General Introduction

For many persons living with spinal cord injury (SCI), motivation is an important and at times challenging aspect of the rehabilitation process. In general, motivation is a complex, goal-oriented process that involves many factors. Although most everyone has some sort of understanding what motivation is, it is difficult to clearly define, measure and shape motivation.

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Jason's story

Jason, 17 years old at the time, was on track to complete an apprenticeship as a technician. His life was suddenly interrupted after falling 50 metres into a quarry, suffering multiple injuries, including a spinal cord injury (SCI).

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Assessment

At the start of the Rehab-Cycle^® i.e. the assessment phase, Jason's rehabilitation team conducted a comprehensive assessment that involved a battery of discipline-specific evaluations (health professional perspective) and an interview with Jason to capture his perspective about his functioning (patient perspective).

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Goal-setting/Determination of Intervention Targets

Based on the rehabilitation team's assessment results and Jason's own statements about his functioning and overall situation, intervention targets and concrete goals to achieve during Jason's Rehab-Cycle^® were identified.

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Assignment and Intervention

Every intervention target that was determined during the assessment phase was assigned to corresponding member(s) of Jason's rehabilitation team during the assignment phase of the Rehab-Cycle^®. The respective team member was then responsible for addressing the targets with specific interventions during the intervention phase.

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Evaluation

Jason’s Rehab-Cycle^® lasted three months, and at the end of the Rehab-Cycle^® a re-evaluation of Jason's functioning took place. This was seven months after Jason incurred a spinal cord injury (SCI).

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Discussion

Among persons working in a rehabilitation setting there is a general understanding that motivation has an impact on the achievement of rehabilitation goals and ultimately on long-term outcome. However, evaluating a person's motivation and targeting interventions that address motivation is an inexact science.

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Literature

1. Gerrig R. Chapter 11: Motivation. In: Gerrig RJ. Psychology and life. Boston, USA: Pearson Education; 2013. p343-371.
2. Cook DA, Artino AR Jr. Motivation to learn: An overview of contemporary theories. Med Educ. 2016; 50(10): 997-1014.
3. Eccles JS, Wigfield A. Motivational beliefs, value, and goals. Ann Rev Psychol. 2002; 53: 109-132.
4. Wise R. Drive, incentive, and reinforcement: The antecedents and consequences of motivation. Nebr Symp Motiv. 2004; 50: 159-195.
5. Ryan R, Deci E. Intrinsic and extrinsic motivations: Classic definitions and new directions. Contemp Educ Psychol. 2000; 25(1): 54-67.
6. Reiss S. Multifaceted nature of intrinsic motivation: The theory of 16 basic desires. Rev Gen Psych. 2004; 8(3): 179-193.
7. Ryan R, Deci E. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000; 55(1): 68-78.
8. Siegert R, Taylor W. Theoretical aspects of goal-setting and motivation in rehabilitation. Disabil Rehabil. 2004; 26(1): 1-8.
9. Maclean N, Pound P. A critical review of the concept of patient motivation in the literature on physical rehabilitation. Soc Sci Med. 2000; 50(4): 495-506.
10. Sweet SN, Tulloch H, Fortier MS, Pipe AL, Reid RD. Patterns of motivation and ongoing exercise activity in cardiac rehabilitation settings: A 24-month exploration from the TEACH Study. Ann Behav Med. 2011; 42(1): 55-63.
11. Wilbanks SR, Ivankova NV. Exploring factors facilitating adults with spinal cord injury rejoining the workforce: A pilot study. Disabil Rehabil. 2015; 37(9): 739-749.
12. Farholm A, Halvari H, Niemiec CP, Williams GC, Deci EL. Changes in return to work among patients in vocational rehabilitation: A self-determination theory perspective. Disabil Rehabil. 2016 Nov 7: 1-8. Early online.
13. World Health Organization. International Classification of Diseases 11th revision (ICD-11) beta-browser. [Internet] Update November 2016. Available from: http://apps.who.int/classifications/icd11/browse/f/en. Accessed November 2016.
14. Miller W, Chan C. Spinal Cord Independence Measure (SCIM). [Internet] 1 February 2013. Available from: http://www.scireproject.com/outcome-measures-new/spinal-cord-independence-measure-scim. Accessed November 2016.
15. Avellanet M, Selb M, Stucki G, Cieza A. Utility of using the ICF Core Sets in clinical practice. Rehabilitación. 2015; 49(4): 197-201.
16. World Health Organization. International Classification of Functioning, Disability and Health (ICF). Geneva, Switzerland: World Health Organization; 2001.

Questions and Answers

Q1. Describe the contemporary theories of motivation. (Refer to BITTE ANKER AUF BOX 1 for the answer.)

Q2. Explain how the concept of motivation can be integrated into rehabilitation practice based on the self-determination theory. (Refer to BITTE ANKER AUF General Introduction unter dem Heading "Motivation and Rehabilitation" for the answer.)

Q3. List the practices that Maclean and Pound have suggested for fostering motivation in rehabilitation. (Refer to BITTE ANKER AUF BOX 2 for the answer.)

Q4. What role did the concept of motivation play in Jason's rehabilitation? (Refer to BITTE ANKER AUF Jason's Story unter Heading "Role of Motivation in Jason's Rehabilitation for the answer.)

Q5. Explain how Jason's case reflects the individualistic-social approach of motivation proposed by Maclean and Pound. (Refer to BITTE ANKER DISCUSSION, 5. Absatz der mit "Jason's case seems to reflect the combined individualistic-social approaches..."anfängt for the answer.)