Motivation After a TBI


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.


Posted on BrainLine July 21, 2009

Celeste Campbell

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.


I had TBI, frontal lobe, 30 years ago. I have terrible trouble getting motivated and staying motivated. One thing that helps (sometimes) is turning off the TV and using a timer. Then I get bored. But I "try" to use it as a reward. 1/2 hour of cleaning (which I hate) and a 15 minute reward of TV. Still trying to perfect this system though. 😇

It stinks when you're no longer the capable person you were pre-tbi, and for a teenager that has to be especially hard. No doubt you already do a good job empathizing with her. Maybe try expanding from empathy to celebration of even the small things she's doing. Give her a genuine compliment whenever she accomplishes even the tiniest thing that takes focus, or organization, or planning, or extended effort - or any of the things she used to be able to do so easily. Maybe keep a little diary (a scratchpad would do) to jot down a word or two about what you saw her do that was worth a compliment. Then maybe once a week or every few weeks, take a look at that scratch pad & see what she's done. Share it with her so she can see she's making progress. Does she use facebook? Maybe suggest she connect with a brain injury group that way - folks who know what it's like to walk a mile in her shoes. It'll take time and effort and patience and help and enthusiasm, and maybe especially new tips & tricks to do familiar tasks. She needs you to believe in her to help her believe in herself again, and she needs you to be genuine - no fake happy faces. Best of luck for both of you.

Yes, try & do nice things maybe go to countryside or park. Relaxing activities. I have had multiple PCS/tbi & trauma. It is winter & feel even less motivated now. The GP shouted at me & minimises & denies tbi which I know it is. It takes time to heal.

Having had a severe Brain Injury myself I know how she is feeling. Her brain is working but ever so slowly and thinking and responding to people is very difficult. You need to allow her to relax. Watch her closely and offer her things she liked before the brain injury. Life is ever so different. Nothing is easy but you don't have any connection with reality as the rest of the family and friends do around you. Be there for her. Keep it simple. Don't change routines or she will become more frustrated. Put things back where they were so she can find them. Having to lay around is a way of coping the best way you can. In time she will start to get it together. In the meantime walk at her speed and don't expect the old daughter responses.  Some challenging activities can be introduced like buying a carton of milk at the shop. I can remember going across the road to buy 3 things and having to come back 5 times to ask again what they were. Then My wife gave me the list. That worked.

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.

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. HÃ¥nell, A. (2011). Plasticity and Inflammation following Traumatic Brain Injury. Uppsala: Acta Universitatis Upsaliensis. Retrieved from,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
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.

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