05.09.2024
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Rehabilitation following a childhood brain injury poses significant challenges, particularly as children enter adolescence—a stage of life where they naturally seek independence and test boundaries. These complexities are compounded when adolescents struggle with executive function deficits, making it difficult for them to engage in activities that are crucial for developing the skills needed in adulthood.
For adolescents with brain injury engaging in rehabilitation can be a particularly daunting task. But why? Is it because they struggle with self-awareness or lack the initiative to start? Are they simply exercising their growing independence, or do they feel overwhelmed by the demands placed upon them?
Understanding these barriers is crucial if we are to help young people develop the skills they need to live independently and eventually enter the adult world of work. But how do we motivate them to engage in this process?
Alice and Adam, both of whom sustained traumatic brain Injuries (TBI) as young children due to vehicle collisions, provide valuable insights into these questions. Now adolescents, each face significant challenges in initiating and completing tasks—challenges that are common among young people with developmental delays following a brain injury.
Alice’s Experience: Alice, who attends a mainstream high school, was the first to participate in a financial incentive programme. This programme allowed her to select tasks each week, with payment tied to the number of tasks completed. While she did engage more consistently, she often chose the quickest, easiest tasks to maximise her earnings with minimal effort. Does this mean financial incentives encourage the wrong kind of engagement?
Adam’s Journey: In contrast, Adam’s programme was more structured, with clearly defined tasks and standards. He actively selected tasks, such as cleaning the guinea pig cage and setting the financial rewards. The process of completing this task involved multiple steps, from preparing the necessary supplies to ensuring the guinea pig’s well-being and cleaning up afterwards. Did this increased structure and involvement make a difference in his engagement?
Let’s delve into one of Adam’s tasks to see how it worked in practice:
Preparation:
Process:
Clean-Up:
After completing the task, Adam would log it on a spreadsheet and send it to his occupational therapist for verification. The payment was then processed via bank transfer—a system designed to enhance his digital and financial skills. Did this level of detail and responsibility contribute to his sense of independence and accomplishment?
The preliminary results suggest that financial incentives are a powerful motivator for adolescents with brain injury, but why? Could it be because money is perceived as “adult-worthy,” tangible, and measurable? Adam himself reported feeling proud, independent, and happy when he was paid for his efforts. Is this sense of adult responsibility key to motivating adolescents?
Yet, there are questions we must consider:
What Are the Long-Term Effects? While financial incentives have been shown to increase engagement in the short term, what happens in the long term? Does reliance on financial rewards diminish intrinsic motivation, or does it serve as a bridge to developing more sustainable habits?
Is This Approach Universally Applicable? Could this method work across different socioeconomic backgrounds and with various types of funders? In Adam’s case, his engagement improved significantly, but would the same be true for every adolescent with TBI and also with other types of brain injury?
Reflecting on Alice’s and Adam’s programmes, several important lessons emerge:
The Importance of Structure: Alice’s programme lacked clear standards and structure, which led to minimal effort tasks. In contrast, Adam’s more structured approach fostered greater responsibility. Does this indicate that adolescents benefit more from clearly defined expectations?
Engagement in Decision-Making: Both Alice and Adam were involved in selecting their tasks and setting their own financial rewards. How critical is this involvement in motivating adolescents? Does giving them control over their tasks make them more likely to engage?
The Need for Regular Reviews: Alice’s programme lacked regular reviews, making it difficult to adjust as needed. Adam’s, however, included regular check-ins and feedback. How important is it to review and adjust these programmes to keep them effective?
As we reflect on these case studies, several broader questions arise:
How Would Different Funders Respond to a Programme Like This? Would they see the value in using financial incentives, or would there be concerns about the ethics and long-term implications?
Where Might It Be Inappropriate to Use Financial Incentives? Are there situations where financial rewards could be counterproductive, and if so, what alternative motivators might work better?
What Other Rewards Could Serve a Similar Function? If financial incentives are not viable, what other forms of motivation could be equally effective? Could privileges, social opportunities, or other forms of recognition serve the same purpose?
The use of financial incentives in rehabilitating adolescents with brain injury offers a promising approach to overcoming motivational barriers. However, as with any intervention, it raises as many questions as it answers. By sharing these insights and experiences, we hope to encourage a broader conversation about how best to support adolescents in their journey toward independence.
As we continue to explore innovative strategies in rehabilitation, we must remain open to learning from both successes and challenges. What are your thoughts on the use of financial incentives in this context? What other methods have you found effective in motivating young people with brain injuries?
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