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Motivation After a TBI

Comments [3]

Dr. Celeste Campbell, BrainLine

Ask the Expert: Motivation After a TBI
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My teenaged daughter sustained a brain injury in a car accident more than a year ago. Now she has no motivation and wants to sleep or sit in front of the television all day. What can I do to get her up and more involved?


Your daughter's lack of motivation may stem from a number of factors. One, she is a teenager — not the most motivated developmental age group. But after a brain injury these tendencies may be drastically exacerbated.

A second factor is that she is likely recognizing that she is not able to do some of the things she used to enjoy at the level that she use to enjoy them, and is feeling a lack of confidence in her ability to do them at all. Teens are particularly loathe to stand out from the crowd for making a mistake, and your daughter may be avoiding participation in activities in order to avoid embarrassment.

A third factor to consider is that she may feel overwhelmed by activities more complex than sitting in front of the television, and may not have developed effective strategies to manage situations which she finds overwhelming. So, for example, the prospect of getting involved again with band may be too overwhelming for her to contemplate, but practicing her flute for 10-15 minutes a day might be more manageable.

Finally, your daughter's apparent lack of motivation may be a function of the brain injury itself. Parts of the brain are responsible for alertness and initiation of activity. Frontal lobe involvement may make it difficult for her to engage in activities even if she has a desire to do so. Diffuse axonal injury may induce a level of physical and cognitive fatigue even with what may appear to be a simple activity. A neuropsychological assessment will be able to determine which of these factors are having an impact on your daughter. She may benefit from some cognitive rehabilitation to help her to be better able to initiate and manage a more active lifestyle. Some counseling with a therapist who is familiar with the effects of brain injury in adolescents should also provide some support and strategies to rebuild her self-confidence.

You can help her look at some of the activities she used to enjoy or may be interested in and talk about ways to break them down into more manageable units.

Enlist the assistance of her friends. Look for a mechanism to help them to understand your daughter's brain injury, so that they can provide support and a sense of security for her. Many friends back away because they do not know how to react; engage them in the recovery process and they will be more likely to stick around.


Click here to go to About Ask the Expert.

Celeste Campbell, PsyDCeleste Campbell, PsyD, Dr. Celeste Campbell is a neuropsychologist in the Polytrauma Program at the Washington, DC Veterans Administration Medical Center. She has a long history of providing cognitive psychotherapy and developing residential behavioral management programs for children and adults.

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Comments [3]

Most of what I wanted to say has been said by these other contributors. Well said! 

I haven't lost any of my motivation, but I am frustrated daily with how mental fatigue over activities as simple as making a "to do" list can wipe me out to the point that I see flashing lights, get completely thrown off-topic by the simplest interruption (which most people would not consider significant enough to count as an interruption). I frequently take what I intend to be a half-hour nap around 10:00 am, fully expecting and desiring to get back to the project I started, only to wake at 4:00 pm with no more mental energy than when I got up in the morning. Then, if I hear a comment about lacking motivation on top of the frustration I have already endured, the emotional pressure builds to a point that I have to leave an take a nap or risk loosing control, and shouting nonsense in a state of rage.

I haven't done that in a long time, because after much discussion, my family understands the need to let me rest when I need rest. But even though my family understands, I don't really understand, and I deal with a lot of false guilt over the things I don't do that I so strongly want to do.

Jan 1st, 2015 2:38am

Thank you for pointing out that apparent lack of motivation does not mean the same thing in a TBI survivor than it would otherwise. When every step of every decision requires filtering of dozens of related, but ultimately inapplicable ideas, a person with very high internal motivation can come across to others as distant, and uninterested. There may also be some depression involved in understanding that some former abilities may never be regained, but we all have abilities we never explored, and for every lost ability, a previously neglected ability may take its place. Long term, there is plenty of cause for hope. Another reason not to be too quick with a diagnosis of depression is that an injured brain can be loosing neurons due to excessive levels of neurotransmitters released by dying neurons, in a cascade that could be exacerbated with antidepressants. Rest, and careful monitoring of the balance of inflammation may be the best approach during the first two years after an injury. Too much inflammation may cause more neurons to die, but too little inflammation may prevent healing. Hånell, A. (2011). Plasticity and Inflammation following Traumatic Brain Injury. Uppsala: Acta Universitatis Upsaliensis. Retrieved from https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=8&cad=rja&ved=0CGkQFjAH&url=http://uu.diva-portal.org/smash/get/diva2:398436/FULLTEXT01&ei=3RukUaL5NInx0wHmv4GADQ&usg=AFQjCNH7Abtk0eRg8g3lFhl8ff_-bOTzwg&sig2=_qPiBQQSpMfWw1dYOmRXxw&bvm=bv.47008514,d.aWc Morganti-Kossmann, M. C., Rancan, M., Stahel, P. F., & Kossmann, T. (2002). Inflammatory response in acute traumatic brain injury: a double-edged sword. Current Opinion in Critical Care, 8(2). Retrieved from http://journals.lww.com/co-criticalcare/Fulltext/2002/04000/Inflammatory_response_in_acute_traumatic_brain.2.aspx

Nov 18th, 2013 11:01pm

My TBI has had many things come and fewer of these go, which can be quite depressing. I suffered a brain and spine injury when a careless employer slammed a large 600+ pound overhead fast falling shop door on my head, causing me multiple issues from blown discs in my cervical and lumbar to narcolepsy, which is extremely expensive to treat using Xyrem and central apnea. The brain is a complex organ and when it is damaged or bruised, can take a toll on the rest of the body. About all I can suggest is to try and stay positive and keep your head up. Don't let the voices of negativity bring you down, and believe me many sadly will try when at a time as critical as this, you need their support. Stimulate your mind with mental exercise, go back to school, read if you can and if you find yourself not enjoying the occasional glass of wine, music, television, or crowd, this I have learned is quite normal. Don't be too hard on yourself and don't give up. Good luck, God bless or what ever you do, because somehow you can make it.

Jun 21st, 2013 1:42pm

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