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:
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”
- 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?”