Cognitive readiness denotes a person's ability to respond and adapt to the changes around them. This includes functions like keeping balance after tripping, or making the right decision in a challenging situation based on knowledge and past experiences. For military service members, cognitive readiness is crucial for their health and safety, as well as mission success. Injury to the brain is a major contributor to cognitive impairment, and between 2000 and 2024, more than 500,000 military service members were diagnosed with traumatic brain injury (TBI) - caused by anything from a fall during training to blast exposure on the battlefield. While impairment from factors like sleep deprivation can be treated through rest and recovery, others caused by injury may require more intense and prolonged medical attention.
"Current cognitive readiness tests administered to service members lack the sensitivity to detect subtle shifts in cognitive performance that may occur in individuals exposed to operational hazards," says Christopher Smalt, a researcher in the laboratory's Human Health and Performance Systems Group. "Unfortunately, the cumulative effects of these exposures are often not well-documented during military service or after transition to Veterans Affairs, making it challenging to provide effective support."
Smalt is part of a team at the laboratory developing a suite of portable diagnostic tests that provide near-real-time screening for brain injury and cognitive health. One of these tools, called READY, is a smartphone or tablet app that helps identify a potential change in cognitive performance in less than 90 seconds. Another tool, called MINDSCAPE - which is being developed in collaboration with Richard Fletcher, a visiting scientist in the Rapid Prototyping Group who leads the Mobile Technology Lab at the MIT Auto-ID Laboratory , and his students - uses virtual reality (VR) technology for a more in-depth analysis to pinpoint specific conditions such as TBI, post-traumatic stress disorder, or sleep deprivation. Using these tests, medical personnel on the battlefield can make quick and effective decisions for treatment triage.
Both READY and MINDSCAPE are a response to a series of Congressional legislation mandates, military program requirements, and mission-driven health needs to improve brain health screening capabilities for service members.
Cognitive readiness biomarkers
The READY and MINDSCAPE platforms incorporate more than a decade of laboratory research on finding the right indicators of cognitive readiness to build into rapid testing applications. Thomas Quatieri oversaw this work and identified balance, eye movement, and speech as three reliable biomarkers. He is leading the effort at Lincoln Laboratory to develop READY.
"READY stands for Rapid Evaluation of Attention for DutY, and is built on the premise that attention is the key to being 'ready' for a mission," he says. "In one view, we can think of attention as the mental state that allows you to focus on a task."
For someone to be attentive, their brain must continuously anticipate and process incoming sensory information and then instruct the body to respond appropriately. For example, if a friend yells "catch" and then throws a ball in your direction, in order to catch that ball, your brain must process the incoming auditory and visual data, predict in advance what may happen in the next few moments, and then direct your body to respond with an action that synchronizes those sensory data. The result? You realize from hearing the word "catch" and seeing the moving ball that your friend is throwing the ball to you, and you reach out a hand to catch it just in time.
"An unhealthy or fatigued brain - caused by TBI or sleep deprivation, for example - may have challenges within a neurosensory feed-forward [prediction] or feedback [error] system, thus hampering the person's ability to attend," Quatieri says.
READY's three tests measure a person's ability to track a moving dot with their eye, balance, and hold a vowel fixed at one pitch. The app then uses the data to calculate a variability or "wobble" indicator, which represents changes from the test taker's baseline or from expected results based on others with similar demographics, or the general population. The results are displayed to the user as an indication of the patient's level of attention.
If the READY screen shows an impairment, the administrator can then direct the subject to follow up with MINDSCAPE, which stands for Mobile Interface for Neurological Diagnostic Situational Cognitive Assessment and Psychological Evaluation. MINDSCAPE uses VR technology to administer additional, in-depth tests to measure cognitive functions such as reaction time and working memory. These standard neurocognitive tests are recorded with multimodal physiological sensors, such as electroencephalography (EEG), photoplethysmography, and pupillometry, to better pinpoint diagnosis.
Video: MIT Lincoln Laboratory
Holistic and adaptable
A key advantage of READY and MINDSCAPE is their ability to leverage existing technologies, allowing for rapid deployment in the field. By utilizing sensors and capabilities 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.
"We can immediately apply our advanced algorithms to the data collected from these devices, without the need for costly and time-consuming hardware development," Smalt says. "By harnessing the capabilities of commercially available technologies, we can quickly provide valuable insights and improve upon traditional assessment methods."
Bringing new capabilities and AI for brain-health sensing into operational environments is a theme across several projects at the laboratory. Another example is EYEBOOM (Electrooculography and Balance Blast Overpressure Monitoring System), a wearable technology developed for the U.S. Special Forces to monitor blast exposure. EYEBOOM continuously monitors a wearer's eye and body movements as they experience blast energy, and warns of potential harm. For this program, the laboratory developed an algorithm that could identify a potential change in physiology resulting from blast exposure during operations, rather than waiting for a check-in.
All three technologies are in development to be versatile, so they can be adapted for other relevant uses. For example, a workflow could pair EYEBOOM's monitoring capabilities with the READY and MINDSCAPE tests: EYEBOOM would continuously monitor for exposure risk and then prompt the wearer to seek additional assessment.
"A lot of times, research focuses on one specific modality, whereas what we do at the laboratory is search for a holistic solution that can be applied for many different purposes," Smalt says.
MINDSCAPE is undergoing testing at the Walter Reed National Military Center this year. READY will be tested with the U.S. Army Research Institute of Environmental Medicine (USARIEM) in 2026 in the context of sleep deprivation. Smalt and Quatieri also see the technologies finding use in civilian settings - on sporting event sidelines, in doctors' offices, or wherever else there is a need to assess brain readiness.
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 developing the READY tests in collaboration with Jun Maruta and Jam Ghajar from the Brain Trauma Foundation (BTF), and Kristin Heaton from USARIEM. The tests are supported by concurrent evidence-based guidelines lead by the BTF and the Military TBI Initiative at Uniform Services University.
