The Congressionally Directed Medical Research Programs’ Traumatic Brain Injury and Psychological Health Research Program has awarded a $3.4 million grant to a team of Cleveland Clinic researchers to develop an augmented reality system designed to assess whether Warfighters recovering from concussions are ready to return to duty.
The tool, called Troop Readiness Evaluation with Augmented Reality Return-to-Duty (Troop READY), is intended to provide a more accurate and efficient assessment of recovery compared to existing protocols.
Concussion, or mild traumatic brain injury (mTBI), is a frequent injury among military personnel. According to the Department of Defense Traumatic Brain Injury Center of Excellence, over 80% of TBI cases among Service Members from 2000 to 2024 were classified as mTBI. These injuries occur in combat zones, training environments, and even during sports activities. Most Service Members recover within two weeks, following a six-step protocol known as the Progressive Return to Activity (PRA). However, the PRA relies heavily on self-reported symptoms, which can make the process subjective.
“The PRA is not 100% objective,” said Dr. Dwayne Taliaferro, program manager for the Traumatic Brain Injury and Psychological Health Research Program. “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 employs a Microsoft HoloLens 2 augmented reality headset and a simulated M4 carbine to create realistic scenarios that assess both cognitive and physical readiness. The system tasks users with activities such as marching, shooting from standing and kneeling positions, and clearing rooms. Machine learning algorithms analyze a patient’s cognitive, motor, and task performance to determine the presence and severity of symptoms.
Dr. Jay Alberts, director of Cleveland Clinic’s Concussion Center, is leading the three-year project to refine Troop READY. Originally developed under a previous CDMRP grant, the system will now be further enhanced in collaboration with Microsoft Federal to improve its diagnostic capabilities and personalize treatment recommendations for faster recovery.
Under the new grant, Alberts and his team will conduct a usability study with volunteers to refine simulation modules before testing them on a larger group to establish baseline performance data. These data will then be used to train the system’s machine learning algorithms to ensure accurate assessments.
Existing concussion assessments, such as the Automated Neuropsychological Assessment Metrics (ANAM), evaluate attention, reaction time, memory, and decision-making abilities through multiple-choice surveys. However, these sit-down tests lack the immersive, real-world fidelity of a 3D simulation. More advanced systems, such as the Computer Assisted Rehabilitation Environment Laboratory at the National Intrepid Center of Excellence, offer high-level virtual reality rehabilitation but are limited to fixed locations.
“The Computer Assisted Rehabilitation Environment Laboratory blends virtual reality with a treadmill, immersive video, surround sound, and even smells,” Taliaferro explained. “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.”
Beyond military applications, Troop READY could be adapted for other high-risk fields such as professional sports, construction, and law enforcement, where mTBI is a concern, according to Taliaferro.
Before the system can be implemented, Troop READY will need approval from both the U.S. Food and Drug Administration and the Department of Defense to assess its safety and operational readiness.
“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,” said 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.”