Among those who work in a rehabilitative setting there is an understanding that motivation can impact a patient’s achievement of rehabilitation goals and his or her longer-term outcomes. Nevertheless, despite its relative importance, targeting interventions for (and evaluating) a patient’s motivation is an inexact science. In this case study - and as suggested by some studies9 - motivation appeared to be affected by both internal (individual) and external (social) factors.

Jason’s attitude progressed over the course of rehabilitation from a state of disinterest and passivity to being active and goal-focused. Whether this shift in behaviour towards greater motivation was intrinsic, extrinsic or a combination of both is not entirely clear. His health care team realized that for some reason he began to take responsibility for his own life. From his perspective in hindsight, a chance at being able to walk again was an important driving factor; but the root reasons that caused this change in attitude were difficult to define. In retrospect, the range of factors mentioned in Jason’s evaluation each likely played some role in his motivational shift. Viewing behaviour and goals in terms of drive functions, it may help to understand motivation as a complex bio-psycho-social phenomenon. Jason’s case helps illustrate how motivation in rehabilitation is also an outcome of a range of contextual factors both in the environment and as an aspect of the patient’s personality.

Motivation is difficult to address directly and even in Jason’s rehabilitation there were no specific interventions to address his lack of motivation. It was only during the Cycle that the issue was recognized and efforts were undertaken to motivate him. However, there is no single approach to improving his or her motivational state. Based upon some of the factors known to impact motivation, the Rehab Cycle can nevertheless provide a good framework for support. The inclusion of the patient’s perspective in the assessment and the encouragement of shared goal-setting may lay the groundwork for motivating a patient during the interventions. Positive feedback in the evaluations may also be productive. Finally, clear communication and a mutual understanding of needs, processes and goals between both the patient and providers is essential, particularly following the life-altering event of a spinal cord injury and the long road of rehabilitation it entails.