Motivation in Rehabilitation

//Motivation in Rehabilitation

Motivation in Rehabilitation

By |2019-02-12T05:27:00+00:00March 5th, 2019|Practice Tips|Comments Off on Motivation in Rehabilitation

In November 2018, the NSW Chapter of the Aust. Physio Assoc. Neurology Group ran a panel discussion about Motivation in Rehabilitation. To lead this discussion, we were joined by:

Kathryn Millar
Kathryn Millar
Kath is a woman with cerebral palsy spastic quadriplegia. She uses a manual wheelchair for mobility. In May 2016, Kathryn had multi-level orthopaedic surgery to treat contractures of the hips and knees, which required several months of intensive therapy in a rehabilitation unit to regain functional mobility. She now works casually as an Electorate Officer.
Adrian O’Malley with his daughter Eve
Adrian O’Malley with his daughter Eve
Adrian works for Synapse, an organisation that advocates for and helps people living with a brain injury, he is also a spokesperson for the National Stroke Foundation. Adrian had a stroke when he was 34 years old and spent 5 months in rehabilitation, he has recently been able to access therapy services again with NDIS funding
Daniel Wallekers
Daniel Wallekers
Daniel continues his rehabilitation following a traumatic brain injury which happened when he was 22 and riding his motorbike to work. At the time he was an electrical apprentice only 5 days away from doing the final test to become qualified. He spent over a year in hospital doing rehabilitation with the Liverpool Brain Injury Unit.
John Garbutt
John Garbutt
John is the President of Stroke Recovery NSW, he previously worked as a senior officer in the NSW public Service. He had a stroke when he was 46 years old in 2003 and spent months in rehabilitation and participating in community stroke team rehab programs. He has continued his rehabilitation through utilising his Chronic Diseases Health Care Management Plan to access five Physio Therapist visits under Medicare each year, volunteering for research projects in the Hunter region, private physiotherapy and most recently through NDIS funding. Almost 16 years post stroke he is still working on his recovery.

The main aim of the evening was to inform therapists what they can do better to help motivate people when they are in rehabilitation. Simone Dorsch facilitated the evening discussion and has written up the following summary of the evening and some memorable quotes and messages from Adrian, John, Kath and Daniel.

Click on each question for detail.

Main message – The relationship between the therapist and the patient is critical

  • This relationship needs to be a collaboration, Kath talked about the reassurance she found in knowing that her physiotherapist was determined to help her find a solution to the problem of how to transfer in and out of a car again.
  • Daniel talked about how he was motivated by having a therapist that could talk to him about things apart from therapy. He liked to feel like his therapist was a real person and prepared to have a relationship with him that was friendly as well as being about therapy.
  • Adrian talked about the importance of people recognising his goals and not putting roadblocks in the way. He had a goal of going bushwalking a year after his stroke and felt although many health professionals may not have believed he was going to achieve this goal it was important that they didn’t disrespect it. The update is – that he did do the bushwalk one year after his Stroke.
  • Kath talked about the very vulnerable position that patients in rehabilitation are in, and how their personal space is being constantly invaded. She feels that where appropriate a therapist should be able to be vulnerable too, she reminded us of the quote from Coach Eric Taylor in Friday Night Lights “Clear eyes, full hearts, can’t lose”

Other comments:

  • Therapists need to have empathy and to remember that patients have usually been through a traumatic experience.
  • Therapists need to ask patients to voice their concerns and frustrations in order to know what is causing difficulties and in order for the therapist to be able to help where possible.

Main message – In inpatient rehab, discharge is a very motivating goal but after discharge external motivators become more important

  • An exercise log can be used like a contract and be very helpful.
  • John talked about having ongoing involvement in research projects as a way of accessing more therapy and maintaining the motivation to practice.

Main messages – Concerns were about the relevance of practice, explanations of practice, objective feedback and goal setting

Relevance of Practice  – Practice must be meaningful;

  • Adrian talked about the frustration of practicing irrelevant tasks “I’m a 34 year old intelligent man, why am I stacking cotton reels on pins??!!” At the same time his request to practice something meaningful such as tasks related to being able to hold his new baby was ignored.
  • He suggests that therapists should use a variety of exercises in order for patients to have choice in what they are doing.

Explanations are needed

  • John talked about the need for explanations and to relate the exercise back to the impairments the person has and say why this exercise is beneficial for example, “this exercise is to achieve…..” , “this exercise will help to make you stronger in these muscles….”

Objective feedback as an external motivators is critical in order for patients to see and know that change is happening

  • Daniel talked about the motivational value of Video as it can show how far someone has come since their stroke or injury.
  • External motivation needs to be meaningful – not “polishing a turd” as Adrian says. Achieving 5 degrees more wrist extension might be exciting for a therapist but not necessarily for a patient.
  • “good stuff’ is not enough, feedback needs to be specific.

Goal setting is essential

  • Adrian said that the first time he was explicitly asked what his goals were was years after his stroke.
    He suggests therapists use a simple question such as “What do you want to do, that you can’t do now?”