WEBVTT

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I used to go right up there with
the boys who played football.

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[music]

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Thank you very much Bill, very appreciated
Bill, you are great guy. Thank you.

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Where you come to Allen. Right here in
New York. Why are they filming you?

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I have had some bad head
problems in the past.

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You can see this large dark spots
it’s not supposed to be there.

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In 1991 I had two heart valves replaced

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and then it caused

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blood to go to brain and that
caused a little hemorrhage

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then I had three brain operations.

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Truett was 15 seconds from death.

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After that I was in NYU Hospital

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from the 7th of February until Christmas Eve and
I didn’t want to ever see a hospital again.

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We have all wanted to see

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the Truett Allen that we
knew before reappear.

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Mrs. Allen said there is no
similarity to his previous existence.

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He person I married who
fathered my children.

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Truett is no longer Truett.

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[sil.]

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And I think I know what this is,

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skis, I think I know what this is

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it’s got to be what I think it is.

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Truett is and is always been
the kind of person that

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nothing daunted him if it
could be done he believed

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he can do it –

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when I met him he was just starting, he
was just out of Harvard Business School

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and he was just starting (inaudible) interest
company and he very calmly and sincerely

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presented to me the fact that his intention

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was to be CEO of the bank. It was Fred who
gave me the news that I have been elected

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the Vice President of the bank. I can remember your
words, I bet you can’t. You should be very proud of this

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because we are a lot more careful about
giving a mouth that we used to be.

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The bank used Truett as a representative

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of who they were and what they
had to give their customers,

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they even used him
frequently and repeatedly

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in their own advertising, they were
using Truett as the person to attract

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other young men and women who
wanted to be banking professionals.

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Happy birthday Truett Allen.

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I just love that, we got to frame these things.
Yes, you can make it chronological order.

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You will never be 50 again.
Never be 50 again.

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In 1991 Truett was handed a
challenge he never anticipated.

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In a period of three months he went through

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a strep infection that led to
the need for open heart surgery

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and two valves replaced that
produced the potential aneurism

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that required frontal lobe
neurosurgery to clip the aneurism

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and four weeks later an infection required

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left frontal lobe neurosurgery
at 7 o’clock one morning

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followed by the need for a
second frontal lobe neurosurgery

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that same evening. Truett survived.

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Hi, how are you doing? All right.

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Good.

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Oh, look at these dogs beautiful cruise.

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I got a letter from Mrs.
Allen in October of 2001,

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she said that Mr. Allen was able to
walk to go to the gym, to drive a car,

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she said superficially he seems
restored, he was able to

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engage in social conversation but she said at a
deeper level though something very much missing.

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[sil.]

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I used to go right up there with the boys

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who played football. Right,
right, there outside there

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and they was always a
place to there I can walk

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away from the home and walk all around and
see a lot of people and do a lot of things

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and I just loved it for that reason.

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And of course I saw Truett himself,

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he said, I walk in the park,
Central Park every day,

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enjoy talking to people, I met a lot of
people there made friends, I enjoy it.

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I used to go walk down to a Health
Club and I did that everyday

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but I stopped doing that several years ago

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but now I am just happy get out and take a
walk around that’s what the trees been out.

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Mrs. Allen said, he doesn’t see

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how much he is being altered but every so
often that would be what she called a blip

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when the old spontaneity and
the old Truett re-emerged

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and she wondered whether something
could be done to make these blips

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more frequent, more continuous,
how much could a husband

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the former Truett be restored

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and this is why she came to me
and why, in turn I referred

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the two of them to Dr. Goldberg.

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[music]

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A number of features of these

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CAT scans are abnormal and in my opinion

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the abnormalities which are particularly are
damaging to the patients cognition and behavior

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are those found in his
frontal lobes and of course

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as this often the case we CAT scan
images, the images are inverted so,

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I am saying the right but pointing to the
left because right is left and left is right

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in this image. You see this dark rim

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around the frontal pole
particularly on the right side

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but also on the left side and
this is suggestive of atrophy

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which is a technical term for
brain tissue wasting if you will,

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brain tissue death and in this instance

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this atrophy is quite significant
in his frontal lobes.

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All right 10 seconds no noise
coming up, try not to move.

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[music]

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Frontal lobes are among the most

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intriguing and mysterious parts of the brain
and here we are looking at the frontal lobe

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of the left hemisphere and this is
the part of the brain which serves

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the role of the orchestra conductor
if you will which organizes behavior

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and goal directed coherent sequences

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When a stroke or bleed affects

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the frontal lobes then
the ability to organize

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once behavior in the meaningful
way and formulate goals

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and pursue goals and plan one’s
behavior will become impaired

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even though the elementary ability
such as the ability to work, to talk

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and to recognize things may remain intact.

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[music]

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One of the things that

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we are hoping for is somehow
we can get more of dad

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from before the surgery back

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and there are glimpses and there are
elements of his personality now

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but he is a different person.

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Can you give me a big hug, boy,
this is my elder son Jefferson.

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You know, I have to go back to when
I was a teenager and growing up

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and he was very involved
with us in what we did,

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he paid attention to the
classes we took in school,

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he would ask us about things,
cannot play golf together,

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we played tennis together
and his personality

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has always been very opinionated and he would ask us
about what we were doing and he would make his comments

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about what we were doing and let us know
what he thought about what we were doing

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and that was good, it was very helpful and I think
it helped keep me going in the right direction.

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Mr. Ball was never mad, I am sure
he had put many opportunities to me

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but he never want because he devoted

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a 100% of his time everyday

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doing (inaudible) crying and
Jeff and I were (inaudible)

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my biggest customer. I don’t
know if he got this one

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he was talking about Mr. Ball. And I
was sitting in his room at night…

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He go back to a memory of
something that was pleasant

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and it triggers this
incredible emotional response

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that is somehow we can’t figure out why
you are getting so emotional about,

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I mean, it’s a good pleasant memory and it’s
totally overwhelmed him that’s typical,

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that goes on frequently. I tell Mr. Ball

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I am (inaudible) and I
could live to be your age

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and still wouldn’t have one third
of your knowledge replaced.

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[music]

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One of the things we have been trying
to find for years is what might

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trigger his prior personality to come back.

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[music]

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[sil.]

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Yes, it’s right up here. The kinds of
symptoms frontal lobe damage often reduces

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may be more illusive at least
to an uninitiated layman’s eye

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then many other symptoms, they may
be either overlooked all together

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or dismiss as a peculiar personality.

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Navy terrace named in honor
of all the men and women,

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Navy Coast Guard, so forth

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in World War I and II. You
cannot escape noticing that

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certain things are peculiar how all of a
sudden he begins to talk about something

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and then without any particular
reason he burst into tears,

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this tearfulness gives way to again
normal cheerful tone of voice,

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so this emotional ability is quite
noticeable in this case as well.

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And I had basic at Fort
Jackson, South Carolina

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and then I went to Fort Devens,
Massachusetts to ASA School.

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Also he becomes distracted by
various rather incidental things

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in his environment and this distractibility
is also something that is quite common

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for letting damage to the frontal lobes.

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[sil.]

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Mr. Allen could be charming in company
but when he was alone and unstimulated

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he might show complete lack of goal and
motivation that he would sit ideally in front of

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the TV all day and may be
all night vaguely start

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but not doing anything. When Truett
that came out of the hospital

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since the same person that went into the
hospital and it’s mainly behavioral

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and it’s initiative, appropriate behavior,

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motivation and in general

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caring about the existence
of others beyond ones self.

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He doesn’t see how much
he has been altered.

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One can get very great changes
in character with massive

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frontal lobe damage. No I remember
because I say this of a cosmic mind

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who had a frontal lobe stroke and how
when I drove her back from the hospital

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to her place I opened the car door,

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I said, would you like to get out now Madeline
and she said sure but she didn’t get out

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and I repeated my question and said would like to
get out, she said, sure I would like to get out,

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of course I would like to get out but
she didn’t get out. It was this gap

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between utterance and action.

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The frontal lobes of the brain engulf human beings
is what scientist today call executive functions.

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Any time that I think or
try to solve a problem,

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I am actively making decisions. I am
deciding which type of information

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is useful to me and then I select
this information out of the totality

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of all knowledge available to me.
What we recognize as complex

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behaviors like the ability to form
goals and desires and aspirations

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all these is also controlled by our brain

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and particularly controlled by our frontal lobes.
Mr. Allen I will ask you to do a few things. Yes.

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Do you mind? Oh, no.

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These are like visual puzzles, Umm ….
You see these cells are filled,

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this one is empty - you need
to find one among these six

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which best fits this space.

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Neuropsychologist and cognitive neuroscientist studied
their relation between the brain and the mind.

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We study how different types of brain
damage affect various mental functions.

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In this instance, what was
so particularly interesting

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that our patient has done well on this
test, it’s a relatively complex test,

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it’s a collection of visual puzzles, some
of which are pretty straight forward

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but some others are quite challenging
and quite demanding but he was able to

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cope with this task reasonably well.
Okay, terrific,

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well we have done very well here. Not all of the patient’s
brain is affected by damage to an equal extent,

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we see an extensive damage
in the frontal lobes

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but we see considerably less damage
in the posterior parts of the cortex,

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those parts of the cortex which are far removed from the
frontal lobes and that of course agrees was our observation

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that the patients powers of
language have not been impaired

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he is quite articulate despite
his neurological illness

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and also his ability to solve
spacial puzzles is also quite good

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as our testing has demonstrated. You
see there are these four cards here

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and they are characterized by
certain color and certain shape

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and certain number of items in the card,
then the single card appears in the bottom

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and you have to decide which
category it belongs to,

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whether it belongs better with this one,
with this one, with this one or that one

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and you do that by clicking on one of the
top cards and the computer will be telling

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whether you are right or wrong and
it’s a guessing game of sorts.

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[sil.]

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Four dots. Another task the so called

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Wisconsin Card Sorting Test has been
one of the foremost tests to examine

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the functional integrity of the frontal
lobes. The essence of this task

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is the ability to take
into account the feedback

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that you are given on the particular
item in order to figure out

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how to deal with subsequent items,
it’s an essentially sequential task

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and on this task our patient
has done abysmally poorly.

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[sil.]

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What happened here, he started
with the wrong guess,

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instead of guessing that the principle
of classification was based on color

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he made the guess that it was based
on the number of items in the frame,

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he continue to cling to this wrong
principle despite the feedback

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advising him that his guesses
were consistently wrong.

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As we look more closely at these images
we see a number of abnormalities,

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this large dark spot is
not supposed to be there,

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it’s a vestige of an old bleed

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affecting the right frontal lobe and the right caudate
nucleus a very important subcortical structure

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in charge of motor

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and behavioral initiation. You see
this dark rim in the frontal lobes

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particularly in the right
frontal lobe, these are the

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aspects of his brain damage which
account for the cognitive rigidity,

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inflexibility seen in his performance on
test sector the Wisconsin Card Sorting Test

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lack of initiative and other symptoms
of frontal lobe dysfunction evident

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in his behavior, he didn’t like it.

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Right, that’s true, that’s good way
to put it at, I didn’t like it,

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that’s a gentleman way to put it. Frontal
lobe patients are not over like,

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this is an example of a patient with
extremely severe frontal lobe symptoms,

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a young man, the graduate student whom I
encountered when I myself was a graduate student,

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we were both in our 20s and he
was a very formative influence

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in my own clinical education
as in your psychologist,

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so he was completely devoid of initiative.
He would lie in bed motionless,

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mute, incapable of initiating
any activity whatsoever

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but after a lot of effort

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it was possible for me to
give him a simple experiment,

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so I asked him to do a simple geometric forms but
to do that I had to put the page in front of him,

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I had to literally place a pencil

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in between his fingers, squeeze his
fingers around it, take him by his wrist

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place his hand on the page and give it a
little shove and only then would he oblige

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and draw a cross as I requested but
then just as he was incapable of

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initiating this behavior he was incapable of
terminating it and he would continue to fill the page

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with little crosses until again
I would intervene physically

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by taking him by his wrist and
physically removing his hand of the page

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and only then would he stop drawing this little crosses
and then sometime later the cycle repeated it so,

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when I asked him to draw a circle.
Patients with frontal lobe dysfunction

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sometimes cannot initiate behaviors
and they cannot terminate them.

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On a day by day basis he just seems to be

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ever so slightly more
participatory in this life,

00:21:50.000 --> 00:21:54.999
I see these little blips now and then.

00:21:55.000 --> 00:21:59.999
Through this whole trauma the
actual illness and the recovery,

00:22:00.000 --> 00:22:04.999
there has always been my knowledge

00:22:05.000 --> 00:22:09.999
that the Truett I knew was
intact against all opinions

00:22:10.000 --> 00:22:14.999
of the professionals all along
preparing me for the worst,

00:22:15.000 --> 00:22:19.999
I knew the best was still there,
I knew Truett was still there.

00:22:20.000 --> 00:22:24.999
Last week I saw a woman charming,

00:22:25.000 --> 00:22:29.999
gifted woman with multiple scoliosis
affecting the nervous system

00:22:30.000 --> 00:22:34.999
and the brain and spinal cord, she had being
devastated by a neuropsychological report

00:22:35.000 --> 00:22:39.999
which listed all the
things which were wrong.

00:22:40.000 --> 00:22:44.999
However it didn’t bring out
adequately her strengths,

00:22:45.000 --> 00:22:49.999
her resources, emotional and
intellectual, the fact that she was a

00:22:50.000 --> 00:22:54.999
talented writer and lawyer and the fact
that she could still function pretty well

00:22:55.000 --> 00:22:59.999
if she did so in her own way in her own time,
I think one of the functions of the physician

00:23:00.000 --> 00:23:04.999
is to mediate these things and to visualize

00:23:05.000 --> 00:23:09.999
the sort of life which a person can have.

00:23:10.000 --> 00:23:14.999
Find a way to make it all the
way to the top right block,

00:23:15.000 --> 00:23:19.999
titled gold and analyzed this shape again,

00:23:20.000 --> 00:23:24.999
is this the same shape, is this the
same color as the previous one. No.

00:23:25.000 --> 00:23:29.999
Okay, so what role do you
think computer is following?

00:23:30.000 --> 00:23:34.999
Neuropsychologist or neuroscientist
had been able to design exercises

00:23:35.000 --> 00:23:39.999
which allow us to train and
enhance various mental functions,

00:23:40.000 --> 00:23:44.999
various functions of the brain.
We have exercises,

00:23:45.000 --> 00:23:49.999
for instance, designed to train
planning where we start with

00:23:50.000 --> 00:23:54.999
trials and errors then the computer
tells you whether your move was

00:23:55.000 --> 00:23:59.999
correct or incorrect and based on that you
try to figure out the rules of the game

00:24:00.000 --> 00:24:04.999
which in turn is necessary for you to move
through one end of this visual display

00:24:05.000 --> 00:24:09.999
to the other. Let’s try out.

00:24:10.000 --> 00:24:14.999
I got to change colors. Do you
really want to change colors

00:24:15.000 --> 00:24:19.999
after the same color work for you all
this time? Well, no, I go down again.

00:24:20.000 --> 00:24:24.999
Okay.

00:24:25.000 --> 00:24:29.999
[music]

00:24:30.000 --> 00:24:34.999
You can move here, right, you can
move here or you can move here.

00:24:35.000 --> 00:24:39.999
What is happening now is

00:24:40.000 --> 00:24:44.999
Truett is still rewiring his brain
frontal lobes that were traumatized

00:24:45.000 --> 00:24:49.999
for invaded and seriously invaded are still

00:24:50.000 --> 00:24:54.999
rewiring routes to his

00:24:55.000 --> 00:24:59.999
what they refer to as executive
capacity which is initiation

00:25:00.000 --> 00:25:04.999
of significant behavior.

00:25:05.000 --> 00:25:09.999
So, which out of this to be moved?
The left I will do that.

00:25:10.000 --> 00:25:14.999
Right exactly, it looks the
most familiar right. Yeah.

00:25:15.000 --> 00:25:19.999
Even the few decades ago it was of
being unthinkable to even attempt

00:25:20.000 --> 00:25:24.999
to treat effectively those
aspects of our mental life

00:25:25.000 --> 00:25:29.999
which we now know are under the
control of the frontal lobes

00:25:30.000 --> 00:25:34.999
but today we are on the brink of developing such
treatments and increasingly effective treatments

00:25:35.000 --> 00:25:39.999
are becoming available.

00:25:40.000 --> 00:25:44.999
[music]

00:25:45.000 --> 00:25:49.999
Okay, so how did you
find your new exercise?

00:25:50.000 --> 00:25:54.999
Well, it’s more challenging.

00:25:55.000 --> 00:25:59.999
I personally believed that
mental fitness will emerge

00:26:00.000 --> 00:26:04.999
as a very important future
trend in our lifestyles

00:26:05.000 --> 00:26:09.999
which will become part of
our mainstream culture

00:26:10.000 --> 00:26:14.999
just as physical fitness has
emerged as an important trend

00:26:15.000 --> 00:26:19.999
over the last few decades. Find the game,
done, all right, that’s pretty good.

00:26:20.000 --> 00:26:24.999
That’s someone it means being a good
banker. I have. So physical fitness

00:26:25.000 --> 00:26:29.999
and mental fitness are not that fundamentally
different with one is an extension of the other.

00:26:30.000 --> 00:26:34.999
I have had enough for the day
or do they give out a number.

00:26:35.000 --> 00:26:39.999
For today. Yeah. Do you think so.
I think it’s very important

00:26:40.000 --> 00:26:44.999
not just a focus on the disability but on
whatever is essential in someone’s life

00:26:45.000 --> 00:26:49.999
I think one always has to
find the, the central passion

00:26:50.000 --> 00:26:54.999
and interest, now what one will do

00:26:55.000 --> 00:26:59.999
with Truett, I don’t know

00:27:00.000 --> 00:27:04.999
but an interest or concern

00:27:05.000 --> 00:27:09.999
over relationship holds
one together, binds one.

00:27:10.000 --> 00:27:14.999
I hope to be better than I am today

00:27:15.000 --> 00:27:19.999
but I hope to live as long
as my dad did who was 94

00:27:20.000 --> 00:27:24.999
when the Good Lord took him.

00:27:25.000 --> 00:27:29.999
I hope to be better and doing things

00:27:30.000 --> 00:27:34.999
then are helpful to other people.

00:27:35.000 --> 00:27:39.999
He knows he should have died, he
knows he is lucky to be alive,

00:27:40.000 --> 00:27:44.999
he knows he has a second lease on
life and he is happy to exist,

00:27:45.000 --> 00:27:49.999
he is happy to exist in this country,
he is happy to exist in this world,

00:27:50.000 --> 00:27:54.999
he is glad that he is here.

00:27:55.000 --> 00:27:59.999
Everything Barbara does is for my own good,

00:28:00.000 --> 00:28:04.999
I know that, she believes in me
and she believes that I am much

00:28:05.000 --> 00:28:09.999
better than I show the world,
she wants to get the best

00:28:10.000 --> 00:28:14.999
available counseling for me

00:28:15.000 --> 00:28:19.999
that she can managed to get a hands on and
she done it and she done it beautifully

00:28:20.000 --> 00:28:24.999
and that said right there

00:28:25.000 --> 00:28:29.999
what she thinks of me

00:28:30.000 --> 00:28:34.999
and that is that she loves me a great deal.

00:28:35.000 --> 00:28:39.999
If I hadn’t married Truett,
I never would have married.

00:28:40.000 --> 00:28:44.999
Truett is the only man I ever
met who I would consider

00:28:45.000 --> 00:28:49.999
forming a partnership with. I
wouldn’t know anything I know now

00:28:50.000 --> 00:28:54.999
if Truett hadn’t worked to
stay off to get me to marry.

00:28:55.000 --> 00:28:59.999
I appreciated that. Yes sir,

00:29:00.000 --> 00:29:04.999
well we made it all around
and got home again.

00:29:05.000 --> 00:29:09.999
Yes sir,

00:29:10.000 --> 00:29:14.999
now if you guys come on upstairs and
take a little break and so forth, okay.

00:29:15.000 --> 00:29:23.000
[music]

00:29:40.000 --> 00:29:45.000
Hello there… Well, that was a long trip. Well, we
had a good walk in the park and we folks. Yeah.

00:31:15.000 --> 00:31:20.000
[sil.]