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MOTIVATION
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Synopsis After a brain injury, an individual is relatively incapacitated. The route of traditional therapy brings about change from the outside in. In searching for more affective therapy internal resources need to be inspected. Heidi Lerner was awarded a grant by the Center for Education and Human Services in Acquired Brain Injury at George Washington University for researching internally inspired rehabilitation. The affect of therapy being disguised in activities of personal interest is investigated in this project. Introduction What is the best way to secure a person’s attention? Let it be said that by using an individual’s interests to entice a patient, s/he can then become immersed in the therapeutic activity, thus gaining progressively better results. In this study, we intend to contour the participant’s interventions to their particular interests. This approaches the question - if participants in the study’s interests are used in implementing rehabilitation, will they have a better chance for success? Conducting therapeutic activities around objects and activities of interest is a way to ensure participants’ enthusiastic participation. Bundy states in his study (1991) that “If play is the vehicle by which individuals become masters of their environment, then play should be among the most powerful of therapeutic tools” (as cited in Linder, 1993). Murphy says in his study (1962) “Experiences that are full of pleasure and pleasantness are central to the development of an acceptable sense of self. Children behave as if much of what they do is done chiefly because it is exciting, gratifying or fun.” (as cited in Savage and Wolcott, 1994, p. 309). This proves the obvious to be true, what is not obvious is how much this need for a pleasurable experience can be directed and used in a therapeutic capacity for children or adults. For a survivor of a traumatic brain injury, he or she has faced a life threatening experience, sense of self may very well be shattered s/he may find it difficult to know who they are and where they are going; after such an experience, the act of touching on personally pleasurable experiences in rehabilitation will find welcoming recipients. Rehabilitative therapy that allures and engages the student can help to reintegrate and reinvent his/her sense of self. Professionals in the field are noted to recommend the pursuit of personal hobbies (i.e. crafts, games, toys, etcetera) for clients who have sustained a head injury. This recommendation serves to reestablish a sense of self-worth and self-esteem as well as developing hand-eye coordination. This research study proposes the Individualized Creative Rehabilitation model, which uses the student’s interests to capture his/her enthusiasm in therapy. Successful implementation of the program is measured by whether the objectives are met and if the students can reach or surpass the objectives set forth by the intern. It is assumed that the quality of enthusiasm developed will affect how often the students will practice and how well they will perform the activity, thus the fervor with which the students perform the activities will be an influential variable determining their quality of performance. In the Individualized Creative Rehabilitation (ICR) model, therapy is disguised in the activities of interest for each participant. This may serve to enhance and perhaps accelerate the children’s progress in rehabilitation. This project is innovative in that it explores the role of personal will in rehabilitation, for the assumption is that a person’s inner state of well-being directs his or her recovery. ICR allows the student active involvement in their rehabilitation, for when a greater percentage of the patient’s energy and concentration is immersed in the act of rehabilitation from brain injury, what effect could this have?. The goal of the ICR model will be to simultaneously work on: • Therapeutic endeavors • Building self-confidence and self-esteem • Strengthening personal will and motivation • Harnessing the student’s motivation and directing it to the rehabilitation process. The ICR plan introduces an internal dynamic into the rehabilitation process. Though the effectiveness of traditional rehabilitation practices cannot be debated, the implementation of newly developed techniques can complement already established ways. The field of rehabilitation will benefit by this project’s inquiry into the extent to which rehabilitation is up to the participant. This study seeks to find out the effectiveness of interventions when utilizing rehabilitative activities that the student is interested in. ICR creatively ignites the desire of those clients involved to partake in rehabilitative tasks. This method will allow rehabilitation professionals to see the value and the necessity of intrinsic motivation. Problem Statement If clients are treated in a desensitized manner in the process of rehabilitation, this has an emotional impact on their recovery. Rehabilitative therapies tend to emphasize medical treatment, not the building of inner strength and motivation of the patients in order to accelerate rehabilitation. The goal of this research is to improve the therapeutic program by helping the students to feel a part of the rehabilitative process. The ICR model will simultaneously be working on therapeutic endeavors, building self-confidence and self-esteem, strengthening personal will, harnessing the student’s motivation and directing it toward the rehabilitative process. When therapy is altered from something the sick individual has to do to something s/he enjoys partaking in, his or her personal will is enlisted in order to pursue rehabilitation. At Hospital for Sick Children, in Washington DC, toys are utilized to encourage the student’s motivation to participate. An observation important to note was that one student would not partake in therapy until he was given the toy of his choice. The student was then willing, even enthusiastic about participating. Perhaps one reason why the role of personal motivation in recovery from injury has not as of yet been considered, is the approach of rehabilitation hospitals and centers usually have restricted personnel and use of materials, thus, this tends to lead them to using only the more traditional methods. As mentioned by Theresa Krankowski, rehabilitation hospitals use only the methods that they know (personal communication, March 26, 1998). It is not common that they think about the individuality of the patients and their responsiveness. When the healing modalities are presented to individuals in a manner that engrosses them, they will participate more willingly in the act of their own personal rehabilitation. Compared to those who need to be dragged through a program, the value of those that are enthusiastic about a project is, as of yet, immeasurable. This study will determine the difference in the students’ rehabilitative outcomes when their rehabilitation is supplemented using the Individualized Creative Rehabilitation model. Purpose This research grant will benefit: · Rehabilitation participants - by allowing them to have an active involvement in their treatment through exploring creative adaptations to therapy. Being allured by activities that interest them, they will pull themselves deeper into the rehabilitation process. · Rehabilitative staff - by showing them that individuals will participate more actively in rehabilitation if the therapy incorporates their interests. · Families - in learning to adapt personal compensations to their loved one’s personal preferences in order to see better results. · The field of rehabilitation - by inquiring into the extent to which rehabilitation is up to the individual. Need for Study A person's inner desire governs his or her state of well-being and directs him or her either toward health or sickness. In a study by Broyard, it is noted, "The sick person's best medicine is desire (i.e. motivation)- the desire to live, to be with other people, to do things. I'd like to suggest, to invent, imagine or recall ways of keeping one's desire alive as a way of keeping one's self alive" (as cited in Rode, 1995). A sick person's motivation or desire to live and get better is so important, that it orchestrates a person's recovery, state of illness or at times, death. This study will serve to ignite the participant’s desire to partake in rehabilitative tasks. These tasks will be transformed into activities that they will love to perform (e.g. occupational therapy, games and crafts, physical therapy, directed dance moves, speech therapy, poetry and song, or whatever activity is based on the participant’s interest). The student's energy and concentration is thus immersed in the act of rehabilitation; their desire is directed toward personally suited interventions in order to fulfill their own therapeutic needs. The strategy of the study is that the students will not be aware that when they are performing their fun-filled activities, that they are actually in therapy. Tailoring the activities to fit the needs of the students is pertinent to their personal development. Ylvisaker states that “At the early stage in the development of services for students with brain injury, it is perhaps most important that clinicians approach their task creatively and flexibly, evaluating more like detectives than like technicians and treating more like problem-solving engineers than like deliverers of therapy programs.” (Savage and Wolcott, 1994, p. 229). When teaching a student to compensate after a brain injury, a creative designing of the intervention oftentimes, produces the most effective outcome. We must try to realize, when we get stuck using stereotypic and unimaginative patterns of treatment, we need to abandon our preconceived notions about the way we "should" treat a student and expand our perspective to consider alternative options (Aurey, 1991). It is important to note that rehabilitation professionals are known to recommend the pursuit of personal hobbies (i.e. crafts, games, toys, etcetera) for clients who have sustained a head injury for purposes of developing hand-eye coordination, and reestablishing a sense of self- worth and self-esteem. Integrating therapy into these self-fulfilling activities for students arouses their excitement to perform therapeutic activities that they usually just have to do. It is important to note that the approach to compensation is what needs to be creative, not necessarily the intervention. For example, Gary has a case of hemiplegia. He needs to utilize some of his fine motor skills. Heidi, Gary’s ICR coach, encourages his playing with a basketball. She even encourages his rolling or throwing it, aiming at a target and even seeing how many times he can hit it, thus getting him to practice working on fine motor skills and coordination. In researching the effect of motivation on recovery, findings were scarce. Only one study was found that researched the same topic (Barry, Duntaman & Webb, 1967); this study was conducted in 1967 with an adult population. No studies have covered this topic regarding children. Such isolated findings confirm the need for this research in the field. When this project demonstrates success, partakers will desire more creatively adapted rehab to take the form of activities that they love, thus survivors and families will demand for its continuation. Over time, when the success of this project proves to be profitable for adult as well as pediatric rehabilitation centers, replication will be necessary in order to spread the impetus of Individualized Creative Rehabilitation. Conceptual Framework Everyone's engine must be revved to get him/her through life's challenges. We must realize what it is that fuels our engine. At our foundation, is our sense of competence; without a sense of feeling capable, one is as a car with no air in its tires. Support for a person with a brain injury’s competency acts in inflating his or her sense of self. Additionally, how we are with others serves to enhance our well-being. Knowing that another person is available to offer support may be a brace to help a person to get things done on his/her own (hence the value of support groups). Lastly, encouraging one's sense of autonomy encourages good gas mileage for the long haul (Stevens, Van Werkhoven, & Castelijns, 1997). This study investigates how the psychological aspect of motivation affects a person’s rehabilitation. A little rousing of the inner will may lead a person to fulfill challenging objectives, thus personal motivation knows no bounds. In the traditional medical model, little emphasis is placed on the building of inner strengths and inspiration to accelerate rehabilitation. The ICR perspective conceptualizes and works with the whole individual in building self-confidence, self-esteem, strengthening personal will and motivation, and directing it to the rehabilitative process. Encouragements of different types are used in the process. Incentive Incentive is the anticipation of a positive, pleasurable or rewarding state. In other words, an incentive serves as an internal trigger of motivation. Rick Parente has done research regarding the effects of incentive on the cognitive development of adults with brain injury. His findings showed that with monetary compensation, the brain-injured participants’ performance was greatly increased. The therapeutic purpose of this experiment was to show that a client's thinking processes could improve rapidly if there is a reason to perform. The incentive for performance does not have to be financial (it could be in providing certain social stimulation). People tend to learn far more effectively when they are engaged in tasks that are meaningful and enjoyable. If a participant is to perform an activity that s/he enjoys, then in learning s/he has the incentive to perform. Students will then perform better when the goal is intrinsic to the task (e.g. when a person feels success in what they’re doing) rather than when they are told that their goal is to learn. (Savage and Wolcott, 1994). Assumptions What underlies this study is the theoretical assumption that if a student’s intent is more fully invested in therapy - emotionally, mentally and therefore physically, the results will be intensified or the rehabilitation will be enhanced or quickened. As is pointed out in Rick Parente’s study, when a person with brain injury is motivated (i.e. the person’s will is fully charged- in this case, due to an incentive of some type) the result is notably beyond what is expected of that individual (1991). Another assumption that is inherent in this study is that intrinsic motivation will enhance the traditional techniques used in rehabilitation. The ICR model will serve to exemplify an edifying approach in assisting in rehabilitation. The words “heal” and “whole” come from the same root. Brain injury survivors usually have what can be considered drifting attention. If the ICR serves as a catalyst focus a student, and his or her whole self is invested into the rehabilitative process, a quickened rehabilitation is the natural development. Research Findings This research gives evidence that if a therapist (i.e. or special educator) utilizes an interest of the participant in implementing interventions for head injury rehabilitation, s/he will show significant jumps in cognitive performance. In this process, the participants’ emotions are used as a variable. When enthusiasm is put into activities that combine areas of interest with cognitive tasks, results are simply incredible. The developments noted in this study are the following: Oscar. These findings are the result of a student with not only a brain injury, but also a bipolar disorder; he was noted to tend toward self-condemnation. Being accompanied by a live drummer, Oscar was directed to repeat affirmations to the rhythm. In this way, he learned to counteract his self-demeaning comments with edifying statements. For example, he would commonly state to himself, “ I don’t know”. Ms. Lerner would encourage him to oppose himself and state that he does know! The aim of this intervention was to act as a means for Oscar to start believing more in himself. He immersed himself in the activity and joined in with some drumming, while repeating the affirmations. Oscar reacted to the intervention at a slower pace than the other participants, but with persistent therapy, our intervention and family support, especially from his father, Oscar experienced substantial progress. Christine. The therapeutic purpose of this intervention was to show that Christine’s attentive skills could improve significantly when partaking in her chosen activity. A rapid jump was experienced by Christine in the act of writing her autobiography. Her excitement spurred on her attentive skills resulting in more than doubling the time she was able to attend; she went from being able to attend for forty minutes to one hour and thirty minutes. Suzanne. In the circumstance of the participant experiencing mathematical confusion, Ms. Lerner designed a method aligned with the participant’s love for music. She encountered difficulty in counting by twos; she was only able to count by twos up to five. After learning to use rhythm in counting (i.e. Rythmetics), Raeye’s skills in counting by twos jumped up to sixty! Her performance developed almost twenty times the initial attempt! These episodes portray the potential of interventions that are adapted to the student’s interest. These therapeutic activities utilized personally preferred activities to bring about cognitive development. OVERALL CONCLUSION Research question · If the activities of education/rehabilitation are centered around the student’s interests, will this excitement increase the therapeutic capacity of the interventions? Therapist’s role At the National Institute of Health’s Consensus Conference, Prigatano mentioned that activating clients (i.e. increasing their awareness, uplifting their moods and stimulating - not frustrating them) is a strategy used in the field by any good therapist. Directing the student to use activities of personal interest or strength in his/her rehabilitation will surely incite the ability to concentrate all mental powers on the rehabilitative act. In order to facilitate motivation in the student, therapists or educators need to think of themselves as vehicles to progress. They can act in creating an atmosphere that is enriched with optimism, enthusiasm, hope, a love for learning and the building of confidence. Creative compensation If a student is encouraged to utilize an individualized approach to compensation, the activity used may even make it fun for the student, especially if it is a personally preferred activity. This stimulates excitement in performing the compensatory strategy. Linder states that play is the student's most natural activity, he says that in it’s own way, it encourages cognitive or thinking skills (Almy, Monighan, Scales &VanHoorn, 1984; Pepler, Ross, 1981; Piaget, 1962; Rubin, Fein & Vandenburg, 1983; Smilansky & Shefatya, 1990; Vygotsky, 1967; Yawkey, Jones & Hrncir, 1979). It also encourages social-emotional development (Burns & Brainerd, 1979; Connoly & Doyle, 1984; Curry Arnaud, 1984; Smilansky & Shefatsya, 1990), communication - language abilities (Guarvey, 1977; Heath & Mangiola, 1991; Nicholich, 1977; Pelligrini, 1981; Smilansky, 1968) and movement proficiency ( Athey, 1984; Bundy, 1991; Musselwhite, 1986) . Individualizing activities that will help a person cope with challenges can occur in any of these categories. Ripples of confidence In this research study, the participants performed the activities of interest with such diligence and grace that this acted to build their self-confidence, self-esteem and hope for future development. This experience has been captured, as a mental photograph in the students’ minds. Such acts of confidence building will later be recalled in edifying their sense of self. Therapy of self-discovery There is cause for interest in the momentum spurred on by self-discovery. When a person uncovers his or her strengths, s/he is then self-propelled in order to perform their best. In this way, an individual becomes the pulse of motivation in his or her own treatment; this can be referred to as Self-Implemented Therapy. There is a warranted cause for more research to be done in this area. Ending The field of brain injury will greatly benefit by research into utilizing the inner human processes for facilitating rehabilitation from brain injury. As a nation, we sustain research into advanced technological methods of rehabilitation for people who have sustained a traumatic or acquired brain injury, but perhaps we should consider the fertileness of the territory of research into the inner workings to benefit the field of rehabilitation. This would lead the brain-injured population to gain accessibility to rehabilitative processes that are held very close by. References The American Heritage Electronic Dictionary (3rd edition). (1993). Novato: CA: WordStar International. Auery, John (1991). Oppositional Students versus oppositional teachers: Managing resistance. Beyond Behavior 2 (4), 7-8 . Barry, J., Dunteman, G., Webb, M. (1967). Personality and motivation in rehabilitation. (University of Florida and Bay Pines VA Hospital). 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Available E-mail: Gstephen@welchlink.welch.jhu.edu. Stevens, L., Van Werkhoven, W., & Castelijns, J. (1997). In the Netherlands: Reclaiming kids’ motivation. Educational Leadership, 60-62. Rode, D.C. (1995). Building bridges within the culture of pediatric medicine: The interface of art therapy in student life programming. Art therapy: Journal of the American Art Therapy Association, 12(2), 104-110. Wiersma, W. (1995). Research methods in education: an introduction (6th ed.). Needleham Heights, MA: Allyn & Bacon.
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