At this stage of the placement all is moving in the right direction and most importantly in a positive way. The measurement questionnaire has been adapted to the current situation and completed by the client. The results have been assessed by myself with consultation with the psychologist and the recommendations have been developed. The knowledge and skills that I have acquired during the process primarily are communication skills and gaining a understand of the challenges that people who have Acquired Brain Injury constantly encounter. Further the placement has provided a opportunity to research and develop a multidimensional measurement method to assess the clients current level of motivation that provides basis for the program. The development of appropriate motivation strategies for people with ABI has been a challenge. The strategies had to consider the clients levels of impairments such as short term memory, cognitive limitations, speech impairments, physical limitations, monetary and social support. The following is the scale description, questions and recommendations for the current program.
Scale Description
The Intrinsic Motivation Inventory (IMI) is a multidimensional measurement method designed to assess participants’ subjective experience related to a target activity in laboratory experiments (Ryan 1982, Deci, Eghrari, Patrick and Leone 1982, 1994). The IMI consists of a multi-item questionnaire assessing the participants interest/enjoyment, perceived competence, effort, value/usefulness, felt pressure and tension, and perceived choice while performing a given activity. The interest/enjoyment subscale is considered a self-report measure of intrinsic motivation. The perceived choice and competence concepts are regarded as a positive predictor of intrinsic motivation. The pressure/tension is theorised to be a negative predictor of intrinsic motivation. Effort is a separate variable that is relevant to some motivation questions. The value/usefulness subscale is used in internalisation studies (e.g., Deci et al, 1994), the idea being that people internalise and become self-regulating with respect to activities that they experience as useful or valuable for themselves. The inclusion or exclusion of specific subscales appears to have no impact on the others. Another important issue of the IMI is that of item redundancy. In fact, items within the same subscale overlap considerably, although randomizing their presentation makes this not relevant to most patients. The full version of the questionnaire includes 45 items and 7 subscales; shorter versions have been used and found to be apparently reliable (McAuley, Duncan & Tammen 1987, Loureiro, Johnson & Harwin, 2006). However, in part, because of their straightforward nature, caution is needed in interpretation. Like other self-report measures, there is always the need to appropriately interpret how and why participants report as they do. Ego-involvements, self-presentation styles, reactance, and other psychological dynamics must be considered. For example, in a study by Ryan, Koestner, and Deci (1991), found that when participants were ego involved, the engaged in pressured persistence during a free choice period and this behaviour did not correlate with the self-reports of interest/enjoyment.
Recommendations for JL
The model is based on achievement motivation. Essentially the assessment will focus on the participant’s stage of achievement, motivation, goal orientations, personal attributions and the conditions or situations that clients avoid and / or approach. The emphasis will be on task goals, downplaying outcome goals, monitoring and providing attribution feedback, correcting inappropriate or maladaptive self assessments and enhancing feelings of perceived competence and personal control. Achievement outcomes have been regarded as a function of the two characteristics of skill and will. The focus in the current model is on will, or the motivation to achieve the outcome, and it will be considered separately from level of skill. The majority of the model is based on the three fundamentals of attitude, drive and strategy, such that each makes a distinguishable but interrelated contribution to motivation for achievement. Without attitude, there is no reason to believe that one is capable of the necessary action to achieve, and therefore no reason to attempt it. Without drive, there is no energy to propel that action. Finally, without strategy, there is nothing to help select and guide the necessary action. The questionnaire was developed to ascertain what is the primary style of motivation (intrinsic / extrinsic) that JL currently displays. The following includes the questions, scores and recommendations that will possibly enhance the motivation of Mr JL.
THE PRE-EXPERIMENTAL INTRINSIC MOTIVATION INVENTORY
For each of the statements, the following scoring scale was employed:
1 2 3 4 5 6 7
not at all somewhat very
true true true
Scoring information for the IMI. To score this instrument, you must first reverse score the items for which an (R) is shown after them. To do that, subtract the item response from 8, and use the resulting number as the item score. Then calculate the subscale scores by averaging across all of the items on that subscale. The subscale scores are then used in the analyses of relevant questions.
Interest/Enjoyment
(1) Do you enjoy doing the rehabilitation activities very much?
(2) Do you find the activities are fun to do?
(3) You think that rehabilitation is a boring activity? (R)
(4) Does the activity / rehabilitation hold your attention at all? (R)
(5) Would you describe the rehabilitation training as very interesting?
(6) Do you think that rehabilitation is enjoyable?
(7) While you are doing your rehabilitation do you think about how much you enjoy it?
(8) Is there enough personal reward in the current program?
(9) Would you rather have external rewards such as social, material, activity reinforcers and special outings?
(1) (2) (3) (4) (5) (6) (7)
Scoring high in this category is considered a self-report measure of intrinsic motivation. Low scores are an indicator of a-motivation and questions (8, 9) are indicators of extrinsic motivation. For the interest and enjoyment component the client attained a total score of 23 (M=2.56).
JL will be encouraged to provide appropriate music with parental permission. Playing music of the client’s choice before or during rehabilitation will enhance achievement motivation through the creation of an elevated mood environment. As well where possible, JL is recommended to be paired with training partner(s) with slightly higher abilities and similar interests to develop both individual and collective goals. Research suggests that people perform best when the level of difficulty or training partner is slightly above one’s current ability.
Therefore it is suggested that the task(s) or rehabilitation exercise be personally challenging. Empirical evidence suggests that if the task at hand is too easy, then this promotes boredom and may communicate a message of low expectations or a sense that the instructor believes the person is not capable of higher standards. A task that is too difficult may be seen as unattainable; may undermine self-efficacy, and may create anxiety. Scaffolding is one instructional technique where the challenge level is gradually raised as personal capabilities are increased. JL mentioned that for an extrinsic reward he would like outings such as the movies, sporting events, and interestingly commented that he would like to go to the arcade to participate in table tennis (ping pong). Such incentives would provide a positive reinforcement for his level of effort and commitment. To encourage extrinsic motivation the positive approach model will be implemented that focuses on rewarding appropriate behaviour through the use of effective extrinsic reinforces such as, social, material , activity reinforcers and special outings. However, when using extrinsic rewards, never use rewards over a long period nor do not increase the reward for increased expectations, and finally, decrease the rewards as soon as they begin to become effective as lengthy use only reinforces the external control.
JL motioned that he was a former A grade cricket player and enjoys rugby league; therefore, if possible, implement sport specific training drills into his rehabilitation program. During the client’s personal time provide JL with either a practice cricket ball or football, as simple throwing and catching drills will help the Nero-muscular system. If required I can provide the staff with sport specific drills for either sports. Strategies to further increase intrinsic motivation include providing successful and positive experiences, rewarding specific behaviours such as new skills, using verbal and non verbal praise, and varying the training to break the monotony.
Perceived Competence
(1) Do you think that you are pretty good at the rehabilitation activities that the physiotherapist gives you?
(2) Compared to other clients here at Headway, do you think you are pretty good at the activity that is provided for you?
(3) Do you feel competent in your own ability after working on an activity for awhile?
(4) When you do a task, are you satisfied with your performance?
(5) Do you think that you are skilled in the exercises that you are asked to perform?
(6) Do you think that rehabilitation is an activity that you don’t do very well? (R)
(1) (2) (3) (4) (5) (6)
Perceived Competence is a concept that is regarded as a positive predictor of intrinsic motivation. Recording high scores are indications of the client’s self confidence / efficacy levels. JL displayed a moderate level of confidence (M=4.67) in his ability and competence in performing the tasks assigned of him. From a sport psychology perspective that is a positive and powerful opinion to have of oneself. JL believes that he displays the ability to achieve his set tasks. However this category only consisted of one reverse question and I would appreciate the opportunity to observe JL in the rehabilitation program to completely assess this attitude under challenging circumstances. Therefore the suggested recommendations include the gradual raising of challenges and setting more complex tasks ensure that JL is educated in the fact that even the most challenging tasks can be made more manageable by breaking them down into smaller parts and then prioritising the steps. As each small part is achieved, a measure of success is attained. As the successes accumulate, JL will begin to recognise his own enthusiasm for rehabilitation. Not only is this is an essential problem solving strategy, but it is also an essential life skill. Finally rehabilitation staff record and highlight mastery performances; provide vicarious experiences, verbal persuasion and positive encouragement.
Effort/Importance
(1) Do you put a lot of effort into your rehabilitation?
(2) How would you respond to this statement on true scale: “I didn’t put much energy/ effort into my rehabilitation training activity? (R)
(3) Do you think you try very hard on the training activities?
(4) Is it important to you to do well at your rehabilitation?
(5) How would you respond to this statement on true scale: “I didn’t try very hard to do well at this activity? (R)
(1) (2) (3) (4) (5)
The effort and importance category highlights the attitude of the client about the program. If the client displays low scores in this category the suggestion is to
Create learning activities that are based on topics that are relevant to the client’s life.
Clients may display increased motivation when they feel some sense of autonomy in the learning process, as motivation declines when they have no input in the rehabilitation program. Offering choices develops ownership. When the clients make decisions, then they are more likely to accept ownership and control of the results.
Value/Usefulness
(1) Do you believe this activity / training could be of some value to you?
(2) Do you think that doing this activity is useful for ______________________?
(3) Finish this for me: I think this is important to do because it cans _____________________
(4) Would you be more willing to do these activities again because it has some value to you?
(5) Finish this for me: I think doing this activity could help me to _____________________
(6) Do you believe that by doing these activities could be beneficial to you?
(7) Do you think rehabilitation is an important activity?
(1) (2) (3) (4) (5) (6) (7)
Low scores in both of the above categories will indicate the client’s perceived lack of input, ownership, meaningful goals and personal value in the current rehabilitation program.
JL’s scores (M=2.6) in the effort and importance category reflected that his effort is below average and the rehabilitation program is of average personal importance. In the value / usefulness section the scores (M=7) were affected by response bias, as no reverse scores were asked. Therefore it is recommended that in order to foster intrinsic motivation, it is imperative to create learning activities that are based on topics that are relevant to JL’s life and he regards as personally important. Research suggests that personal value of an outcome affects personal motivation. Incentive theories of motivation suggest that people will perform an act when the result is the outcome one desires or is of personal importance. The way to achieve this is through personal goal setting. Goal setting is a powerful tool that must be implemented correctly to improve performance. Goal setting works in improving motivation by directing one’s attention to the important elements of the skill being performed, mobilising one’s efforts, increasing the performer’s persistence and by fostering the development of new learning experiences (Locke & Latham, 1985). To maximise goal effectiveness for the present motivation, JL must set appropriate goals; develop goal commitment, evaluate barriers to goal attainment, construct an action plan, obtain feedback, evaluate goal attainment and reinforce goal achievement. Further considerations when goal setting include setting meaningful goals; placing powerful reminders around the home or journal about the goals and desires to maintain momentum and creating specific detailed strategies to achieve goals. JL will be encouraged to develop a timeline that will include not only a deadline but also a time to begin. Without a definite timeline, potentially rewarding and fulfilling goals may silently slip away until they become only distant memories.
JL’s journal will include a list of personal self-motivators for achieving goals, both extrinsic and intrinsic. Staff and client will develop realistic expectations while maintaining a positive attitude towards goal achievement. Staff will periodically review goals, celebrate JL’s accomplishments and provide rewards for achieving goals. Such actions will increase commitment. By setting personal goals, JL will gain a sense of control over personal actions and be able to move beyond beliefs or fears
that may prevent an increase in personal performance. Goal setting has been shown to enhance performance, reduce anxiety, increase confidence and understanding, and enhance purpose and motivation. The developmental plan should include a year-long goal schedule divided into monthly, weekly, and daily sub goals. With this guideline in place it will be possible to track performance and adjust goals as needed. Therefore it is recommenced that JL create a staircase model of goal setting. This involves the long-term goal or dream at the top, the present level of ability at the lowest step and a sequence of progressively linked, short term goals connecting the top and bottom of the stairs. According to Weinberg & Gould (2003) short and long-term goals should be linked. To create a progression of goals the clients are recommended to begin with something simple that can be easily achieved, then progress to a series of more immediate short-term physical and psychological goals that are linked to the long term goal. The following are principles for effective goal setting:
Set goals for mental as well as physical skills
Set goals that are specific and measurable
Set a target date for completion
Set goals that are difficult but realistic
Set short-term, intermediate, and long-term goals
Remain flexible enough to adjust goals as needed
Emphasise performance goals over outcome goals
Write the goals down on paper / journal
Keep it simple, rates of adherence to any lifestyle change tend to be lower when the regimen is complex, inconvenient or expensive.
Finally it is recommended that staff meet with each client periodically to set, review, and evaluate goals. In many cases, parents should be involved in these meetings too.
Pressure/Tension
(1) Do you feel very tense while doing these activities?
(2) Are you very relaxed when you are doing the training (R)?
(3) Where you anxious while working on the task?
(4) Do you feel pressured while doing rehabilitation?
(5) Do you feel nervous at all while doing new tasks?
(6) Do you feel like you should be better rewarded for adherence to the rehabilitation program? If so, what would be the reward?
(1) (2) (3) (4) (5)
The pressure/tension is theorised to be a negative predictor of intrinsic motivation. High scores are an indicator of extrinsic motivation. In this section JL scored (M=3.67), indicating a mid range level of pressure and tension to perform the tasks ascribed to him. Therefore it is recommended to create and maintain a personal journal. JL will begin an individual journal by documenting experiences and identifying and outlining goals. JL will be encouraged to write in the journal each day / week. This will not only help overcome obstacles but also help discover personal desires; record and highlight mastery experiences; clarify goals and express current thoughts and feelings. The journal will provide an avenue to convey any pressure or tension felt and provide focus and clarity to situations. Writing in a journal can help elucidate one’s emotions and reactions to certain people or circumstances and assist in decision making. Maintaining a daily diary is one of the best techniques for discovering patterns, particularly those that are self-defeating and will clearly demonstrate any reoccurring personal difficulties.
Perceived Choice
(1) Do you believe that you have some choice about doing this activity?
(2) How would you respond to this statement on the true scale: “I feel like it was not my own choice to do this task”? (R)
(3) Do you do this activity because you wanted to?
(4) Do you feel like you have to do this? (R)
(5) How would you respond to this statement on the true scale: “I didn’t really have a choice about doing this task” (R)
(6) Do you do the rehabilitation and tasks because you have to? (R)
(1) (2) (3) (4) (5) (6)
JL revealed a low perceived choice score (M=2). Therefore it is recommended that JL be encouraged to have the opportunity for autonomy in the goal setting, decision making and some of the rehabilitation exercises; for example, choosing warm-up drills or an activity at the end of practice translates to greater fun and enjoyment which creates intrinsic motivation. Client autonomy can foster increased interest, enjoyment, engagement and improve performance. Motivation increases when a sense of autonomy in the learning or training process is offered, by providing choices which develops personal ownership in the rehabilitation program. When participants are involved in decisions, then they are more likely to accept ownership and control of the results. This sense of control fosters responsibility. When the control belongs to the instructor, so does the ownership of the program. Therefore it is important that JL is consulted regularly on personal thoughts, feelings, stress management, goal setting, goal attainment and physical sensations that will improve performance and make adjustments to the program if required.
The program will recognise that social or physical environmental situations may place JL at high risk for setback. Preventing setbacks begins by identifying the true causes and planning for setbacks to normalise them as predictable occurrences. Self-efficacy/ self-confidence will be checked periodically to assess the effect of experiences on competence, as the degree of relationship between self-efficacy and action is affected by temporal disparities. The current program mastery experiences will be structured in ways to build coping skills and install beliefs that one can exercise control over potential threats.
The experience thus far has provide me with the opportunity to research and develop the most appropriate measurement tool that suited the particular clients situation. Further I had to gain a better understanding of the various difficulties and the cognitive functions and impairments that are associated with ABI. The opportunity to work with a professional dedicated multi discipline team that provides such an important service with so little government assistance has been a positive experience. The placement has provided me with copious challenges and an enormous level of research that has been incredibly interesting. The experience thus far has been extremely positive and the project at this stage will achieve the set objectives.
Reece Norris
References
Locke, E. A., & Latham, G.P. (1990). A theory of goal setting and task performance. Englewood Cliffs, NJ: Prentice Hall.
Weinberg, R. S., & Gould, D. (2003). Foundations of Sport & Exercise Psychology
(3rd ed.). Human Kinetics.
