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Why do we do what we do, day to day? Getting up on dark winter mornings, sitting through tedious meetings, and doing all the rest of these things that are part of the grind of everyday life? Sheer habit plays a part, but habits tend not to continue indefinitely unless there is some reinforcement from time to time. The monthly pay cheque is one example, but professional successes and the recognition and status that go with them are also effective, among other things.
When someone suffers damage to the brain, whether through trauma or disease, many things happen to them, but perhaps among the less recognised are the loss of rewards in their lives: jobs evaporate, social and leisure activities are curtailed, and relationships—sometimes even with those closest—are diminished or even lost. This creates an enormous challenge for motivating patients to engage in the …