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  • Enhancing Warfighter Readiness in a Virtual Environment

    By Pinata Sessoms, Ph.D., research biomedical engineer, Naval Health Research Center

    Innovation in military medicine is about saving lives on the battlefield, preventing or mitigating injuries in our warfighters, and ensuring that we have a fit and ready force. Innovation is also vital to medical research, which ensures our military leaders and medical providers have the latest information, tools, and techniques available to support the health and readiness of our service members.
    In the Warfighter Performance Department at the Naval Health Research Center (NHRC), our Physical and Cognitive Operational Research Environment (PhyCORE) team is one group whose innovative research is continually enhancing the physical and cognitive health and readiness of our warfighters. The  research we conduct spans a diverse portfolio of topics to include:
    • Rehabilitation methods for wounded warriors with amputations and mild traumatic brain injury
    • Evaluation of personal protective equipment
    • Countermeasures for the impact of fatigue on cognitive performance
    • Assessing gear and equipment design variations on performance and survivability
    • Finding objective measures to determine injury level and fitness to return to duty
    One of the unique capabilities of the PhyCORE team is the tool we use to conduct cutting-edge research.  Housed in NHRC’s Warfighter Performance Lab is the Computer Assisted Rehabilitation Environment (CAREN), an immersive virtual reality system—a very large, state-of-the-science piece of technology. When first installed in 2008, the CAREN was initially intended for rehabilitation research in our wounded warriors. Original features of the CAREN included:
    • A 9-foot diameter platform, programmable to move in six degrees of freedom, independently or simultaneously
    • A treadmill centered in the platform with integrated force plates to measure ground reaction forces
    • A 180-degree wide, 9-foot tall curved screen surrounding the platform
    • Motion capture cameras integrated with the screen to track user movement
    While the CAREN’s off-the-shelf capabilities were well-suited to its original intent of supporting clinical investigation and therapy for the wounded, ill, and injured, the PhyCORE team saw the potential for creating a tool to support additional avenues of research—research that would look beyond rehabilitating wounded warriors to studying novel approaches for keeping warfighters healthy and fit and optimizing their performance.
    Expanding the research capabilities of the CAREN required making multiple system enhancements. Leveraging our combined expertise (physical therapy, biomechanics, software and hardware engineering, sleep physiology, aerospace experimental psychology, and neurophysiology, among others), the PhyCORE team has modified and improved the CAREN’s original configuration to meet military medicine’s emerging research needs. Our enhancements include:
    • A programmable scent-delivery system, 3-D projection capability, improved sound system and a high-performance treadmill for destabilizing movements that increase the immersive experience
    • A custom driving cab built in-house that integrates with the system for adaptable, simulated driving scenarios, used as a tool to measure the effects of operational task performance and test fatigue-related countermeasures
    • Surface electromyography (sEMG) to measure muscle activation and fatigue
    • Mobile electroencephalography (EEG) systems to measure brain activity patterns of the user engaged in different tasks to assess real-time cognitive states
    • A laser-based marksmanship training and evaluation system that integrates with the treadmill and motion platform to create a tool ideal for testing cognitive effects of new protective gear and equipment loads on performance in virtual battlespaces, including villages, urban cities, oceans, rivers, fields, and mountains.
    Thanks to the collaborative efforts of our team, the CAREN is now a single system with multiple capabilities that we can use to research a diverse set of health and readiness needs in a highly controlled, operationally relevant, virtual environment.
    In addition to the CAREN, our Warfighter Performance Laboratory  has a Sleep and Fatigue Lab, functional testing systems, swim flume, and environmental chamber. This allows us to conduct a wide range of studies under one roof for the different issues faced by warfighters, including  fatigue, heat stress, musculoskeletal injury, and cognitive performance. 
    In addition to enhancing the CAREN at NRHC, the PhyCORE team often partners with other DoD CAREN sites and the global community by sharing information and disseminating research findings. Our team members also run regular DoD CAREN operator meetings, help other sites troubleshoot and advance their systems, and implement new technologies at other sites so the DoD CAREN systems are cross-functional and capable of running multi-site studies.
    New areas of research will investigate the use of the system for psychological health issues such as post- traumatic stress and use of VR technology for promoting psychological resilience.  Improved methods to build and customize applications are also being developed that will meet the needs for task specific training or personalized therapy. Looking ahead, the PhyCORE team will continue to embrace the spirit of innovation to improve our research capabilities and provide novel solutions to the unique challenges facing the military health research system and our warfighters.
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