Disclosures: Lissa Hewan-Lowe, DO: No financial relationships or conflicts of interest

Case Description: The patient presented to our traumatic brain injury unit after transfer from a nearby acute rehab facility for difficult to manage albulia. He sustained traumatic brain injury secondary to falling on a business trip 2 weeks prior. He initially presented with Glascow coma scale(GCS) of 9, bilateral subarachnoid hemorrhages and contusions with nondisplaced occipital fracture on imaging. The patient was managed nonoperatively, GCS score improved and was discharged to acute rehabilitation. He was noncompliant with the rehabilitation regimen and was transferred to our institution for specialized management. On initial exam the patient presented with flat affect, poor eye contact and tachycardia. We continued Modafinil, started at the previous facility, at the initial dose. In the setting of tachycardia we added Amantadine for increased initiation. As a result of albulia the patient exhibited poor PO intake and was eventually given a 1 liter bolus and abdominal binder for orthostatic blood pressure.

Setting: Acute inpatient rehabilitation, traumatic brain injury unit.

Patient: A 69-year-old male with abulia after traumatic brain injury Assessment/

Results: Immediate pharmacologic results were observed as increased participation, slight improvement in affect and compliance which lessened before the next dose. He required additional encouragement for medication compliance, however began showing improved participation and interaction. He was discharged on Amantadine and at follow-up motivation and affect improved.

Discussion: Abulia, or lack of motivation, may be seen throughout acute rehabilitation stay in patients who have sustained traumatic brain injury. It may impede treatment as patients lack initiation, refuse medications and may have poor oral intake. We observed improvement in motivation and compliance with a combination of Modafinal, a stimulant, and Amantadine, a dopamine agonist, and with face to face prompting and reassurance.

Conclusion: In traumatic brain injury patients with abulia, two pharmacological agents and supportive measures may have to be initiated to create a significant change in initiation.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/the-unmotivated-patient-managing-abulia-after-traumatic-brain-injury-a-case-report/