- [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 Hövding, I don't know if some of you might have heard of the Hövding.  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 Hövding 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 Hövding, 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.  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)