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Cognitive preparedness refers to an individual’s capacity to react and adjust to the shifting environment surrounding them. This encompasses abilities such as maintaining stability after stumbling, or making sound decisions in difficult situations by utilizing knowledge and prior experiences. For military personnel, cognitive preparedness is vital for their well-being and safety, as well as the success of their missions. Brain injuries are a significant factor contributing to cognitive dysfunction, and from 2000 to 2024, over 500,000 military personnel were identified with traumatic brain injury (TBI) — resulting from incidents ranging from falls during training to exposure to blasts in combat. While issues arising from conditions such as sleep deprivation can be addressed through rest and recuperation, those stemming from injuries often necessitate more rigorous and extended medical intervention.
“Existing cognitive preparedness evaluations given to personnel are insufficiently sensitive to identify nuanced variations in cognitive performance that may manifest in individuals exposed to operational hazards,” asserts Christopher Smalt, a researcher in the laboratory’s Human Health and Performance Systems Group. “Regrettably, the cumulative consequences of these exposures are frequently not thoroughly recorded during military service or subsequent transition to Veterans Affairs, complicating the process of delivering effective support.”
Smalt is part of a team at the laboratory crafting a collection of portable diagnostic assessments that provide near-instantaneous screening for brain injuries and cognitive wellness. One of these instruments, known as READY, is a smartphone or tablet application that assists in detecting a potential variation in cognitive performance in under 90 seconds. Another tool, termed MINDSCAPE — being developed in partnership with Richard Fletcher, a visiting scientist in the Rapid Prototyping Group who manages the Mobile Technology Lab at the MIT Auto-ID Laboratory, and his students — incorporates virtual reality (VR) technology for a more comprehensive analysis to identify specific conditions such as TBI, post-traumatic stress disorder, or sleep loss. By employing these assessments, medical personnel on the front lines can promptly make informed decisions regarding treatment prioritization.
Both READY and MINDSCAPE are a response to a series of legislative mandates from Congress, military program necessities, and mission-focused health demands aimed at improving brain health screening capabilities for service members.
Cognitive preparedness biomarkers
The READY and MINDSCAPE platforms incorporate over a decade of laboratory investigations into identifying suitable indicators of cognitive preparedness to integrate into rapid testing applications. Thomas Quatieri led this initiative, pinpointing balance, eye movement, and speech as three dependable biomarkers. He is spearheading the development of READY at Lincoln Laboratory.
“READY stands for Rapid Evaluation of Attention for DutY, and is founded on the belief that attention is essential for being ‘prepared’ for a mission,” he states. “One perspective is to view attention as the mental condition that enables you to concentrate on a task.”
For an individual to maintain attentiveness, their brain must consistently predict and process incoming sensory data and then instruct the body to react accordingly. For instance, if a friend exclaims “catch” and launches a ball in your direction, to successfully catch that ball, your brain must process the incoming auditory and visual information, anticipate what might transpire in the upcoming moments, and then direct your body to take action that aligns with those sensory inputs. The outcome? You realize from hearing “catch” and observing the moving ball that your friend is throwing it to you, prompting you to extend your hand just in time to catch it.
“A compromised or weary brain — due to TBI or sleep deprivation, for example — might face difficulties within a neurosensory feed-forward [prediction] or feedback [error] system, thereby hindering the individual’s attentional capacity,” Quatieri explains.
READY’s three evaluations assess a person’s capacity to track a moving dot with their eyes, maintain balance, and hold a vowel stable at one pitch. The application then uses the gathered data to compute a variability or “wobble” indicator, reflecting deviations from the test taker’s baseline or from anticipated outcomes based on others with comparable demographics or the general population. The findings are presented to the user as an indication of the individual’s attentional level.
If the READY assessment indicates an impairment, the administrator can then refer the individual to MINDSCAPE, which stands for Mobile Interface for Neurological Diagnostic Situational Cognitive Assessment and Psychological Evaluation. MINDSCAPE employs VR technology to conduct additional, comprehensive tests to assess cognitive abilities such as response time and working memory. These standard neurocognitive evaluations are recorded utilizing multimodal physiological sensors, including electroencephalography (EEG), photoplethysmography, and pupillometry, to refine diagnosis.
Comprehensive and adaptable
A primary benefit of READY and MINDSCAPE lies in their capacity to utilize existing technologies, facilitating prompt deployment in operational environments. By making use of sensors and functionalities already incorporated into smartphones, tablets, and VR devices, these assessment tools can be seamlessly adapted for use in field conditions at a significantly lower cost.
“We can promptly apply our sophisticated algorithms to the data amassed from these devices, eliminating the necessity for expensive and time-consuming hardware development,” Smalt notes. “By leveraging the features of commercially available technologies, we can swiftly provide valuable insights and enhance traditional assessment practices.”
Integrating new capabilities and AI for brain-health monitoring into operational settings is a common theme across various projects at the laboratory. An additional example is EYEBOOM (Electrooculography and Balance Blast Overpressure Monitoring System), a wearable technology created for the U.S. Special Forces to track blast exposure. EYEBOOM continuously observes a wearer’s eye and bodily movements as they encounter blast energy, alerting them to potential risks. For this initiative, the laboratory devised an algorithm capable of detecting a potential physiological change resulting from blast exposure during operations, rather than waiting for a scheduled check-in.
All three technologies are designed to be adaptable, allowing for application in other pertinent contexts. For instance, a workflow could combine EYEBOOM’s monitoring capabilities with the READY and MINDSCAPE evaluations: EYEBOOM would continuously monitor for exposure risks and then prompt the user to seek further evaluation.
“Often, research concentrates on one specific modality, whereas we at the laboratory aim to find a holistic solution that can be utilized for various purposes,” Smalt observes.
MINDSCAPE is currently in testing at the Walter Reed National Military Center this year. READY will be assessed with the U.S. Army Research Institute of Environmental Medicine (USARIEM) in 2026 concerning sleep deprivation. Smalt and Quatieri also envision the use of these technologies in civilian environments — on sports event sidelines, in medical offices, or wherever there is a need to evaluate brain preparedness.
MINDSCAPE is being developed with clinical validation and support from Stefanie Kuchinsky at the Walter Reed National Military Medical Center. Quatieri and his team are creating the READY assessments in collaboration with Jun Maruta and Jam Ghajar from the Brain Trauma Foundation (BTF), and Kristin Heaton from USARIEM. The assessments are backed by concurrent evidence-based guidelines led by the BTF and the Military TBI Initiative at Uniform Services University.
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