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Cleveland Clinic, in collaboration with Microsoft, has received a three-year, $3.4 million grant from the Congressionally Directed Medical Research Programs Traumatic Brain Injury and Psychological Health Research Program to make enhancements to the Troop Readiness Evaluation with Augmented Reality Return-to-Duty (READY) tool. Troop READY is software designed to detect military concussive brain injury and assist in assessing a service member’s readiness to return to duty.

The Congressionally Directed Medical Research Programs (CDMRP) is a global biomedical research funding organization within the Department of Defense that manages cancer research, military medical research and other disease and injury specific research programs. The new funding will help the Troop READY tool transition from a research project to a commercially viable product that meets federal requirements for potential purchase and use throughout the military.

A team led by Jay Alberts, PhD, received an initial grant from the Department of Defense in 2019 to develop Troop READY, which uses the Microsoft HoloLens2 augmented reality (AR) platform to create realistic scenarios for return-to-duty assessments that test a service member’s motor and cognitive skills after mild traumatic brain injury (mTBI), also known as a concussion. Concussion is the most common military-related brain injury and is typically difficult to diagnose and treat. Common side effects include dizziness, blurred vision, confusion and trouble thinking clearly. It is critical that service members who experience concussion are appropriately vetted prior to returning to duty to ensure the safety of themselves and others.

“Right now, it’s essentially a guessing game to determine when they’ll be ready to return to duty,” Dr. Alberts explains. “As a scientist, I knew this presented an opportunity to improve this process through the creation of a tool that provides objective and quantitative data to medical personnel and commanding officers to facilitate communication and make the best-informed decision about a soldier’s readiness. We’re talking about life-or-death situations, there should be no guessing involved.”

Dr. Alberts has studied Parkinson’s disease for the past 20 years and has developed similar AR-based tests and tools for Parkinson’s disease assessment and treatment.

“There are lot of similarities if you think about it from a concussion perspective. Individuals experiencing concussion report being slow, individuals affected by Parkinson's are bradykinetic,” he says. “Both patient pools also have information processing problems – so while the pathology is different, there are many similar symptoms and effects of the conditions.” 

How is military concussive brain injury currently assessed? 

A common method to test readiness post-concussion involves the service member sitting at a computer to take the Automated Neuropsychological Assessment Metrics (ANAM) test, which assesses cognitive function, including attention, memory and thinking ability.

Dr. Alberts doesn’t have a military background himself, so he consulted a variety of sources for the project, including military handbooks and military officers. During these discussions, Dr. Alberts learned that assessing only via a computer test may limit the understanding of other comprehensive factors unique to a service member, such as physical fitness requirements or serving in an operational environment. The Troop READY team’s goal was to create more objective and realistic scenarios.

“A soldier’s commanding officer wants to be sure that post-concussion a soldier can move fast, make decisions under immense pressure and stress, all while effectively communicating with their fellow soldiers and watching each other’s backs,” Dr. Alberts says. “It was imperative that my lab created a tool that could provide a level of nuanced data reflecting these skills that they weren’t getting from a computerized test.”

How can AR support a more realistic readiness assessment?

An AR headset captures the service member’s movement data through sensors that feed into the Troop READY software. Using the AR equipment, a service member is guided through scenarios they may encounter to progressively test different aspects of cognitive and physical performance, including:

• Step symmetry and frequency during marching
• Kneeling to standing shooting test using a Bluetooth-connected M4 machine gun
• Proper target identification and speed of movement during a room breach-clear scenario

Simulated room breaches also test decision-making and communication skills to assess how a service member will operate within their team during this high-stress situation. During the four-person room breach module, the AR software simulates the door being breached. The service member enters the room with three digital avatars and must clear the room as part of this team under four different scenarios.  The Troop READY software collects data on how the service member communicates with team members and monitors performance when the avatar makes an error.  

Medical professionals and commanding officers can play back the footage to analyze the service member’s performance and identify any concerns.

“Ultimately, a human will make the final decision about a soldier’s readiness to return to duty, but they will now be equipped with objective data that reflect that soldier’s performance in highly specific and nuanced situational assessments which far surpasses the data obtained from the traditional testing methods,” Dr. Alberts explains. “Our AR scenarios are highly customizable in a way that’s just impossible to replicate in a physical training facility.”

What can move the project from research to the field?

Testing for the first stage of the project (a proof of concept) was with 157 healthy service members at Fort Moore, Georgia. In the next stage, Dr. Alberts’ team is working to improve the device and the software to test with another group of Fort Moore service members. This time, the service members will be a blend of healthy individuals and those having experienced concussion.

Dr. Alberts’ team is collaborating with Microsoft to integrate the accumulated data into the military’s cloud system, which is a critical first step to deploying it to the military environment. The next stage of development also includes creating easy-to-understand guidelines for interpreting the data collected through the Troop READY software. The Alberts lab will use AI to create a predictive model to make recommendations for follow-up care based on an individual service member’s results. The lab will be working with neurologist Andrew Russman, DO, to develop these programs and guidelines.

“This predictive mapping tool will enable a soldier’s medical practitioner and commanding officer to be more prescriptive with the potential next steps they sketch out to rehabilitate and improve readiness for return to duty. Hopefully, the guessing game will be in the past,” Dr. Alberts says.

About this study

The work was supported by the Assistant Secretary of Defense for Health Affairs endorsed by the Department of Defense, in the amount of $3,491,232, through the Traumatic Brain Injury and Psychological Health Research Program under Award No. HT9425-24-1-1109Opinions, interpretations, conclusions and recommendations are those of the author and are not necessarily endorsed by the Assistant Secretary of Defense for Health Affairs or the Department of Defense.