The impact of motivation on stroke rehabilitation

It remains a puzzle why some stroke survivors show great benefits from rehabilitation while others do not.

It is widely assumed that patients with strong motivation recover better, while psychological issues such as depression, apathy and fatigue limit participation in rehabilitation and thus contribute to poorer outcome after stroke. Yet there is very little evidence to support these assumptions.

This project will investigate different forms of motivation (e.g., intrinsic vs extrinsic), how motivation changes over time after stroke, how it is affected by other factors (e.g., depression, fatigue) and the effect motivation has on active participation in stroke rehabilitation. Participation in rehabilitation will not be quantified with crude measures such as length of inpatient stay or number of therapy sessions; it will involve measuring movement with accelerometer-based devices during therapy sessions.

Results from this project have the potential to answer important clinical questions. What is the best way to motivate individual stroke survivors to participate fully in rehabilitation? What approach should be taken when a stroke survivor is highly motivated but is not making gains in recovery?

Key references:

Maclean N, Pound P, Wolfe C, Rudd A. Qualitative analysis of stroke patients' motivation for rehabilitation. BMJ. 2000;321:1051-1054.

Mayo NE, Fellows LK, Scott SC, Cameron J, Wood-Dauphinee S. A longitudinal view of apathy and its impact after stroke. Stroke. 2009;40:3299-3307.

White GN, Cordato DJ, O'Rourke F, Mendis RL, Ghia D, Chan DKY. Validation of the stroke rehabilitation motivation scale: A pilot study. Asian Journal of Gerontology and Geriatrics. 2012;7:80-87.

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