Tech on the Brain

Image

A roadside bomb goes off, sending soundwaves rippling through the air and into the soft tissue of a soldier’s body. The blast continues up, popping microscopic blood vessels in the brain. The service member is dazed, but regains their footing and presses forward, thinking they narrowly avoided a serious wound.

This is just one example of how someone in the military might sustain a traumatic brain injury, or TBI. TBIs can be caused by a blow to the head or anything that causes a jolt to the brain. It is one of the most common forms of injury in recent military conflicts.

Moderate and severe TBIs can be fatal or lead to lifelong health problems. Fortunately, most TBIs are mild. But even a mild TBI, also referred to as a concussion, can have ongoing complications and need time to heal.

“A mild TBI can cause portions of the outer layer of the brain, the cerebral cortex, to shift or slide. This tears the nerves connected to it. These damaged connections often repair themselves, but sometimes they shrivel up and die,” says William D.S. Killgore, a professor and the director of the Social, Cognitive and Affective Neuroscience Lab in the University of Arizona College of Medicine – Tucson’s Department of Psychiatry.

“A person with this injury could have trouble concentrating or remembering information, experience dizziness, fatigue or disturbed sleep, and they might have trouble regulating their emotions.”

Killgore and his team are developing a small, portable tool to quickly diagnose military personnel with TBI in the field. The Virtual Reality Military Operational Neuropsychological Assessment, or VRMONA, will use virtual reality and artificial intelligence to identify brain deficits through a combat-type game.

The gold standard for assessing a TBI is a neuropsychological assessment usually consisting of a battery of paper-and-pencil tests administered by a highly trained psychologist. It can take four to eight hours. For small teams conducting military operations in far flung areas, this approach is usually not feasible.

“The traditional style of assessment can be taxing on a person. You want to measure multiple domains, like memory, language and spatial skills. On paper, that involves a separate test for each,” says Killgore, who also is a member of the university’s BIO5 Institute. “If successful, our computer systems may find where these domains overlap on different tasks in the game and distill the whole process down to 10 or 20 minutes. VRMONA could be a revolutionary new way to assess traumatic brain injury.”

Killgore’s team has already developed a prototype for VRMONA that is made up of a VR headset and handheld controllers paired with an AI technique known as deep neural network learning. Their new research, funded by a $1.5 million Department of Defense grant, will upgrade the equipment and the game itself while evaluating 1,000 participants over several phases of development.

In the first phase, participants will be split into three groups: a healthy control group, people with mild to moderate TBI, and those with other neurological disorders. Data will be collected from traditional neurological exams and cross-referenced with the data and results from VRMONA. Researchers will update and revise the system over three cycles of testing.

Killgore and his team will use traditional neurological exams and VRMONA to assess four neurocognitive domains that are particularly sensitive to the effects of mild TBI: attention, processing speed, memory and executive function.

“Some people might not see the value in something like an abstract puzzle test; I think soldiers will relate to something that resembles their job,” Killgore says. “The great part about VRMONA is that it connects the service member to tasks relevant to their day-to-day lives. The simulation might require the person to pay attention to what is going out over their radio, quickly sight a weapon, or make a decision to shoot or not shoot. It will look similar to video games they might have already played, and I think they will want to beat the game.”

If successful, VRMONA will be able to instantly collect and analyze data, allowing it to identify deficits associated with TBI in a fraction of the time of a traditional assessment. Killgore hopes future iterations and advancements of VRMONA will be scaled down in size so that the equipment can fit into a medic’s bag and be operated by nonmedical personnel, if needed.

“Eventually, we also want to increase the diagnostic abilities to precisely identify what type of neurological disorder someone is suffering from. This could be anything from adult attention deficit disorder to Parkinson’s or Alzheimer’s disease,” Killgore says. “I think we will be able to adapt VRMONA for people outside of the military as well. Instead of a combat-style game, it could be a simulation where you need to drive to the store for groceries or prepare a dinner.”

Killgore has focused much of his research on the mental health and well-being of those in the armed forces. His work in this area dates to his own military service, which began after Sept. 11, 2001. In total, he has spent 22 years in the military.

“When the planes hit the Twin Towers, I decided to join the Army as a researcher. I left Harvard, where I was already starting my research career, and joined the military. My friends couldn’t believe it,” says Killgore, who became a research scientist in the Sleep Research Center at the Walter Reed Army Institute of Research in Silver Spring, Maryland.

“I spent five years on active duty doing research on sleep, post-traumatic stress disorder and other issues,” he says. “I went back to academic research after that, but I stayed in the Army Reserves.”

Killgore says the symptoms of a mild concussion can easily be overlooked on a chaotic battlefield. VRMONA could help teams quickly assess an injured soldier so they can make the best decision for that person’s health and for their mission.

“Veterans often call mild TBI an ‘invisible wound of war,’” Killgore says. “Soldiers may look OK on the outside, but every area of their life may be impacted. VRMONA may help reduce the risk of continued injury and allow someone the opportunity they need to rest and heal.”

The VRMONA project was made possible with a seed grant from the U of A Health Sciences SensorLab. The SensorLab team developed the prototype for VRMONA and demonstrated its proof of concept. SensorLab resources include state-of-the-art devices and wearable sensors that can track variables like heart rate and eye motion. Killgore’s team launched their project and collected pilot data with a commercially available VR system and a simple shoot/no-shoot game. They brought in 20 healthy individuals to play the game and compared results to traditional neurological assessments.