FORT DETRICK, Md. – The Congressionally Directed Medical Research Programs’ Traumatic Brain Injury and Psychological Health Research Program recently awarded a $3.4 million grant to a team of Cleveland Clinic researchers to develop an innovative augmented reality tool for assessing whether Warfighters recovering from concussion are ready to return to duty. The new tool, called Troop Readiness Evaluation with Augmented Reality Return-to-Duty, or Troop READY, promises to provide answers more quickly and reliably than existing methods.

Concussion, also referred to as mild traumatic brain injury or mTBI, is a relatively common injury in the military. According to the DOD Traumatic Brain Injury Center of Excellence, over 80% of the TBI injuries sustained by Service Members between 2000 and 2024 were classified as mTBI. Service Members can experience an mTBI while on deployment, during training, and even when participating in a sport. Most injured Service Members are able to return to duty within two weeks. Military doctors currently follow a six-step protocol called the Progressive Return to Activity for safely returning an injured Service Member to duty, but the PRA has some shortcomings.

“The PRA is not 100% objective,” explains Dr. Dwayne Taliaferro, CDMRP’s TBIPHRP program manager. “While a medical professional guides the Service Member through the protocol, progress is dependent on the Service Member’s self-assessment of the mildness or severity of their symptoms. Troop READY offers an opportunity to provide more objectivity in the PRA protocol.”

Troop READY uses a Microsoft HoloLens 2 augmented reality headset and simulated M4 carbine assault rifle to generate a series of realistic and increasingly intensive scenarios that a patient must complete in order to simultaneously assess their cognitive and physical readiness. The exercises involve marching, shooting while standing and kneeling, and breaching and clearing a room. The patient’s cognitive, motor, and task performance capabilities are then analyzed using specially trained machine learning algorithms to determine the severity of any detected symptoms.

Dr. Jay Alberts, director of Cleveland Clinic’s Concussion Center, is leading the three-year project to further refine Troop READY, which he originally developed and tested under a previous CDMRP grant. In partnership with Microsoft Federal, Alberts and his team will use the new grant to improve the tool’s ability to detect signs of mTBI and to recommend personalized treatment plans for patients that streamline their return to duty.

Under the TBIPHRP grant, Alberts and his team will conduct a usability study with volunteers to refine the simulation modules, which will then be tested on a larger cohort of volunteers to identify baseline performance levels. Those baseline data will be used to train the machine learning algorithms to ensure a high degree of accuracy when assessing a patient’s current condition and guiding their continued treatment.

Taliaferro says that Troop READY offers several potential advantages over existing methods for assessing mTBI recovery in Service Members. For example, doctors use a battery of neurocognitive tests called Automated Neuropsychological Assessment Metrics to assess a Service Member’s readiness to return to duty. The computer-based ANAM assesses changes to a Service Member’s attention, reaction time, memory, and decision-making abilities based on their answers to a series of survey questions. However, as a sit-down multiple-choice test, ANAM lacks the fidelity of an active 3D simulation.

“The Computer Assisted Rehabilitation Environment Laboratory at the National Intrepid Center of Excellence blends virtual reality with a treadmill, immersive video, surround sound, and even smells,” Taliaferro says. “It is very powerful, but it’s in a fixed location and not very portable. Whereas with Troop READY, you can deploy the goggle set and the mock weapon anywhere quickly.”

In addition to helping Warfighters return to duty, the Troop READY tool has the potential to be adapted for use in other fields where mTBI is a risk, such as professional sports, construction, and law enforcement, says Taliaferro.

Before it can be deployed with the military or other users, Troop READY will need to be assessed by both the U.S. Food and Drug Administration and the DOD for its safety and readiness for use.

“CDMRP’s role is to accelerate the development of products like Troop READY so that they can be properly evaluated to determine how, when, and where they can be deployed,” explains Taliaferro. “We do not always put things directly in the hands of Warfighters at the end of a study, but we get them as close as we can. That is a great use of taxpayer dollars.”

By Paul Lagasse, USAMRDC Public Affairs Office