- [Tom] Welcome, everyone, to Wednesday Nite @ the Lab.
I'm Tom Zinnen.
I work here at the UW-Madison Biotechnology Center.
I also work for UW-Extension and Cooperative Extension,
and on behalf of those folks,
and our other co-organizers,
Wisconsin Public Television,
Wisconsin Alumni Association,
and the UW-Madison Science Alliance,
thanks again for coming to Wednesday Nite @ the Lab.
We do this every Wednesday night,
50 times a year.
Tonight it's my pleasure to get to introduce
to you Lyn Turkstra.
She's a professor in the communication sciences
and disorders department in the college of
arts and letters, nope, letters and science.
Lyn was born in Dundas, Ontario, and she
was educated at Trent and at McMaster.
She wrapped around Lake Ontario there
and got her PhD at SUNY Buffalo, now known
as the University at Buffalo.
Nope, she got her Masters degree there.
Got her PhD at the University of Arizona,
and then spent some time at Case Western Reserve,
before she came here.
This week is "Brain Awareness Week."
It's a really good thing to be aware of your brain.
Everything from stroke to concussion
to how wonderful things work, and how plastic and...
Yeah, how good the brain... (audience laughing)
That was intentional.
(Tom and audience laughing)
When I was a kid, we were taught
that you only had so many brain cells, and the brain couldn't
regenerate or really couldn't get better,
and I think we know better now than we do.
I think learning about brains through the
acquisition of language and recovery of language
after an injury is going to be pretty interesting
thing to hear about.
Please join me in welcoming Lyn Turkstra.
to Wednesday Nite @ the Lab.
(audience applauding)
- Good evening, everyone.
How's that audio?
Great, thank you.
It's an honor to be invited here to present
at Wednesday Nite @ the Lab,
and to see so many of you who, as Tom said, are really
interested in knowing about your brains.
How many of you have a brain?
(audience laughing)
Good. Hang on to it.
It's really important.
My first, so I'm going to talk a little about my
journey, which is shown here in pictures,
and I'll come back to these pictures as
I talk today.
So this is in honor of Tom.
(audience laughing)
Helmets are really important.
Why don't people wear them?
I don't understand it.
It's kind of a mystery.
So I refer to the spring at University of Wisconsin
as recruitment season for my lab.
So I study brain injury, and it's possible to get
participants from right at the corner of
Charter and Linden, sometimes.
Some of you might have seen last year that
campus police posted videos of two crosswalk
accidents, one bike, one pedestrian.
I showed them to all my students,
but fear doesn't really compel people to wear
helmets all the time.
If you feel self conscious wearing a bike helmet,
that's a really handsome helmet, you could wear
a H?vding, I don't know if some of you might
have heard of the H?vding.
This is an inflatable helmet that has
accelerometers embedded into it, so it looks like
a sort of a scarf around your neck, unless you're
falling, and as soon as it detects that you are
rapidly falling towards the ground, it inflates.
So the H?vding is now commercially available,
and designed specifically for women who want
to wear their hair like this.
(audience laughing)
You can't get a helmet on top of that.
The bike rental program on campus also drives
me bananas because there's no helmet rental.
So even more people are riding bikes
with no helmets.
So if you don't want to wear a H?vding, you could
also wear something that just looks like your head.
(audience laughing)
That's actually a helmet with an ear painted on it.
So when people say to me, especially teenagers,
I don't want to wear a helmet because I'll look like a dork,
I always say, you know if you have
a severe brain injury and you're drooling,
that will look less attractive than a helmet.
So, yes, so a helmet is not going to prevent
a person from having a brain injury altogether,
if they have a really bad fall,
but most falls from bikes aren't really bad falls,
they're just small enough falls to do some damage,
as Tom knows well from his concussion
...last week.
For those of you who didn't know
he had a concussion a couple of weeks ago,
and was kind of out of it.
Right, Tom, wouldn't you say?
After your concussion?
(Tom inaudibly answering)
(audience laughing)
You were a little... - [Tom] Addled?
- [Lyn] I didn't say addled!
But you were affected by your concussion.
(Tom inaudibly answering)
Right, so concussions in the news...
(Tom inaudibly answering)
Right, and language.
Pardon? What was he wearing?
Weren't you wearing a bike helmet?
- [Tom] I broke my bike helmet.
- He broke his bike helmet, which is great.
That means the bike helmet protected him.
I mean, it's not great that he fell hard enough,
but the fact that it took the impact and broke
is actually a really good thing, because otherwise
you might not be here talking to us today,
you might be in my study.
Yes, so everyone's talking about concussion,
and we think about brain injury as something that
affects young people, because the concussion talk
is all about youth sports and football, but
the fastest growing age group of people with
brain injury are over 65.
So, that is actually, for the first time last year,
is taking over being the biggest demographic
of individuals with brain injury.
And I used to think, when I was younger, probably,
oh, over 65 is probably falls in the elderly.
This is an expression everyone said:
falls in the elderly.
But it turns out that a lot of people are doing
higher risk things and being more active older,
and so, and maybe not having the greatest
reflexes, and so it's not just falls, it's everything,
also people who wouldn't have survived
years ago are now surviving into older age,
if they've had a brain injury younger.
So we have a really big population of older
people with brain injury, about whom
we know nothing.
So there's no rehab literature, there's very
little outcome literature.
I have a post-doc in my lab, Lindsey Byom,
you may hear from her if you're affiliated with
any organization in the community because she's
looking for community organizations hoping
that they might include some people over 65,
because that's her main area of interest.
So, that's my plug for Lindsey.
So, enough about helmets and Tom's concussion.
So, in the spirit of Wednesday night at the lab,
and talking about your journey,
this is kind of the beginning of my journey.
So as Tom said, I went to Trent University in Ontario,
small liberal arts school.
I'm a huge fan of a liberal arts
undergraduate education.
I have an undergraduate degree
in French literature and language,
and it stood me in very good stead in my later career.
So that's where I started.
And I went for career counseling,
and was told to be a speech language pathologist,
and is anyone here Canadian, by any chance?
Canadian? Everyone's American?
So Canadians have a reputation of being compliant,
so when I was told to be a speech language pathologist,
I did. (audience laughing)
I'd never heard of it, but it sounded good.
So, in the course of preparing,
I took some undergraduate courses at McMaster
University in Hamilton, Ontario, it's close to
my hometown, and then as I was getting ready
to go to graduate school, I had an opportunity to
volunteer in the clinic of a neurosurgeon,
Dr. Andrew Talala.
It was a complete fluke.
Dr. Talala's son wanted to go to law school.
My dad's a lawyer, and I was interested in medical things,
and so they exchanged children for the summer.
(audience laughing)
So Dr. Talala's son worked in my dad's practice
and I got to work in the clinic.
It was a pretty amazing experience for
an undergraduate student, as you can imagine,
and now it wouldn't happen, because students
really aren't allowed to observe in the operating
room anymore, unless they're medical students.
That's actually been really a shame for my
students, and for people like me, who just
learned an amazing amount.
So, I was allowed to observe these awake
surgeries of patients who had movement disorders.
So, patients who had multiple sclerosis,
who had tremor, children who had cerebral
palsy, who weren't able to eat properly,
and my job in the operating room was to
hold the patient's hand.
And so as I mentioned, these are awake surgeries,
and these photos are not of the surgery I
observed, these are much more recent, so here
is a surgery for a patient who's having,
who has a head frame, a titanium frame attached
to his head, there's an electrode that's being driven
into the brain, recordings are made, and then
the brain is stimulated.
This photograph right here is actually from
the Cleveland clinic, and this is my husband
right here, who is right there.
If he snores, just...
(audience laughs)
He's heard all this before.
My husband's a neurologist, Irwin Montgomery,
and he does deep brain stimulation surgery,
so it was not his OR at the time, but I wanted
to put the picture up.
So the technology at that time was cryosurgery.
You put this probe into the brain and then froze
parts of the brain to kill them.
That helped a lot of patients with movement disorders.
And so what I did was, I held the patients hand,
and when they felt their lips were tingling,
then I needed to report to the neurosurgeon
because he knew he was near the internal capsule,
which is a major motor pathway going from
the brain out, and then they would stop the cooling.
So a lot of responsibility for a 20 something,
but I got really hooked on the brain.
So I found the brain totally fascinating.
And I saw it!
How many people get to do that before they
start seeing patients?
I saw brains.
And so I learned brain anatomy from line drawings,
and then there were these beautiful sections,
so this is a lateral view of the brain, like so,
the eyes would be on your left, and these are
all the white matter tracks, are the pathways that
connect different parts of the brain.
And this is a just a beautiful dissection from
Wilder Penfield, from the 1950s.
So that's an actual brain specimen, where they've
taken all the neurons out and just left the
white matter pathways.
Nowadays, students are seeing this kind of thing.
So this is a diffusion tensor imaging.
It's tractography, so it's showing how water is
diffusing along those white matter pathways
in the brain.
This is a superior view looking down on the brain,
and the pathways are color coded by their
direction, and so for students today learning
about the brain, to me, is so much easier than
it was when I was looking at a line drawing,
because they're looking at these three dimensional
images, but we also know a lot more, so what you
have to know has increased just incredibly
since that time.
If you're wondering where your brain is,
this is from body worlds.
Has anyone been to the body worlds?
You've been to the body worlds exhibits?
And so these are plastinated specimens.
Plastination means they exchange the intra
and extra cellular fluids for silicone, so they
are exactly as they were in situ, but you
can handle them, and they're fixed.
And so this is a human minus the body.
So this is a human nervous system.
You can see the brain at the top here,
and then the spine.
And these are all peripheral nerves, the nerves
that go out to your arms and legs, and some that
have a really long and stressful journey from the
middle of your back to the bottom of your foot,
by way of your backside.
So, you're sitting on those ones all day, and
that's what makes it a really difficult journey for them.
Very stressful.
You might think, like I did, that the brain goes
a long way down the back, but if you feel the
back of your skull, there's a little ridge right
at the back, that's actually the base of the brain.
So it's called the nuchal ridge, that bone,
and your whole brain is sitting on top of that.
So it sits pretty high up in your skull, and it's
smaller than you might think.
It's only about three and a half pounds, and
actually, bigger is not always better, when it
comes to the brain.
You don't really need extra.
I'm saying that specifically for my husband.
His brain is larger than mine, but...
(audience laughing)
He does have a little extra arm of his inferior
frontal gyrus, and that's not necessarily
a good thing.
And women have slightly bigger brains than
men, when body size is factored in.
So men have bigger brains, and that used to
be thought to be why men were more intelligent,
but it turns out that they are just bigger.
Their brains aren't that bigger, proportionally.
So, anyway.
That's where the brain is, up there,
sitting in the top of your head,
weighing about 3 1/2 pounds,
if you're lucky.
So, my main interest is in what happens when
there's damage to the brain.
This is clinical neuroscience.
So basic neuroscience, a person might be
interested in knowing how the brain works
just for understanding the brain, you know,
how do we develop this incredible brain,
how do the pathways form,
how does one side of the brain control the
other side of your body?
I'm interested in all of those things, but because
I want to help and understand people
with problems.
And this photograph here, this image here,
is from Bob Woodruff.
You might know him, he was the NBC reporter
who was embedded with troops in Afghanistan
and an IED went off, and he had this injury.
So you can see here that the left part of his
skull is caved in.
He, at one point, you can see this online,
at one point he had a big skull defects, fore
and aft, where they had taken, removed these
parts of his skull.
You can also see in this image that there's
a fracture, right down here, and in this image
you can see it here, it goes right through
his orbit, so it's pretty amazing that he has vision
in that eye, when you consider the bones all
around the eye are damaged.
And he's a fascinating person anyway.
He spoke five languages, and was incredibly
fluent before he had this happen to him, and
you may have seen him back doing some NBC
reporting since.
So he had language problems after the injury
because the left side of your brain is involved
in language, and it's just incredible to me that
he is back speaking.
Yes?
(audience asking inaudible question)
Oh, I'm sorry, you're looking at a reverse image.
Sorry. Thank you, Tom!
I'm sorry, yes.
It's a reversed image.
So he actually had damage to the left side of his brain.
I'm a little left right disorientation.
I have to forewarn you.
Yes, it's the left side of his brain that was damaged.
The image is flipped.
So this is the typical person I see.
So, this is a brain scan.
It's a horizontal section, so it's sliced across
this way and then flipped up.
Eyes would be at the top, the back of the head
would be at the back, above the head would
be this way, and the spinal cord and body
would be going away from you.
So on your left you can see a
good-looking brain.
So a good looking brain fills the inside of the
skull but is not under pressure.
You can see these spaces here where there's
dark fluid, those are the ventricles of the brain,
they're filled with cerebrospinal fluid.
You can also see cerebrospinal fluid goes
around the outside of the brain.
So this is really a nice looking brain.
This is a brain after a traumatic brain injury.
And you don't need to be a neuroradiologist to
spot that things are not the same on the
right sided brain as they are on the left sided
brain, and you can see that there's a lot of
damage to this part of the brain, and that's
true of many people I see.
And the reason for that is that many people
I see are injured in motor vehicle accidents,
and in motor vehicle accidents you go this way.
So, the car stops, then your body stops,
then your head stops, then your brain stops,
not all at once.
And so the damage in a motor vehicle accident
tends to be like this.
So front and back of the brain.
I also see people who have been assaulted and
had other causes of brain injury and don't have
that kind of damage, but that's not unusual for
the people I see, and so my quest for the last
20 something years is to figure out what the
effects are of this
kind of brain damage, and what we can
do to help.
Well before last year, the biggest group of people
who had brain damage were teens.
And adolescents are fascinating to me.
They may not be to you, if you have them at home.
(audience laughing)
And I appreciate that.
But, they really,
they're just,
I don't know.
They're very strange and interesting.
The adolescent brain is still developing.
So this is from a laboratory at the NIH,
Jay Geed is the PI.
They're doing a big cross sectional and
longitudinal study on brain development.
And the point of this cartoon, with the color
changes, is just to show things are still happening.
So these are areas of the brain that are developing
from age 5 to age 20.
And you've probably heard quite a bit in the
popular press about brain developing
continuing into your 20s.
It's been discussed a lot in regard to
criminal culpability, so whether someone
who's 18 or 19 can truly be responsible
for their actions, if their brain's not
fully developed.
It's also used in the context of the
aforementioned people still living at home
in your house.
So you might say,
"When are they going to get out of my house and be adults?"
But it turns out they're not really fully mature
brain-wise until their 20s, and so that's
the excuse of some teens and young adults
for still living at home.
Their brains aren't fully developed.
So it's a really pivotal time for injury, though,
because the brain's still developing.
It's not like an adult, where you have a
lifetime of knowledge and experience and
skills, you still need the brain to build that
knowledge and experience and skills.
So I was very interested in understanding
what happens in an adolescent brain when
it develops.
And one thing about adolescence that makes
it even more challenging to study is that
adolescents are so different from each other.
So these four are all the same age.
And you might remember, when you were an
adolescent, which one of these you were.
I think we were all probably different in
how we developed.
I know there was a boy who was in seventh grade
who had a full mustache, when I was in school,
and I'm sure there was...
Sorry, was that someone in the audience?
Was that you, Tom?
(Tom answering inaudibly)
That's what I was just going to say!
And there are people who still, to this day,
probably can't do a full mustache.
And so, they are really variable.
Another thing, and this picture is from Laurence
Steinberg's textbook, "Adolescence."
Laurence Steinberg, actually,
was a faculty member here many years ago.
He's at Temple University.
And so, the other point of this photograph
is that they're talking to each other, and so
communication in adolescence is everything.
It doesn't matter, maybe it's social media,
maybe it's just talking to the person sitting
beside you, god forbid, instead of texting
each other, from sitting next to each other.
But, communication is really important.
And so the potential problems with an injury
at this age are really important problems.
So just to give you an idea of how brain injury
might affect communication, I have a video clip
here from Gary Busey and David Letterman.
You can tell the age of the clip by David Letterman's hair.
So this is just a little clip and I wanted to,
hold on a second here,
I'm showing it to give you a sense of how
it can be a challenge to capture how
communication ability might change when
someone has a brain injury.
So, if someone has a left hemisphere stroke,
and has a language problem, it's called aphasia,
a language problem, it's pretty clear what that is.
People have trouble finding words, they might
not understand what you say.
This brain injury thing is a little bit of a
different situation, so let's see if we can
get Gary Busey here.
Oh, I'm sorry, does anyone know why I picked Gary Busey?
(audience member answering inaudibly)
Exactly!
So Gary Busey's an actor in Hollywood.
He was on The Apprentice, and Celebrity
Rehab, if anyone's a reality TV fan,
and he had a horrible motorcycle accident
just before this.
So, this is...whoops.
- Look at that!
- We'll be right back here with Gary Busey.
Gary Busey is here, and what the heck were we talking about?
Oh I know...
- Pros and cons of junior high football.
- Huh?
Pros and cons of junior high football.
- Now what does that mean?
- That means what's good about it, what's bad about it.
(audience laughing)
Wear a helmet when you play football.
- You know what, congratulations on the success
of this movie, "The Bear."
That's really terrific.
- "The Bear?" - Yeah.
- "The Bear?" - Right.
It's like the number one box office deal now.
- Where are you living? (audience laughing)
- Isn't it?
- That's not me, that's a real bear.
The bear you're talking about is,
it's about coach Bryant.
I wrestled the bear.
You could have had a V8?.
- Yeah. I remember that.
Now that was you, I remember that.
- I wrestled a bear, I wrestled a bear, and this wasn't easy.
- This was a stunt that Bear Bryant did?
- That's how he got his name. He got it in the Depression.
They sent these bears around and you
wrestled them to make money,
and the way you got in for free was saying,
"I'll wrestle the bear."
- [Lyn] So the interesting thing about...
I'm sorry, it seemed really quiet to me.
Did it seem really quiet to you, too?
Is that as loud as we can make it?
Oh, I'm sorry for television, that's
as loud as we can make it.
I apologize if you weren't able to hear it,
but the way Gary Busey's speaking,
his grammar is fine, his speech is clear,
he doesn't have problems finding words,
it's just not all completely coming together.
And so, at the beginning of the clip, David
Letterman says something to him, what were
we talking about, and Gary Busey says
football, which they weren't talking about,
and then he said you need to wear a helmet
during football, which was kind of related to
their previous discussion, which was about
Gary Busey's accident and whether he was
wearing a helmet on his motorcycle.
So it's connected, but it's not
tightly connected.
And so that's the problem.
So it's hard to say what it is about it
that's not quite right,
and that's the big challenge for many people,
certainly not all people with brain injury, but
many people with brain injury, is being able
to put your ideas together in a way that
makes sense easily to the other person.
This might be a little bit easier.
This is from one of our research participants.
He's describing his values and how passionate
he is about knowledge.
He says it's very important to help spread
good values, meaning good fortune, to increase
the knowledge to the families and friends
around us. Go back a few blue moons when
I was just beginning to get out of a coma
and going to rehab, they were being too
overly nice and easy, but I wanted to be
able to give back.
I didn't want to give above their prosperity.
So, see what I mean?
You could probably figure it out.
You get the main idea, right?
You get the general idea.
He's saying something about he wanted
to help, he wanted to be helpful,
and he didn't want people to take it easy
on him and he wants to give back, that's
the message, but for the person listening
to that, it can be really frustrating.
So the language of people with brain injury,
this is TBIs' traumatic brain injury, so the
language of people with traumatic brain
injury has been described as tangential,
sometimes egocentric, talking only about
themselves and not really asking the other
person how they're doing, sometimes vague,
off topic, stuck on one topic, changing topics,
lot of different words that make it hard to
figure out what the problem is.
And people who communicate with individuals
with brain injury sometimes will say that doing
that is just more work than usual.
And so fatigue by family members is a common
consequence of brain injury, and if family
members find it's work to talk to their loved
one, they just might not do it as much,
and if other people in the community find it's
work, they also might not do it as much.
And it's not surprising that social isolation
is one of the biggest consequences
of brain injury.
And loss of friends, loss of employment,
there're all kinds of really big, negative
outcomes from having these
communication problems.
You can have a spinal cord injury and be
paralyzed in both legs and be employed
and be a supporter in your family,
you can even have a memory impairment
and still maintain your friendships and
relationships, but having this kind of cognitive
impairment where you have difficulty expressing
your thoughts and understanding what other
people are saying, that turns out to be the most
significant outcome from brain injury.
Worse than all of those other problems.
And probably the least studied, I think because
it's hard to get your hands around it.
So that was my question is why does this happen
after that kind of brain damage?
So, in my lab, we've been trying to make the link
between that brain damage and that language
sample, and figure out what's causing it.
And how can we help.
So because I am,
I should have said this at the beginning,
because I'm trained clinically as a speech
language pathologist, I want to know how
can we help the person meet their needs, and
how can we provide support so they can be
successful, be employed,
not be socially isolated.
And so, in my lab, we're looking not only at
the mechanism of those communication
problems, but also the bigger picture.
What is it that a person needs to do to be
able to fit in in the world, and how can
we support that?
In terms of communication needs, I put
this up, this is from one of my former PhD
students, Peter Meulenbroek,
he's now going to be a faculty member at
University of Kentucky, and Peter did a study
of communication at work.
So he interviewed people in mid level employment,
so that's like when you have training, but not
advanced training, so it would be a nurse's aide,
or Peter's parents are florists, so florist would
be in that category, I think people might have
called these pink collar jobs in the past.
So it's called semi professional employment,
so you need some training.
And it turns out those are the jobs that
people with brain injury are most likely
to return to.
So, if you have a mid level job, your boss
has probably trained you and your workplace
is invested in you, so they're more invested
in you coming back, and you might also
be able to do that job.
So if you were a lawyer before, a mild brain
injury, if you were a lawyer before a severe
brain injury, and you have mild problems, let's
say you were a barrister and you were arguing
in front of the court as a trial attorney,
you might need to be so fast on your feet
with words that a small problem might mean
you can't go back to work.
And so this semi professional employment
is a really common category.
So Peter went out and interviewed people
in that category and just asked them
what do you use words for?
And he looked at the content of what you
had to say, the audience you talked to,
what kind of talking you were doing,
your goal, and the environment,
and that's just to show you the codes,
but this is just to give you an idea of what
you have to do.
So these were just from people working
at mid level employment.
You don't need to be able to read them,
it's the number of them that's so astounding.
The number of things you have to be able to do
to communicate successfully in the workplace
is incredible.
And think now about multimedia, so you're
not just talking.
You're talking, phoning, texting,
facetiming, tweeting, emailing,
you're talking to people on a speakerphone
with a big room, you're talking FaceTime? because
you're having a business meeting across
different venues, or a multimedia chat.
You're switching among all these
communication partners.
Now you're talking to people all around the
world, and in an instant.
Not when you had the certain people you worked
with and it was predictable.
And in those contexts, especially in our current
sort of service influenced economy, you're having
to perform a lot of functions.
So, persuade people, sell to people,
get along with people,
collaborate, cooperate.
It's kind of a miracle that any of us has a job,
if you consider all this.
So that's the need, so we realized that people
need to be able to communicate in very
complex and sophisticated ways, and those are
the things we've built into our research, so that we
don't just do a task where we have someone name
objects, because most people don't have to
do that at work.
Just my students, sometimes.
Also, I created this really busy model of what
I think goes into doing all those things.
So this is my, what I think is in that question mark,
and I'm not used to...
I'm used to walking, so I'm trying to use the
mouse here, but I want to walk over and point
things out to you, but I can't do that.
I can do that?
Okay, so in this model,
this is just what's in my head, in my brain,
it might be true or it might not be true.
In this model, there are things you have to
do to communicate socially.
So when you go into a social situation like this,
you have to read the room.
So I have to look around here and figure okay,
there's one person who's under 12 here,
so I have to make sure that I don't swear,
and it might be on TV, so I'm reading the room
which means I'm thinking about the situation,
myself, and who the listeners are.
Then I have to think about what I'm going to say.
And then I have to think of all the options of
things I could say, decide on one, and do it.
So that seems pretty straightforward.
However, to do those things,
I need all of these cognitive functions.
I need to be able to see you, and hear you,
I need to be able to pay attention,
and not get distracted by some noise maybe in
the background.
I'm going to mention social cognition in a minute.
I need to control my behavior, so if I do want to
swear, I need to not swear.
Everyone who works in brain injury swears,
I think, because, I don't know, we're the rugged
end of speech pathology.
(audience laughing)
Working memory, I need to keep what I'm
saying in my head so I can stay on topic.
I need to remember the content of what I'm
talking about.
I need all these procedural habits, like I need
to know how to operate a computer, and know
how to walk, and know how to point,
and then I need motor skills.
So I need to actually be able to articulate
my thoughts.
All of those things have to come together
in a millisecond.
And not just one millisecond, but millions
of milliseconds over a word, over a sentence,
over a paragraph, over a day,
over a dissertation,
over a whatever huge chunk of communication
we need.
And then on top of that, are what I called
metapragmatic skills, which means you know
yourself what you're not good or good at.
It's something you learn as you grow up.
One of my colleagues said that she always
eats chocolate before teaching, because then
she has unconditional positive regard
for her students.
(audience laughing)
So you have to know these things about yourself,
and you have to know that there are different ways to behave.
So you know when teenagers,
when they're in school, someone will say
this is how you act in a job interview,
you need to know that that's an option of
behaviors you could have.
Or you need to know that there are consequences
of your behavior, for example, if you email me
and say your classroom location is inconvenient
for me, could you move it so that I don't have
to walk so far, you should probably know that I
will not necessarily be that enamored with you,
as undergraduates have done in the past.
Because our building, goodnight hall is
in the middle of nowhere, so students would
email and like that's really inconvenient,
could you hold class somewhere else?
No, I can't.
I can't hold class somewhere else.
You need to know your own strategies,
like chocolate, so if you're,
I don't know if any of you are not that
comfortable with public speaking, or maybe
you don't really like going to a party,
or maybe you really do like a party, you know
your own strategies, and you use them.
So this multi piece thing is what underlies
every social word we say,
and you can see why it's fragile.
So you can have a problem in any of these
areas and communication can break down,
and it doesn't have to be brain damage.
If you're tired, if you're multitasking,
if you're overloaded and stressed.
I always say that I'm a much better speech
language pathologist at work than I am with
my husband at home.
I don't always practice what I preach.
And my husband has a binaural hearing loss,
and so sometimes I'm just tired of saying
things over.
Which is really bad.
(audience laughing)
It's really bad.
But that's not, I mean, you just get tired.
Anyway.
And so, but especially for my last few minutes,
I want to talk about this last bit.
This is social cognition.
So this, all the other stuff we studied for years
in my lab, and we've looked at how it affects
communication, we know some things about
how to help people when they have that problem,
but this was new to my lab a few years ago.
And it really came from research in autism,
and it is a good lesson for me about looking
outside of my little silo for research that other
people are doing.
And I apologize because my type fonts got changed
in this presentation, sorry,
and I just noticed this now.
Social cognition is defined as
the types of thinking we use to
process the social world.
That's a short definition.
It's not a very helpful definition at all.
But, it includes processes we use to understand
other people, so just what I was talking about,
to read the room, to read people's emotional
expressions, and also, something called
theory of mind.
I love these two little guys.
So theory of mind means I know you have
thoughts and your thoughts are different
than mine, and this is a core deficit in autism.
A deficit in autism, or something that people
with autism cannot do very well, is to appreciate
that other people have separate thoughts,
and that because I'm mad doesn't mean
you're mad.
Or because I'm happy doesn't mean
you're happy, and also because you show that
you're happy on the outside doesn't mean
that you're happy on the inside.
That people can be deceitful.
So these are all aspects of theory of mind.
The second part is how we understand
ourselves, so getting in touch with our feelings.
And the third part is what we know about the world.
For example, this is a picture I found on Google
for burping.
(audience laughing)
So this person knows you're supposed to
cover your mouth when you burp.
So that's social knowledge.
And in my lab, we study this.
So we're interested, we've been looking at
emotion recognition and theory of mind,
with the idea that if a person with brain injury
has trouble reading the world, how can they
do anything else?
They can have the greatest memory, but if they
can't tell when they're supposed to act
appropriately, how would they know what to do?
So, so much therapy in speech language pathology
has been aimed at improving social skills, but
how can you have a social skill if you don't know
when you're supposed to use that skill.
And the way you know when is by reading other people.
So these are emotional expressions.
I know, Tom, you started with talking about
what was going on in the primaries.
So what do you think President Obama
is feeling here?
What do you all think?
Right.
This is like the Rorschach for disgusted,
depressed, sad, and how about
I was going to say Prime Minister,
how about Joe Biden?
What do you think Joe Biden's thinking?
Yeah, right. He is.
Or he's thinking, "Did I just say that? I did.
"I did, didn't I? I just said that."
(audience laughing)
Right, so these are emotions shown by facial
expression, and so we studied that.
One note I just want to mention here is that
much of our facial expressions, as you can see
by these photos, are in the forehead,
and if you have too much Botox in it,
people don't know how you're feeling.
(audience laughing)
This is a video I'm going to show just to show
theory of mind, and so the question we would
ask in this video is, and I hope you can hear it,
the question we would ask is,
this was a young woman on the left, and this is
a boy on the right, they're all much older now,
probably 10 years older than this, and this is
the question.
- Are you on the 32nd level?
- Yep.
- Take a left.
Jump.
Take a right.
Grab that.
Jump.
- [Lyn] So, perfect, thank you.
Does she want the advice?
(audience laughing)
No.
So that's how we test theory of mind.
So you guessed what she was thinking, based
on her facial expressions, and the scene.
So you looked at the whole scene.
I have to give props to this pair.
There's nothing on the computer, it's not
turned on.
So, this was all improv.
Because I was working with adolescents,
they shot all my experimental materials.
We just shot our second round in Montreal
in the fall, in English and French, which
was really a hoot.
Teenage actors...
So it turns out that the parts of the brain you
need to be able to do that kind of social thinking,
are in these locations like the front of the brain,
here, the frontal lobes, and also parts of the
parietal lobes, that tend to get damaged
in brain injury.
And so, this was really a surprise to me.
I had never thought that a problem for some
individuals with brain injury was reading
other people's thoughts.
I just assumed that if you grow up with it,
you couldn't lose it.
I mean, how can you lose something that you have
that's so critical to everything we do?
But no matter how we tested in the lab, it seems
that it's possible that you could lose it.
So often we test it, we ask people to look at faces
like this and guess what they think the person
is feeling.
We also use tasks that are part of an emotion,
so it's not a full emotion, it's just maybe two
thirds to see if it's harder for people when they
don't see a full big smile, or a full frown.
Just to show you what that looks like,
that's one of our morph tasks.
So we ask--
People have to make a decision
about when they know what that means.
So we've shown, using these kinds of tasks, that
people with brain injury, generally speaking, do a
little bit worse than typical adults.
These are all adults now.
And that having more information doesn't help.
So 100 percent means the full facial expression,
that there are some people with brain injury,
it turns out about a third of people with moderate
to severe brain injury who can't really read
other people very well, just in terms of their
basic emotions.
This is the difference between people without
brain injury and people with brain injury,
but also men and women.
And I'm sorry, men, this might not come as a
surprise to you, that women have a slight
advantage in reading emotions in men,
and it turns out, also, that women with brain
injuries are about the same as men
without brain injuries.
(audience laughing)
Sorry.
We found something similar in
theory of mind, so the reading other
people's thoughts.
We see, generally, a female advantage
after brain injury, and males with brain injury
take the biggest hit.
Also, relevant to, I mentioned Lindsey Byom,
the post-doc in my lab, older adults take a
bigger hit than younger adults do on the
same stimuli, especially older men.
So other things, this is just a run through
of some things we've discovered.
The face thing has been really interesting,
but I'm also really interested in words, I mean
that's what I do, I'm interested in words.
So we found that, for example, how you rate
someone's emotions depends on what
they just said to you.
So you can see the same face, and if it was
preceded by a positive word, you think it's a
positive face, and if it's a negative word, you think
it's a negative face.
So what people say really influences how
you read them.
And that is for good and evil.
So sometimes you can misinterpret what
someone's saying, or misinterpret a face
because of what you heard.
We also found that when we analyze the
language of people talking to really close
friends and found that there are these social
cues in words as well, not just in faces,
but in words you say, and that many people
with brain injury were missing a lot of those
social cues that are implied in text.
For example, if I say, yes I'm going back to the
doctor, then you know that's a doctor I've
seen before, because I said back to.
People with brain injury might not get those cues.
We also found out,
down here, we found that there are some
even cues at the level of individual verbs,
that some verbs tend to go with a subject of a
sentence, and some tend to go with the object,
and that people with brain injuries make a lot
more mistakes in attributing which way
the verb goes.
These are all social rules and conventions
that we just have, and we don't even really know
when we learned them.
I put here a nod to my collaborator,
Bilge Mutlu.
You might have heard about the science narratives
that are going on on the UW website right now.
I put the link in here.
They're really kind of fun.
The first series of narratives are focusing on
Bilge's work with robots, and Bilge is my
collaborator, so we're studying how people
respond to robot cues, because you can't
get a human to look in one place for so
many milliseconds.
I can't control them,
so we can control the robots.
So there's our robot now, listening.
So it came all the way back to language.
I started in language in French literature,
went through this pathway, and ended up coming
all the way back to language again,
in social language.
A last few things that we learned that are
things that make you think about what kind
of supports a person with brain injury might need.
One is that charisma
is something that people have, and that really
influences how socially accepted people are,
brain injury or not.
And that's not something we can teach.
Corinne Jones face up here, because
she gave a talk today for Brain Awareness Week,
earlier today.
Corinne is a neuroscience training program and
communication sciences and disorders dual
degree PhD student.
But she did her masters in my lab.
Also, this is from a paper by my husband and I,
and by a graduate student, Amanda Murphy,
just showing that when people are having a
conversation, there are lots of things happening,
and this timing is happening really really fast,
so the problem might be in timing
of individual behaviors.
I mentioned before that it's not everybody with a brain injury.
It might be just about a third of people,
so we have to figure out why are some people really great,
and how can we use that to help people who
aren't so great?
And this diagram here, this was a study by
Lindsey Byom, just showing,
this was all men talking to men, that when the task
was pretty simple, men with and without brain
injury used about the same number of thought
and feeling words, but when the topic got more
intimate, men, I know to some women this will
be a surprise, but men used many more thought
and feeling words when talking about more
intimate topics, and men with brain injury
didn't use so many.
So this reading other people might actually
show up in how you talk to other people, and
might tie back to why some people refer to
individuals with brain injury as egocentric.
Because they might not use
as many thought and feeling words in conversation.
All of that, this complexity, the multiple factors,
the fact that something like charisma can't
be taught, have made me think that perhaps the
best thing we can do to improve social outcomes
for people with brain injury is not try to fix them
at all, but help other people communicate
better with them.
It's a real burden on a person with a cognitive
impairment to expect them to adapt all
their behavior to you.
And so one of the things we did when I was on sabbatical
in Birmingham, Alabama, was
we developed a family training
called "Say What You Feel, Say What You Think."
So that family members can learn to just say what they're feeling
so the other person doesn't have to guess,
doesn't have to figure it out.
So instead of saying I had a hard day, say
I'm tired because work was really difficult today,
and that means I don't want to talk right now.
That could be a lot, make for a much more
successful interaction with a person with
brain injury, instead of expecting that they're
going to practice, practice, practice reading
you and get better at it.
So far we don't really have any evidence
that that works.
We're all practicing, all the time.
So it's a cliche, but,
we have a long road ahead still to try and
figure out this puzzle of the brain,
and how it works in social situations,
and how it responds to injury.
But I'm really encouraged by what we know so far,
and really how much I think we already can do
to support people with brain injuries,
and all of you and your brains.
So I want to finish with thanking my crazy lab.
Here's Bilge Mutlu.
If you see him on the street, with or without a robot.
My collaborator, Melissa Duff, who's at the
University of Iowa, and Kristina Visscher at the
University of Alabama at Birmingham.
And I put up this picture here, this is Kevin Pearce,
some of you might have heard of him.
He's a snowboarder who sustained a severe
brain injury in the run up to the Olympics
in Calgary, sorry, Vancouver Olympics,
and Kevin Pearce created a fantastic film called
"Crash Reel."
It's on Netflix? and HBO?.
I recommend if you have a chance to see it,
about brain injury and also about extreme sports.
But I put his picture there because we're not
allowed to list names of participants anymore,
to protect their privacy, and my greatest thanks
are always to all the people with brain injuries
and their families who participated in all
of our research studies.
So Kevin Pearce is standing for them today.
So, thank you very much.
(applause)