to mention if familial support is not just low, but nonexistent). Establishing that familial support is quite unique and relatively vital to motivation in rehabilitation, future research should target how to best maximize or substitute this component to further patient recovery.