Motivational Interviewing to promote self-awareness and engagement in rehabilitation following acquired brain injury: A conceptual review

Abstract

The benefits of rehabilitation following acquired brain injury (ABI) are all too often disrupted by a lack of engagement in the process, variously attributed to cognitive, emotional and neurobehavioural sequelae, and prominently to impaired self-awareness of deficits. Motivational Interviewing (MI) has been widely applied to address treatment adherence in health settings, including a small but emerging evidence base in brain injury contexts. A conceptual review of the literature is offered, examining the interplay of neurological and psychosocial determinants of engagement difficulties after ABI, and discussing the possibilities and limitations of MI as a therapeutic strategy to enhance motivation. The theoretical bases of MI are outlined, focusing particularly on the transtheoretical stages of change model and self-determination theory. The converging evidence suggests that the guiding philosophy and principles of MI - characterised by non-confrontation, collaboration and self-efficacy - might help to foster readiness for participation in rehabilitation. A dynamic motivational model of engagement is presented, identifying MI's potential contribution in three key areas: firstly, to set the stage for therapeutic alliance and case formulation; secondly, to facilitate acceptance of deficits and realistic goal-setting; and thirdly, to promote constructive engagement in the range of clinical interventions that comprise a holistic neurorehabilitation programme.

Interventions to increase engagement with rehabilitation in adults with acquired brain injury: A systematic review

“…Of those studies utilising this technique, MI was either found not to be more effective than goal setting alone (Corrigan et al, 2005) or its effects were not sufficiently measured (Hsieh, Ponsford, Wong, Schönberger, Taffe & Mckay, 2012;Hsieh, Ponsford, Wong, Schönberger, Mckay & Haines, 2012). This appears to contradict the suggestion of others (Medley & Powell, 2010;Holloway, 2012). It is possible that MI is effective in increasing motivation for rehabilitation in this group, but that the design of the studies reviewed here was insufficient for evaluation.…”

Processing speed and working memory training in multiple sclerosis: A double-blind randomized controlled pilot study

“…More research is needed in order to identify reasons why MS patients either do or do not adhere to cognitive training interventions. Future studies should consider utilizing regular phone check-ins that involve motivational interviewing counseling techniques to improve adherence rates (Medley & Powell, 2010). …”

A conceptual review of engagement in healthcare and rehabilitation

“…Several authors have argued the benefits of rehabilitation are limited if the patient is not fully engaged in the process [2,3]. For example, levels of engagement have been associated with improved functional improvement during inpatient rehabilitation and levels of functioning after discharge.…”