Cognitive preparation shows a person’s ability to respond and adapt to changes around them. This includes features such as keeping balance after a trip or making the right decisions in difficult situations based on knowledge and past experience. For military service members, cognitive preparation is important not only for their health and safety, but also for the success of the mission. Brain damage is a major contributor to cognitive impairment, with over 500,000 military service members diagnosed with traumatic brain injury (TBI) between 2000 and 2024. Disorders from factors such as sleep deprivation can be treated by rest and recovery, while other disorders caused by injuries may require more severe and prolonged medical procedures.
“Current cognitive preparation tests being conducted on service members lack the sensitivity to detect subtle changes in cognitive performance that may occur in individuals at operational risk,” says Christopher Smalt, a researcher with the Institute’s Human Health and Performance Systems Group. “Unfortunately, the cumulative effects of these exposures are often under-documented during military service or after the transition to veteran issues, making it difficult to provide effective support.”
Smalt is part of a lab team developing a series of portable diagnostic tests that provide close-time screening for brain injury and cognitive health. One of these tools, called Ready, is a smartphone or tablet app that helps you identify potential changes in cognitive performance in under 90 seconds. Another tool called MindScape – is being developed in collaboration with Richard Fletcher, visiting scientist at the Rapid Prototyping Group, leading the Mobile Technology Lab at MIT Auto-ID Laboratory, and in collaboration with his students. Using these tests, battlefield health workers can make quick and effective decisions for treatment triage.
Both Readyscape and Mindscape require a set of Congressional Act obligations, military program requirements, and mission-driven health to improve the brain health screening capabilities of service members.
Cognitive Preparation Biomarkers
The Ready and Mindscape platform incorporates over a decade of laboratory research into finding the right indicators of cognitive preparation to build rapid testing applications. Thomas Quatieri oversaw this work and identified balance, eye movement, and speech as three reliable biomarkers. He leads the effort to be ready at the Lincoln Institute.
“It is built on the premise that it is ready to be subject to a prompt assessment of attention for obligations and that attention is the key to being “ready” for missions,” he says. “In one view, one can think of attention as a mental state that allows you to focus on the task.”
For someone to pay attention, their brains must instruct their bodies to continually predict, process and respond appropriately to sensory information. For example, if a friend screams “catch” and then throws the ball in the direction, in order to catch the ball, the brain must process incoming hearing and visual data, predict what will happen in the next few moments, and direct the body with actions that synchronize those sensory data. result? Hearing the word “catch,” you notice it from seeing a friend in motion throwing the ball at you, reaching out to reach just in time.
“For example, an unhealthy or fatigued brain caused by TBI or lack of sleep can have challenges within a neurosensory feedforward (prediction) or feedback (error) system, thus impeding a person’s ability to attend,” Quatieri says.
Ready’s three tests track moving dots with eyes, balance, and measure a person’s ability to hold fixed vowels at one pitch. The app then uses the data to calculate a variability or “wobble” indicator that represents a change from the baseline of the test taker or expected outcome based on others with similar demographics or general populations. Results are presented to the user as a sign of the patient’s level of attention.
If the prepared screen shows a failure, the administrator can instruct subjects to follow up with Mindscape, which represents a mobile interface for neurological diagnostic situation cognitive assessment and psychological assessment. MindScape uses VR technology to manage additional in-depth tests to measure cognitive functions such as reaction times and working memory. These standard neurocognitive tests have been recorded with multimodal physiological sensors such as EEG (EEG), photoplethysmography, and pupil measurements to better identify the diagnosis.
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Mindscape for brain health screening
Video: MIT Lincoln Institute
Overall and adaptable
A key advantage of Ready and Mindscape is that it leverages existing technology to enable rapid deployment in the field. By leveraging sensors and features already integrated into smartphones, tablets and VR devices, these assessment tools can be easily adapted for use in operational settings at a significantly reduced cost.
“Advanced algorithms can be applied immediately to data collected from these devices without the need for expensive and time-consuming hardware development,” Smalt says. “By leveraging the capabilities of commercially available technology, we can quickly provide valuable insights and improve traditional assessment methods.”
Bringing new capabilities and AI for brain health detection to the operational environment is a theme across several laboratory projects. Another example is the eye-opening (an electric charging and balanced blast overpressure monitoring system), a wearable technology developed for the US Special Forces to monitor eye exposure. The eyeball continuously monitors the wearer’s eye and body movements when experiencing blast energy and alerts them of potential harm. In this program, the lab developed an algorithm that could identify potential changes in physiology caused by explosions during operation, rather than waiting for check-in.
All three technologies are under development to be versatile, so they can be adapted to other related applications. For example, a workflow can pair Eyeboom monitoring capabilities with Ready and Mindscape tests. Eyeboom continuously monitors exposure risk and encourages wearers to seek additional evaluations.
“While research often focuses on one specific modality, what we do in our lab is to search for an overall solution that can be applied for a variety of purposes,” says Smalt.
Mindscape is being tested this year at the Walter Reed National Military Center. In the context of sleep deprivation, it will be tested in 2026 at the US Army Institute of Environmental Medicine (USARIEM). Smalt and Quatieri are also seen techniques for finding use in a private environment – whether it’s a side job at a sporting event, a doctor’s office, or wherever you need to assess your brain preparation.
Mindscape is developed with clinical verification and support from Stefanie Kuchinsky of the Walter Reed National Military Medical Center. Quatieri and his team are working with Jun Maruta, Jam Ghajar of The Brain Trauma Foundation (BTF) and Kristin Heaton of Usariem to develop ready-to-read tests. The test is supported by simultaneous evidence-based guidelines led by the Military TBI Initiative of BTF and Uniform Services University.
