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Ep. 146: Leila L. Hartley, PhD, CCC-SLP - Building a Better Brain

April 27, 2021 Sucheta Kamath Season 1 Episode 146
Full PreFrontal
Ep. 146: Leila L. Hartley, PhD, CCC-SLP - Building a Better Brain
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Full PreFrontal
Ep. 146: Leila L. Hartley, PhD, CCC-SLP - Building a Better Brain
Apr 27, 2021 Season 1 Episode 146
Sucheta Kamath

Even though studies after studies show that more than 75% of job success is determined by soft skills ,which in business refers to effective communication, professionalism and work ethics, critical thinking, teamwork, and leadership, the word soft often undermines its nuanced nature and diminishes it potency. In the neuroscience and science of effective communication however,  soft skills are nothing but a combination of Executive Function, pragmatic skills, and social cognition and they can be taught and learned with a strategic approach.

On this episode, author, award winning speech-language pathologist, and leading authority in brain injury rehabilitation, Dr. Leila Hartley, discusses how after neurological damage to the brain,  difficulties in social and interpersonal communication can create the greatest barrier to returning to independent living and sustaining gainful employment. The discovery of neural plasticity assures us that we can all change our brains, but the work has to be done by ourselves; and competent, caring, and invested speech-language pathologists can help.

About Leila L. Hartley, PhD, CCC-SLP
Leila L. Hartley, Ph.D., CCC-SLP, received her Doctorate in communication sciences and neuropsychology from the University of Florida. She has over 40 years of clinical experience with adult neurogenic communication disorders. She is the author of Cognitive-Communicative Abilities Following Brain Injury: A Functional Approach and other publications in the areas of discourse abilities and functional approaches to rehabilitation following traumatic brain injury. She has a private practice in Atlanta, Georgia.

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About Host, Sucheta Kamath
Sucheta Kamath, is an award-winning speech-language pathologist, a TEDx speaker, a celebrated community leader, and the founder and CEO of ExQ®. As an EdTech entrepreneur, Sucheta has designed ExQ's personalized digital learning curriculum/tool that empowers middle and high school students to develop self-awareness and strategic thinking skills through the mastery of Executive Function and social-emotional competence.

Support the show (https://mailchi.mp/7c848462e96f/full-prefrontal-sign-up)

Show Notes Transcript

Even though studies after studies show that more than 75% of job success is determined by soft skills ,which in business refers to effective communication, professionalism and work ethics, critical thinking, teamwork, and leadership, the word soft often undermines its nuanced nature and diminishes it potency. In the neuroscience and science of effective communication however,  soft skills are nothing but a combination of Executive Function, pragmatic skills, and social cognition and they can be taught and learned with a strategic approach.

On this episode, author, award winning speech-language pathologist, and leading authority in brain injury rehabilitation, Dr. Leila Hartley, discusses how after neurological damage to the brain,  difficulties in social and interpersonal communication can create the greatest barrier to returning to independent living and sustaining gainful employment. The discovery of neural plasticity assures us that we can all change our brains, but the work has to be done by ourselves; and competent, caring, and invested speech-language pathologists can help.

About Leila L. Hartley, PhD, CCC-SLP
Leila L. Hartley, Ph.D., CCC-SLP, received her Doctorate in communication sciences and neuropsychology from the University of Florida. She has over 40 years of clinical experience with adult neurogenic communication disorders. She is the author of Cognitive-Communicative Abilities Following Brain Injury: A Functional Approach and other publications in the areas of discourse abilities and functional approaches to rehabilitation following traumatic brain injury. She has a private practice in Atlanta, Georgia.

Book:


About Host, Sucheta Kamath
Sucheta Kamath, is an award-winning speech-language pathologist, a TEDx speaker, a celebrated community leader, and the founder and CEO of ExQ®. As an EdTech entrepreneur, Sucheta has designed ExQ's personalized digital learning curriculum/tool that empowers middle and high school students to develop self-awareness and strategic thinking skills through the mastery of Executive Function and social-emotional competence.

Support the show (https://mailchi.mp/7c848462e96f/full-prefrontal-sign-up)

Sucheta Kamath: Welcome to Full PreFrontal exposing the mysteries of executive function. Thank you for joining me again, once again, we are looking forward to a fantastic conversation. And remember, thinking about your brain requires you to pause it requires you to really consider Are you taking decisions that come from great effort, great attention to detail, and with a sense of purpose and value, because that, surely is a sign of strong executive function. As you know, in this podcast, we discover how to be effective in managing yourself managing your goals, managing your life, but you're also responsible for managing people and managing relationships. And there are some barriers to doing that. And this is the reason I'm going to tie in the topic of soft skills today. You know, recently, I read an article in Harvard Business Review, which said that close to 48% of the labor force works in the middle employment sector, that can be labeled as middle skills job. And that represents roughly 69 million people in America. What's so interesting, and my guest will agree with me that the term soft skills really doesn't do justice to the skills part of it, but mostly focuses on the behaviors of a part of it. And the soft, may refer to not being in your face, or more. So it's juxtaposed with something called technical skills. So you know, we are talking about, you know, Microsoft Word skills or talking about engineering skills, or talking about in medicine or nursing skills. So there are some specific skills related to the job that you hold, and everything else that requires you to not just show up at the job, but manage the success of the job requires some other set of skills. So my experiences in business, the soft skills include effective communication, professionalism, work ethic, critical thinking, teamwork and leadership. But coming from the neuroscience and the science of effective communication to me, and my guest will agree soft skills are nothing but a combination of executive function, pragmatic skills and social cognition. So long term career success comes from mastery of soft skill, we should not really be so lackadaisical or casual about it, we should really dive deep and understand what is it that constitutes soft skills? And how can we really empower children, adults and all of us as we have more and more life experiences. So that brings me to our lovely guest today. That's Dr. Leila Hartley, she received her doctorate in communication science and neuropsychology from University of Florida. She has over 40 years of clinical experience with adult neurogenic communication disorders. She is the author of Cognitive Communicative Abilities Following Brain Injury: A Functional Approach and other several publications in the area of discourse, abilities and functional approach to rehabilitation, following traumatic brain injury. She is currently in private practice here in Atlanta. She is an award winning, highly respected, amazing mentor to many of us and a brilliant clinician, and a dedicated volunteer. And she has been one of my partners in crime as we have launched a communication training program for homeless community in Atlanta. And she and I have been, along with our another colleague, Rita Lor, we were the task force who put together the entire curriculum. So welcome to the podcast. Leila.

Dr. Leila Hartley: Thank you. Thanks for having me Sucheta.

Sucheta Kamath: Well, I ask this question of all my guests, and this will not be at all difficult for you. But since we talk about executive function, and that's your wheelhouse? Do you mind taking a minute and talk about your own executive function? As a young learner as a child? When did you become self-aware? Regarding your strengths and challenges? When did you develop the skills that require go into managing self and did you have any roadblocks or any gifts that really came handy?

Dr. Leila Hartley: Well, I grew up in a very disciplined structured family with five children. So my mother really made sure we were very organized and that we worked hard. So I'm not sure How self-aware I was early on, although I remember reading the book Cheaper by the Dozen, and the guy is an efficiency expert, and that kind of raise the idea in my mind, hey, you can do things differently. And you can think about things and problem solve them, so that you can be more effective. So that really piqued my interest in how we think about things. And then my undergraduate degree was in psychology. And I learned a lot about human memory and learning. And that really helped me go on to the interest that I have, and how do we improve brain functioning.

Sucheta Kamath: You know, it's so interesting that this is my recent conclusion that every individual should have either a degree in undergraduate degree in psychology or should do some courses in psychology, because that that knowledge can be so valuable just to know that there's some parts of us that we can't access because we don't have that access. Second thing are, you know, you're Cheaper by the Dozen story reminded me that when I was growing up in my father made us read a book called Jugaad Cassava, which means how to behave in the world. And I loved that book so much, because it was literally giving you templates of how to behave in the world, in different circumstances that you may have never encountered. And that has informed my knowledge that, Oh, so you get invited to somebody's house, you need to take something that's a protocol. What if you have not been invited in a while or you, your child, and you don't know that because your parents are taking care of it? You know, so that that was another very interesting. So sounds like you are very open to new experiences. And the structure that you were gifted with really came handy in providing you incredible organization, as you're learning.

Dr. Leila Hartley: Yes. Now, I think I was a little bit weak in impulse control and organization to some degree. But I certainly think I've benefited from my mother's love of learning and approaching new things. And so I was drawn to improving myself always, and to new learning. 

Sucheta Kamath: You know, this reminds me of David Brooks quote, which said, "freedom without structure is its own slavery." So I think that she provided you that structure that freed you up.

Dr. Leila Hartley:  Exactly. 

Sucheta Kamath: I love that. So let's start with this very topic that I think we should really dive deep into. Since you are you studied the science of communication and effective communication of on top of that, what do you what, what feelings do you have towards the terminology, soft skills? And can you help our listeners understand a little bit, the science of communication, and that may be lost in the term soft skills.

Dr. Leila Hartley: Well soft, seems to imply something that means not important are so temporary, or just doesn't really apply, in my mind, to the value that social communication really has in the workforce. Because in terms of what we know about people's success on a job, we know that these communication and social communication is one of the critical indicators of who is going to be successful and who was going to be given promotions within an organization who's going to be seen as a valuable member of the team and get along with others. So I agree that those particular skills are the number one thing that should be worked on, for people to get to be successful in the workforce these days. But I just don't particularly care for that terminology, because it almost implies that it's not so important.

Sucheta Kamath: So can you break that down into communication, as you know, we understand as a listening which is that comprehension piece of communication to understand, comes before you communicate or exchange ideas write, and even when it comes to communicate. There are two pathways you can do it in writing or in spoken language, but there's a third the hidden agenda of nonverbal communication. So how Would you describe that framework of thinking about communication as a made of tiers of skills that can be mastered or need to be mastered?

Dr. Leila Hartley: Well, you've kind of described them all right there that the term communication, people don't really understand the complexity that's involved with it. But really, it's our whole brain that's participating in communication. And as you mentioned, nonverbal communication is such a major component of our ability for people to get ourselves across to other people. And so it's even as high as 90-93% of what we communicate. In fact, you can't not communicate, even just you're standing there, being there is communicating to someone else. And so there's a lot of subtlety to nonverbal communication, that we, that people are processing it without even realizing it. Now, there is there are differences in people, some people, particularly males, we know are not too dense, as well to nonverbal communication from the research. So there is a difference in males and females as a general rule. And that's why there are often some problems in a marriage with communication, or in relationships in general, we women tend to have expectations that men will just read our mind our read our emotions, and what we say and we have to be more explicit. And so one thing in the workplace is to, for people to be explicit in what they are aiming to communicate with their words, as well as matching it with their nonverbal communication. So there needs to be a combination. But they're all other kinds of subtleties that people make judgments of people about compatibility, about their cognitive abilities, about their ability to relate to the whole team, or be within their organization, based on their nonverbal communication, and their ability to express themselves clearly. So there are different layers of communication. We also know that listening is almost a lost skill these days at times, because it takes attention and focus, and everybody's interested in giving their opinion. But nobody necessarily wants to listen to someone else without opinion without judgment. And that is a, an acquired skill as well. conversation is like playing a game of catch, you know, to that you talk for hours, then you hand it over to the other person, they keep the ball for a while, and then send it back to you. And some people don't seem to understand that this is a back-and-forth movement, that where one person is not to monopolize the situation, you give equal time to each person and you value the other person's opinion and input.

Sucheta Kamath: You know, it's so interesting, I think, as you talk about this game of catch, I love that visual image because you throw the ball and if there's nobody to catch the ball, that you have to go and get the ball and then again, throw it and so either that person is not doing a good job listening, or the person is not attentive, or the person actually is missing out on cues. And is this So help us understand? Because our work comes from we're having worked with somebody who has had a neurological problem or developmental problem? How does this show up in the clients that you see? So I know you work a lot with brain injuries and, and neurological insult to the brain? How does that affect? Or why does it affect communication ultimately, and creates so many problems for those individuals to either not be able to hold a job, not hold relationships, or just experience a lot of dissatisfaction when it comes to engaging in the world.

Dr. Leila Hartley: Of course, as you know, each individual with a brain injury is different. Because each individual is different. Each injury is different. The combination of their problems with their preexisting tendencies makes each person an individual that you have to consider. However, we do know that that particular areas of the brain are very vulnerable to damage in traumatic brain injury, the prefrontal cortex, and the anterior medial part of the temporal lobe. And those areas lead to problems and the executive functioning area and memory areas and emotional regulation areas. So we know that in the long term, people after a neurological damage can learn to compensate for their physical injuries, and their families learn to deal with that, but it's the social aspects and social communication aspects that are the most difficult for them to deal with, and are the barriers to independent living and to employment for the long term. So it's very critical that we address the executive functioning areas, the behavioral record, regulation, emotional regulation, de planning and self-awareness. issues are very important.

Sucheta Kamath: Oh, and, you know, I'm, I'm going to ask you in a minute to share an example of a brain injury, and how it presents itself or, but I to see this so vividly. And as a particularly people in our field, if they are novices, they are beginning their journey, they might find it very confusing or overwhelming, because no two cases look alike. And you have to be very creative. You have to be very thoughtful. And you have to take a functional context. So do you mind maybe giving us an example of a case? And how do you situate the person's difficulties and needs in the context where they need to be?

Dr. Leila Hartley: That's how long do we have?

Sucheta Kamath: Yes, Lila does day long, or many days long workshops. So this is really very interesting answer. Let's see.

Dr. Leila Hartley: Well, of course, you assess their neurological deficits, and you look at what their functional needs and what they state are their own goals. Because it is so critical. You know, there, they have set so many and semi major problems, often that it's important to address their motivation, and what we call ecological validity of what we're doing, that it makes sense within the environment in which they exist. So you look at what their needs might be in their environment, do an environmental assessment to see what is it that they would like to be able to do in their home. And I'll give an example of a woman that I have seen in the past to was in her mid 30s, had two children had an aneurysm that burst. And that was in the anterior communicating artery. She had a paralysis of on both sides by lateral paralysis. At the very beginning, she recovered some use of her left side, and could write with her left hand a little bit. But she was in a wheelchair, but she wanted to be able to interact with her two children. So we worked on being able to she had lots of promises attention, and affect, and so we worked on a reading of children's books with her children or getting them to read to her. And then getting her to oversee their homework a little bit because she had been a teacher. And so you, she had problems and attention and focus herself. So by having her read to them, it was working on her attention and focus as well, but giving her a chance to be a mother and in the role that she valued.

Sucheta Kamath: Wow. So sounds like you must take a lot of time to investigate what the life of that person must have been before the injury and then also what is going to be the new scope of that life which may have been limited by physical movement or maybe some like speech. impairments such as you know, not having intelligible speech? How? How do you bring the patient or the client to become the partner of the process? What tricks Do you use for that?

Dr. Leila Hartley: Well, I tell them from the very beginning that they are in the driver's seat, you know, I may have the doctor in front of my name, but in this case, that I am just their coach, their advisor and their cheerleader, but that I cannot make them better, you know, they have to do the work themselves, because we know, from if we want to change our brain, we have to do the work ourselves. And somebody else can't, you know, right now, put a new learning in your brain, maybe some point in the future, but you know, it has to be work on your part for you to change your own brain. And so, you know, I'm making it clear. Now, I also believe in giving lots of practice and hold practice. Because we know in terms of neuroplasticity, that it takes a lot of repetition, a lot of practice at something before the brain is changed.

Sucheta Kamath: So that brings me to two other thoughts. And we are really meandering the in the alleys of cognitive rehabilitation. But I love this emphasis that you can have, which is probably very surprising to patients, because they typically come to get advice, but then a lot of exploration that you must do is say, Tell me what you would like me to be of help. And that's really different way to think. So two questions. One question is motivation. There are certain injuries are particularly if their prefrontal cortex injuries, it affects motivation and self-regulation. So somebody may want to become a different person, but they're not motivated to do the work. And the second piece I would love to comment on is something called mirror cognitive deficits, that self-blindness as that also is the function of that prefrontal cortex, which so they may not even know how impaired they are. Or the mom that you were talking about, may not even know that she's actually not focused. But she went give herself credit saying that I'm awesome. So what do you notice that and how do you tackle that?

Dr. Leila Hartley: Yes, that is very, very common problem. And I think it's the you said, the key there to find out what they are motivated to get better at what motivates them as a person, what do they want to do, that I can tap into, like, for her, her goal was to be a mother again. And so I could tap into that, that's a deep emotion, although, with her, which is something that we have to be aware of, and rehab, and sometimes we're not. At first, she was not, she didn't like coming to see me, she didn't want to do anything for me, she didn't want to make an effort at anything. And she just said, I just feel stupid, if this all just makes me feel stupid. And so I had to kind of just say to her, you know, there are so many things that you're still very, very good at, you know, this injury didn't destroy everything about you. And I pointed out the things that she is very good at. And told her unfortunately, she's not paying me to address those areas that she's already good at. She wants, she's coming to get better at those areas that she's bad. And I said, I'm so sorry to have to do this to you. But you know, this is what rehab is about. And if I don't do this, then you won't get any better. And after she realized, Oh, you know, that's I'm coming here because of these things. And this lady is trying to really, truly help me and appreciates me as a whole person and sees the good in me as well. So then she became a very big advocate. And that really helped the process now for other people. The motivation again, you know, again, you have to tap into whatever seems to matter. Take them that they want to get back to work, they want to live independently. If they want to play their guitar better, whatever seems to be able to take care of their child or their husband or their house, whatever seems to be their motivation to get better helps. Now, sometimes you have people so injured, that they lack any idea of self-awareness or any type of goals. And so then you just have to help structure their time, and try to build in some things that you show their progress in certain small areas, and show them how they're making the steps in the right direction. So they can be more independent in general, or just tried to find things that they enjoy doing that can lead you to get something done positive in their cognitive abilities.

Sucheta Kamath: I think that's such a good point. Because in my work, I had a a woman who also had a ruptured aneurysm. And then she developed a lot of deficits. And she had a very unique job. So she used to do it, I'm going to now butcher this but you know, in high school, you did this formations. And is it a marching band? Yeah, missions that can be viewed aerially, and then, right. So it requires like organizing 200 players, you know, with our musicians who are playing different instruments and choreograph them, that was. So she developed significant executive dysfunction, and was unable to even organize, let alone like see the aerial perspective. Sorry, she was really good at that particularly particular area. So she had mastery, because she has so many so much practice. But she couldn't apply before, she could probably apply those same skills in other parts of her life. So here, she couldn't even like find her she had a three-year-old, the three old's blanket like it would be on the sofa in the in the living room, and she would turn everything upside down, and it would be right there. And she wouldn't spot it. But then you ask her show a marching band, aerial picture from her past work, and she would point out who is out of formation, who needs to go next. So she had a lot of knowledge there. And so it was interesting, the whole therapy became this, this formation, almost going back to that job. The problem was, she had paralysis on one side. So she really couldn't do that job. So her high level of motivation was in the area that she could never return, but just so much self-blindness and unawareness, that we couldn't really reveal that because that would devastate her. Exactly. And so we kind of did like, in order to get you ready for that kind of we use that as a lure to keep her engaged and motivated. And one last thing, and which I want to talk about is this emotional recovery after brain injury. And because you have such amazing psychological background as well, but one thing that came up and have seen that now in many, many clients of mine, that any prior trauma, and any prior history of maladaptive and poorly adjusted psychological issues kind of become unveiled. Right? Right. She was in a relationship with an abusive husband. Who would, she was 5' 11''. And he was 5'5''. And, and she was 180 pounds, and he was 120 pounds. Okay, so the, the pair looked very odd when they were together. But he used to beat her, like, beat her black and blue. No. And what happened is, she became so disinhibited, like, she lost her inhibition. So she would started telling people, he beats me. It was well kept secret before her injury. And so in that way, it came out and then people started advocating for her or the community, you know, parents came to support. So anyway, I would love for you to talk a little bit about that emotional trauma of having endured a brain injury but also the journey of recovering after having a sense of loss, a sense of self, you know, loss of sense of self.

Dr. Leila Hartley: Yes. Yeah, it has been you shaped that it was. It's a loss of self and it is a huge emotional blow. When you have any threat to your health, I think anyone who's had something significant happen to their health can understand this. And it's a broken sense of who you are. And it makes live things so unpredictable and on knowing what's going to happen to you in the future. So, you know, as you and I've talked about before, you have to have that emotional bedrock of emotional stability to then for your brain to function well. So it's important to help these individuals understand how to deal with the emotions that they are dealing with, about their future, about their health in general. And so I spend a good bit of time helping them to understand about their brain injury, what it is and where their deficits are. So it's pretty, if they're capable of understanding those things, to give them a good explanation of why they're having some cognitive failures, and why there is some predictability. Because that's another thing is to have a sense of control of who you are as a person now, and I tell them, we're going to be working on generating a new owner's manual for their brain and love that their brain has changed. And not everything is different. But it's like there are holes that you will step in and not be able to do certain things. And it's that unpredictability of where those holes are that make people even more uncomfortable. So we work on identifying, you know, where are you going to have holes? And where are you going to have problems in the future? And how can we develop strategies, so you can handle things, but also giving them avenues for dealing with that sense of loss, that old person is no longer there. And I say that, you know, the life you will have will be different. No matter what level of cognitive recovery you have, because anyone who goes through a significant health incident, no matter what it is, they are changed because they emotionally or dealing with something that's pretty significant. And it could be changed in some good ways. Because you can have greater sympathy with other people who've been through some life episode that's changed them, but that they can still have a good life and a satisfaction to realize some that they can have a sense of satisfaction with their life is just a different.

Sucheta Kamath: That's so brilliant. You I love the way you weave the knowledge that you have with so much compassion, and you truly and having been with you for 17 years, you see the person as a whole. And I think that can be very healing Leila, thank you for being that person, for so many people. Because I think sometimes when we are in the healthcare system, we bring this deficit, wrongness fix loss model, and then we are trying to bring somebody back to interesting everything you are complete as you are. There's I love this idea of there's some holes there. The let's tie this idea back to the larger context of living a more fulfilling life. I think your big one on pro-brain lifestyle and maintaining healthy habits that can nurture the brain health. Can you share some ideas and tips that are applicable to all of us to continue to nurture and protect our brain as we move forward in these crazy times, right? Used to be pre pandemic and cost pandemic. And then people have now I remember like, last year we were saying, post pandemic and now people are like ongoing pandemic. You have adjusted our linguistics there.

Dr. Leila Hartley: Exactly, our mindset has had to be adjusted multiple times through all of this process, but we can, you know, kind of simplify with people with brain injuries, who've had to suffer social isolation and being in a different world, for them to I tell them, well, now everybody can understand what you're experiencing, because they are going through it too, you're, in fact, you're more equipped than a lot of people are to handling it, because you've already had to deal with it. But yes, the research tells us that there are a number of things that all of us can do to maximize our brain functioning, and help me maintain our cognitive abilities as we age. As we all know, aging is no blessing for the brain. Although we do acquire more wisdom, they say, and, actually, I have seen in some ways that I am definitely wiser in some areas, but have lost some cognition in some areas, as I've aged, but, you know, the number one thing that you can do for your brain, if you really want to improve it is to exercise. And so it is very critical that people exercise and that is both aerobic and weight training, all improve not only our overall functioning, but particularly executive functioning. So that's critical that people carve out time. And think that this is just as important as eating or sleeping as anything else to carve out that time to exercise.

Sucheta Kamath: And you Sorry, and when you say exercise, I'm sure you also insinuating it doesn't need to be intense weightlifting, but it can be the movement, bring keeping the movement in your body, correct,

Dr. Leila Hartley: right, just moderate, it doesn't have to be extreme. But I think I've read anywhere, like 15 minutes of moderately intense exercise you have. So walking, walking fast, you know, several times a week, having some simple fitness, yoga, and Pilates and weights, a routine that you do, because maintaining your muscle mass is very important. And all of these things increase the neurotrophic factor in your brain that particularly helps the hippocampus, which is the area of the brain that has to do with formation of new memories. So you know, we have the research that shows that how critical This is. And everyone needs to know that that's very important for brain functioning. Number two is your nutrition. You know, we've always been told you are what you eat, you eat, and people may not go What is that mean? But it's the nutrients that you get through fresh fruits and vegetables and lean meat. And that are the power that your brain needs for it to function, your brain loses a lot of glucose. And by that I don't mean simple sugar. But I mean, then the glucose from fruits and vegetables, and your brain needs protein as well. So it's good to have a good balance of things they are and to get plenty of fluids, because people become anxious when they are dehydrated. And it affects brain functioning as well. So that's very important. Another factor is getting adequate sleep. People who don't sleep well are at greater risk of developing Alzheimer's. And it's none of us function well when we're really tired. So that's very critical. If you want to preserve your cognitive abilities, having social interaction is very important because that takes a lot of cognitive processing. You know, this inner personal interaction requires you to listen and be attentive and then generate something to say. And you engage in process information and complex problem solving in situations. So whatever social interaction you have, and then having some type of spiritual our stress reduction activity in your life, that's very important to keep your brain in its best shape. We know meditation is You can speak to that is a very valuable way of maintaining cognitive health as well.

Sucheta Kamath: I love that. And I think thank you for summarizing. So I love the small distinction you're making from an exercise, think about simple fitness. You don't need to become, you know, Arnold Schwarzenegger. Now, second thing, you're, you're also distinguishing between diet versus nutrients, which is a huge important distinction because people are hyper focused on weight. And they're really not thinking about internal New York neurochemistry, so to speak. I also love again, the distinction in in the quality of sleep, and really, valuing sleep, I think I've so find, dealing with teenagers, you know, in my practice, that there is actually no respect for sleep, which is kind of a shame. Yeah, we are living in a culture where sleep is considered interfering with life,

Dr. Leila Hartley: Right.

Sucheta Kamath: And I also love that emphasis on personal interactions. And, and I think that also requires you to put yourself out there and not really try to be perfect or be a particular way. And lastly, that mindfulness meditation activities. And one thing, if I can add to that last point, you said, Leila, that we now have that this was something, what we call conventional wisdom, told us contemplation and meditation can help. We now though, will have 40 years’ worth of neuroscience showing us that and one key distinction there too, is that trade versus state changes. And if I may quickly speak, you know this already, but so state is after meditation, or during meditation or a little while after having been doing meditation, you may feel calm, but that quickly disappears when you're back in the stressful situation. So it's the state that can be you can be tossed off the horse, so to speak, and the trade is it becomes part of your character, it is like somebody who is always come. And so becoming come can be a long term outcome of such effort, infinite practice. So as we come on,

Dr. Leila Hartley: I do want to add one thing... One other factor there that is engaging in new learning. And I'm doing some things that improve your thinking and cognitive ability to, it's important that we all challenge that, yes. Whether that is, it doesn't have to be like learning to play the piano or a new language. But if you're so inclined, that certainly it but things like travel and planning a trip and engage in cultural learning through traveling or taking a Tai Chi Class where you're having to do something different. It's important to our brain needs new information to challenge us. If we stay in the same rut, and do the same things over and over again, we never really build additional neural connections, and learn to adapt to different situations. So it's important to always be engaged in near learning, reading books, things like that.

Sucheta Kamath: Love that. And you know, you and I have talked about this a lot. You know, lifelong learner, you are a lifelong learner, and committed to it. You love to tease your imagination, because you're a huge reader. I, I also, when I was growing up, my mother had a rule for us as children that we used to get two and a half months of summer vacation, and we didn't have classes and things like that you just like, you know, you did housework, right in the neighborhood. But she had a rule that each of us had to learn a new skill. And that really shaped a lot of my particular dedication and commitment. So recently, you might get a kick out of this last week. In fact, I ordered these pumps that blow balloons, I mean, they pump you know, the pump instead of using your mouth. So I'm going to now teach myself balloon animals. That's my commitment. So I thought it's a concrete skill, you know, something that I kind of know how to make a dog. But, but, I mean, I was obsessed with origami because one thing I kind of tell my patients too, that if you want to really improve executive function, You must involve motor planning. That means you need to come out of your head and you need to be in your hands. So something that requires sequencing planning, and problem solving, particularly because you're engaging the visual field also can be very helpful. So I did obsessively origami. And now I'm like on balloon animals. So I'll let you know my progress. 

Dr. Leila Hartley: Okay, please do. I need to know whether to incorporate that in treatment. Yes. So there are always birthday parties going on. And I'll put your name in for that.

Sucheta Kamath: Well, it was coming, it is going to come so handy because I have now signed up to read to pre k children through a local nonprofit and on zoom. So I actually have my big ears and I have a crown that glows. So I have a lot of trinkets and little tricks to engage them. But I thought I could do a quick balloon animal that is talked about in the story, whatever the story is, just to tie something in to tease myself to challenge myself. Right. So as we come to the end, Leila, it's been so fantastic to have this conversation. What do you have any recommendations of books that I asked my guests to share three recommendations or two, or doesn't matter me one of books that have influenced you or be had been meaningful to you? That Can you share that with our listeners?

Dr. Leila Hartley: Um, well, if you are talking about that have influenced me from the past. I would say that, from the past, Dragons of Eden by Carl Sagan was one yes. And that really led me to go back to school and get my PhD, so that I could learn more about human intelligence and the whole brain. Because when I first started in the field, was when individuals with brain injury, were starting to come into the rehab system before that. You know, people died at the scene of accidents because there was not a modern 911 system where people would get rapid emergency care. And there was wasn't very much known about how to help the individuals with TBI, but so Dragons of Eden was very thought producing to me about human intelligence and human thought, and course everything by Oliver Sacks. I really read and enjoyed the neurologists who wrote about so many of the entities that and people that he dealt with, I think to favorite, the Man Who Mistook His Wife for a Hat.

Sucheta Kamath: I was in the audience in Boston when he did the read of for that book. And that was that time I used to even work on aphasia, so it was so meaningful. And Anthropologist from Mars is also one of my favorite of his. It's great.

Dr. Leila Hartley: And then the book, the Brain that Heals Itself or Changes Itself. Either. Yes, Norman Doge or Dodge,

Sucheta Kamath: I can't pronounce it something like letting you pronounce it... Doge

Dr. Leila Hartley: The Brain that Changes Itself. Yeah. And how neuroplasticity exists, and that people can change that just because they are one particular way doesn't mean that you're stuck being that way. that the brain is much more plastic than we were ever led to believe.

Sucheta Kamath: Well, this is a brilliant list of recommendations. I'm so glad I share interest with you. In two of them. I have not read Dragons of Eden. So that's going to be on my book list. And I'll report back. Thank you Leila, for being here today and sharing your wisdom. This conversation was full of exciting and hopeful message about brain injury is not permanent. That journey can be very arduous, but it's worth it. Because we all are subjected to human condition. So thank you for being here with us and really, finally agreeing to be on the podcast. This is going to go down in history as one of my favorite interviews. Thank you. 

Dr. Leila Hartley: Well, thank you so much for having me, and I appreciate it.

Sucheta Kamath: So that's all the time we have for this interview today. Do stay connected with us through our social media. And if you would like to get some news from us. Sign up for our newsletter. And once again, keep your brain healthy, take care of it. And remember to think is to be and sometimes it can be hard. So enjoy yourself