Opportunities in Neuroscience for Future Army Applications (2009)

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6 Improving Cognitive and Behavioral Performance The transformation of the U.S. military services into a overtraining. At the same time, many of these techniques highly networked force has markedly increased the need for appear to offer possibilities for enhancing soldiers’ perfor- rapid collection and dissemination of vast amounts of data. mance beyond their normal, or unaided, baseline capabilities. This includes the fusion and display of data in formats that This chapter assesses the current status and emerging pros- can be readily comprehended by soldiers who can then take pects for such neuroscience-informed enhancements. the appropriate actions. The combination of optimal performance, data com- Hours of Boredom and Moments of Terror prehension, and decision making required for this trans- formation to a networked force comes as the Army evolves Many of the tasks that make up a military deploy- into a growing variety of combat platforms. Depending on ment, especially for operations in a combat theater, can be their specialties, soldiers can be expected to operate equip- characterized as “hours of boredom and moments of terror” ment ranging from 70-ton Abrams tanks and 35-ton Stryker (Hancock, 1997). During the long periods of waiting that v ­ ehicles to sophisticated manned and unmanned ground and lead up to a combat operation where hostile action may air systems of the Future Combat Systems and to conduct await, the main demand on individual performance is for basic dismounted soldier operations in all environments, vigilance and sustained attention (Warm, 1984). The strong including urban terrain. All of these operations rely on the association between the psychophysical dimensions of the soldier maintaining situational awareness and sharing a com- vigilance task and certain mental workload measures made mon operating picture of the battlefield. possible by advances in neuroscience can aid the soldier The soldiers conducting these varied operations will (Warm et al., 1996). Failures in vigilance can lead to calam- also contend with stressors on cognitive performance as ity in military operations (Rochlin, 1991; Snook, 2000) as described in Chapters 4 and 5. The need to remain vigilant well as in other facets of human life (Hill and Rothblum, and on task continuously for extended periods (longer than 1994; Evan and Manion, 2002). The classic military example 36 hours) in extreme environments (for example, in closed is standing watch, where continuous sustained attention is vehicles, where the temperature can exceed 110°F) while e ­ ssential but the probability of a threat event at any particular enduring the stresses of sustained combat or of security and time is low. stability operations will challenge the baseline cognitive Many prominent cases of military failure associated and behavioral capabilities of soldiers, who must assimilate with human error have involved failures of sustained atten- and react appropriately to the flow of task-relevant informa- tion (e.g., Miller and Shattuck, 2004). Looked at in terms of tion. In short, each soldier’s cognitive performance on his classic signal detection theory, such failures are classified as a ­ ssigned tasks will more than ever before be critical to his or either a false alarm or a miss. Both forms of inappropriate her operational performance. response are problematic, but missing a critical signal for The recent breakthroughs in neuroimaging and other response can result in injury and fatalities not just for the technologies described in Chapters 2 through 5 allow quan- soldier but also for the immediate unit or even beyond. Thus, tifying the physiological metrics of human attentiveness, finding ways to extend attentiveness could have a significant cognitive performance, and neural functioning. The knowl- return for overall military performance. edge gained is guiding the development of countermeasures Fortunately, substantial progress has recently been made against such stressors as fatigue, sleep deprivation, informa- on the problem of sustained attention. For example, Tripp tion overload, dehydration and other metabolic stresses, even and Warm (2007) have linked variations in blood flow and 67 

68 OPPORTUNITIES IN NEUROSCIENCE FOR FUTURE ARMY APPLICATIONS blood oxygenation, as measured by transcranial Doppler performance during the infrequent but intense moments sonography, with occasions on which observers miss signals. of terror? In the modern Army environment, such contexts In addition to measuring blood flow and blood oxygenation, typically involve surging information loads on individuals which are indirect indicators of neural functioning, event- who must process all the relevant information quickly and related potentials may be another way to learn when an appropriately to avoid the twin performance faults: failure individual has missed a critical signal. As discussed in the to respond or incorrect response. When peak demands are following section on neuroergonomics, if the data stream coming from multiple cognitive tasks—e.g., perceptual of the original event-related potentials is formatted so as to judgment, information assimilation to cognitive schema, and elicit, for example, a P300 response when a miss occurs, choice selection (decision making in a broad sense), all of then an augmented perception system could be triggered which must be carried out with urgency—cognitive overload by such an electrophysiological signal. Such techniques for is likely to degrade performance. augmenting perception—in this case to improve awareness As an example, consider a mounted soldier-­operator who of a signal—depend on vigilance for catching a specific is monitoring his own formation of manned and ­unmanned signal. The interface employed for this task may need to be ground vehicles, along with attached unmanned aerial vehi- structured to make best use of the augmentation opportunity, cle assets, and is receiving and sending communications over and such designs are a challenge to scientists in the human his tactical radio system. At the same time that he notices factors and ergonomics communities (Hancock and Szalma, some problem with one of the unmanned ground vehicles, 2003a, 2003b). he loses contact with one of the aerial vehicles and receives Despite the challenges, work on military applica- preliminary indications of an enemy position on his flank. tions for this kind of brain-signal-augmented recognition The soldier in this or analogous circumstances may well have is going forward, as illustrated by two current Defense trained for such events individually, but all three occurring ­ dvanced Research Projects Agency (DARPA) programs. A simultaneously is likely to produce cognitive overload. The Neuro­science for Intelligence Analysts system uses The primary way in which neuroscience can help an electro­encephalography (EEG) to detect a brain signal individual deal with cognitive overload is through improved corresponding to perceptual recognition (which can occur methods for load-shedding as the workload stress on the below the level of conscious attention) of a feature of inter- individual increases beyond a manageable level. In effect, est in remote (airborne or space-based) imagery. In macaque the aiding system removes or lessens one or more of the m ­ onkeys, an EEG signature from electrophysiological stacked processing-and-response demands on the individual. recordings has been successfully detected for target image The load-shedding process can continue as cognitive tasks presentation rates of up to 72 images per second (Keysers are sequentially removed. Thus, in the example above, the et al., 2001). In the Phase 1 proof-of-concept demonstration soldier-operator can focus on the most serious threat—the of a triage approach to selecting images for closer review, signs of hostile activity—while his load-shedding system actual intelligence analysts working on a realistic broad-area automatically moves into problem-management routines for search task achieved a better than 300 percent improvement the two “straying” unmanned vehicles and cuts the incom- in throughput and detection relative to the current standard ing message traffic on the radio to just the highest priority for operational analysis. There is evidence that this technol- messages. Various forms of discrete task allocation have ogy can detect at least some classes of unconscious attention, been around in concept since the mid-1950s and in practice providing support for the notion that perception is not only since the later 1980s. However, in these existing forms, or always consciously perceived. the aiding system does not receive input on how close the The second DARPA program, the Cognitive Technology aided individual is to cognitive overload. This particular Threat Warning System, uses a signal-processing system a ­ spect—­monitoring the status of the individual for measures coupled with a helmet-mounted EEG device to monitor of cognitive overload—is where neuroscience and its tech- brain activity to augment a human sentinel’s ability to detect nologies for assessing neurophysiological state can contrib- a ­ potential threat image anywhere in a wide field-of-view ute to enhancing performance in the moments of terror. In our i ­ mage seen through a pair of binoculars. Again, the objective mounted soldier-operator example, an information workload is to identify potential features of interest using the brain monitoring system would detect the soldier’s nascent cogni- signal, then warn the soldier-sentinel and direct his or her tive overload condition and activate the automated problem attention to those features. management routines for his straying assets and the radio If augmentation of signal awareness can enhance per- “hush-down.” formance in continuous-vigilance tasks during the hours of In the past decade, much effort has gone into the assess- boredom, as illustrated by these DARPA ­ demonstration- ment of neurophysiological indicators of incipient overload. experiments, are there opportunities to enhance soldier At the forefront of these efforts was the Augmented Cogni- tion (AugCog) program of DARPA. The AugCog objective Amy A. was to use a number of neural state indicators to control Kruse, Defense Sciences Office, DARPA, Briefing to the com- mittee on June 30, 2008. adaptive human–machine interfaces to information systems. 

IMPROVING COGNITIVE AND BEHAVIORAL PERFORMANCE 69 The neural state indicators were used to assess cognitive NeuroErgonomics overload stress, and when the stress became too great, they Neuroergonomics has been defined by the individual would trigger the dynamic load-shedding activity of an who coined the term as “the study of the brain and behavior interface management system (McBride and Schmorrow, at work” (Parasuraman and Rizzo, 2007). It is one facet, or 2005; Schmorrow and Reeves, 2007). This pioneering ­effort formalized expression, of the broader field of brain–machine in information workload management via physiological and (or sometimes mind–machine) interfaces (Levine et al., neural feedback, which is discussed further in Chapter 7 and 2000; Lebedev and Nicolelis, 2006). Much of the broader in greater detail in Appendix D, met some degree of success. field, as discussed in Chapters 5 and 7, has focused on ways It also provides important lessons on the challenges for to restore full functioning to individuals who have lost limbs implementing this type of adaptive aiding technology. or who have suffered some form of cognitive deficit follow- The concept of adaptive aiding, which was first ­advanced ing concussive or kinetic injuries. Although many of the by Rouse (1975) for the U.S. Air Force, builds on a long advances in knowledge and in technology for these medical tradition of behavioral adaptation to environmental con- applications are inherently important to all application areas straints (Hancock and Chignell, 1987). However, in a for brain–machine interfaces, the focus of this section is not neural-­indicator-driven implementation, such as in the medical prostheses. Rather, a typical application in neuro­ original AugCog vision, the adaptation is not managed by ergonomics is concerned with enhancing selected capabili- the individual alone but is augmented by the aiding system’s ties beyond an unaided level, whether or not the individual assessment of the individual’s level of cognitive stress or aided by the system has experienced some degradation in other electropsychological parameters. Research projects in capability. Neuroergonomics deals as much with perfor- adaptive aiding have focused on systems for such real-world mance improvement and performance enhancement as with tasks as air traffic control (Hillburn et al., 1997), control of performance recovery. The brief summary below examines unmanned aerial vehicles (see, for example, Mouloua et al., some of the opportunities envisioned by those working in 2003; Taylor, 2006), and augmentation of fine motor skills this field, as well as some of the barriers, acknowledged and such as laparoscopic surgery (Krupa et al., 2002). implied, to successful realization of these opportunities. In fact, most tasks in which humans perform knowledge- intensive work in conjunction with a complex information management and computational system could probably be Specificity of Brain Signals as Control Inputs to a improved by better diagnostic representations of the state Brain–Machine Interface of the human operator. Ultimately, the question becomes how action is integrated within the brain itself. For example, For a nonexpert, the advances in neuroscience described M ­ insky (1986) suggested that the brain could be viewed as in the popular press—and sometimes in proposals seeking a “society of mind.” In this view, a person’s conscious expe- funding—can easily be interpreted in ways that overstate rience is an emergent property arising from the interaction the specificity of the signal patterns within the brain that can of many cortical subsystems. The way in which these sub- be monitored with current techniques. Thus, lay individuals systems appear to interact seamlessly may well represent a frequently ask whether current diagnostic techniques allow template for advanced human–machine systems whose goal an observer to know what the person being observed is would be to reproduce the apparent effortlessness with which thinking. A similarly unrealistic flight of fantasy is that the a person willfully controls his or her own limbs. A sad reality weapons system of an advanced aircraft can be controlled by is that we no doubt will learn more about how this interaction thinking in the language of the aircraft’s designers or pilots. works within the brain by working with individuals damaged In general, an expectation that higher levels of cognition can by war. See, for example, the section of Chapter 7 entitled be immediately comprehended by assessing a small number “Optimal Control Strategies for Brain–Machine Interfaces.” of neural signals is destined for disappointment. The prospect of returning the wounded to their previous However, the confluence of insights from neuroscience level of physiological capability is a potential source of and improvements in complex systems control functions satisfaction. However, the next step beyond recovery of will provide limited opportunities for sending discrete con- c ­ apability—providing capabilities that exceed the norm trol signals directly to an external system. We can, to some of natural abilities—would raise ethical issues if, indeed, it d ­ egree, elicit and subsequently measure, with a fair degree of became technically feasible (Hancock, 2003). accuracy, discrete responses from the brain. A prime ­example is the P300 wave, which not only is a potential index of cognitive workload but also can be employed as a form of binary (yes/no) control to a hybrid human–machine monitor- There may be more cognitive dissonance, or contention and conflict, ing system. Although it remains difficult to distill the P300 occurring in such situations than either the operator or an observer of the wave on a single trial, the signal-to-noise ratio is constantly operator’s behavior can detect unaided by information on the operator’s being improved, as it is for other neuro­physiological and neural state (Hancock, in press). 

70 OPPORTUNITIES IN NEUROSCIENCE FOR FUTURE ARMY APPLICATIONS allied techniques in neural monitoring. Currently, various skills. These skills rely on interconnected visual, motor, and forms of brain function can be monitored for use as binary cognitive brain systems. This common civilian activity of control signals, and simple forms of such controls have been highway driving is regularly performed under conditions created. of varying task workload and stress. Extensive behavioral research on enhancing driver proficiency has been funded by the private sector—principally the automotive original A Pragmatic Approach to Neuroergonomics Applications equipment manufacturers (OEMs)—and by the U.S. Depart- Recently, Parasuraman and Wilson (2008) drew a dis- ment of Transportation (DOT). These behavioral studies are tinction between techniques that measure cerebral metabolic beginning to be extended and deepened into neurocognitive processes, such as transcranial Doppler sonography or func- a ­ nalyses through complementary research that uses neuro- tional magnetic resonance imaging (fMRI), and techniques imaging techniques in a laboratory setting. These studies, that measure neural activity (neural signaling) per se, such which are looking at advanced forms of smart vehicles and as EEG and event-related potentials. Their primary concern driver-support information systems, are relevant to soldier in making this distinction relates to the use of the output performance in high-workload conditions for either combat from these neurophysiolgical monitoring techniques as or noncombat operations that call for combinations of visual, i ­ nputs to adaptive control systems (Hancock, 2007a, 2007b). motor, and cognitive processing in the road-driving context. Parasuraman and Wilson also considered how sequential In addition, the models, simulation techniques, and analysis improvements in spatial and temporal resolution of these procedures developed for driver workload research and electrophysiolgical measures can provide opportunities for smart-vehicle technology have direct application to human– increasingly refined control inputs and thus for increasingly machine interfaces common in military vehicles, complex sophisticated control of complex technologies. The eventual weapons systems, and battlefield operations generally. goal, whether implied or stated, is to translate an intention to Neuroscience research has shown the strong influence of act into a real action—in more colloquial terms, controlling key brain communication networks in the degradation of per- our tools directly with our minds. formance in overlearned skills. The methods of neuroscience The temptation here is to attempt to decide this issue in are very useful for improving the ability to predict behavior terms of current and proposed neuroscience ­methodologies— by paying attention to the role of identified brain networks. that is, framing the discussion in terms of what we can mea- The goal in much of the advanced driver workload/smart- sure now and may be able to measure in the near future—and vehicle research is to develop models that predict behavior asking how such measures might be used as control signals to rather than obtain the most accurate simulation. (Simulation a compliant external system (that is, as an input to the defined systems for operator training have a different goal, and for control interface for the external system). A more practical them, realism is more important.) approach is to ask what the Army and, by extension, its sol- OEM precompetitive collaborative research projects diers are expected to do, then consider how these tasks could of interest to the Army include the workload measurement be accomplished by soldiers interacting with systems via aspects of the final reports from the Crash Avoidance Metrics interfaces supported by advanced neuroscience techniques. Partnership, as well as the Safety Vehicle Using Adaptive The discussions of brain–machine interface technologies in Interface Technology (SAVE-IT) program sponsored by Chapter 7 follow this more pragmatic approach. DOT’s Research and Technology Innovation Administration (DOT, 2008b). SAVE-IT deals with adaptive interfaces for high-workload environments. The Integrated Vehicle-Based Leveraging External Research Safety Systems program, also sponsored by the Research TO Enhance Soldier Performance and Technology Innovation Administration, will include a This section describes two areas of research on per- study of driver performance in an environment with multiple formance enhancement in nonmilitary contexts that have warning systems that are intended to prevent rear-end, run- sufficient relevance to Army applications to bear continued off-road, and lane-change crashes (DOT, 2008a; UMTRI, monitoring. In addition to discussing these applied research 2008). These investments in driver safety technology have programs, Chapter 7 discusses investments by nonmilitary been motivated by an interest in active safety systems to entities in neuroscience-related technology development. avoid a crash rather than survive one after it happens. In many cases, those technology opportunities also aim to These behavioral studies of workload metrics form the enhance cognitive and behavioral performance. basis for a small set of brain imaging studies in simulated environments. Uchiyama et al. (2003) showed that brain networks are activated in driving-like scenarios in labora- Driver Workload Research tory environments. Young et al. (2006) and Graydon et al. Driving a vehicle on highways and streets shared with (2004) reported fMRI and magnetoencephalography results other vehicles is an integrated, multiple-task behavior that showing that a static driving paradigm in a laboratory setting requires proficient performance of different but interrelated activated the brain network more than did the sum of all the 

IMPROVING COGNITIVE AND BEHAVIORAL PERFORMANCE 71 component tasks in the paradigm. They interpreted these A second NSBRI team, the Human Factors and Perfor- results as suggesting that a critical mass of stimulation cues mance team, is studying ways to improve daily living and in a laboratory imaging environment can reasonably replicate keep crew members healthy, productive, and comfortable a real-world scenario for studying driving behavior. Spiers during extended space exploration missions. Overall aims of and Maguire (2007) developed a technique for analyzing this team are to reduce performance errors by studying envi- blocks of driving activity using fMRI and a video game ronmental and behavioral factors that could threaten mission stimulus. Bruns et al. (2005) have used EEG to monitor an success. The team develops information tools to support crew individual driving a military vehicle, and Harada et al. (2007) performance and guidelines for human systems design. have demonstrated near-infrared spectroscopy technology to Team members are examining ways to improve sleep monitor the cortical blood flow of an individual operating a and scheduling of work shifts and looking at how light- civilian automobile. ing can improve alertness and performance. Other projects a ­ ddress nutritional countermeasures and how factors in the environment, such as lunar dust, can impact crew health. NASA Neuroscience Research Recent projects of the Human Factors and Performance team The National Aeronautics and Space Administration includes research on sleep disruption in space and finding a (NASA) has made the second largest federal investment, nutritional counterbalance for the loss of muscle mass and after DOD, in studying performance under stressful condi- function attributed to long spaceflights. Because rapidly tions. The National Space and Biomedical Research ­Institute changing light-dark cycles in space can affect the human (NSBRI), a NASA-funded consortium of institutions study- body’s natural circadian cycle, Lockley et al. (2006) have ing health risks related to long-duration spaceflight, has been investigating whether exposure to short-wavelength sought to develop countermeasures to the physical and blue light can be an effective means of shifting the circadian psychological challenges of spaceflight. The NSBRI also pacemaker, suppressing melatonin, and essentially increas- works on technologies to provide medical monitoring and ing alertness. Gronfier et al. (2007) found that a modulated diagnosis capabilities in extreme environments, including light exposure, with bright light pulses of 100 lux being cognitive capabilities. NSBRI investigators come from over supplied in the evening, can retrain human subjects to a 70 U.S.-based universities, and the institute is governed by light-dark cycle. an oversight committee comprising a dozen of its member institutions (NSBRI, 2008a). NeuroPharmaceutical Approaches to The Neurobehavioral and Psychosocial Factors team Performance Enhancement at the NSBRI seeks to identify neurobehavioral and psycho­ social risks to the health, safety, and productivity of space Chapter 5 discusses nutritional supplements and phar- crews. Additional research focuses on developing novel maceuticals used to sustain performance (measures to m ­ ethods of monitoring brain function and behavior and mea- counter environmental stressors) as opposed to enhancing sures that enhance the quality of life for astronauts, along with it above an individual’s baseline optimum. The committee improving their performance and motivation. This team’s has significant concerns about the potential for inappropriate current projects range from researching ways to enhance the use of currently available performance-enhancing drugs by performance of a team carrying out a space exploration mis- the military. sion to developing new techniques for monitoring cognitive The caveats noted in Chapter 5 to the off-label use of changes and the effects of stress on performance. The team is neuropharmaceuticals to sustain performance, outside the also developing a computer system that monitors speech pat- FDA-approved medical indications for prescribing them, terns for use in predicting changes in mental capacities, such apply even more stringently when the intent is to enhance as cognition and decision making, which may be affected by performance beyond the baseline capability. The require- the heightened exposures to radiation or hypoxia that may be ments for specificity and selectivity must be set high and encountered on an extended mission. Another current project must be clearly met with scientifically sound evidence. And is to develop a computer-based system for the recognition and the risk of undesirable and still-unknown side effects must treatment of depression (NSBRI, 2008b). be weighed carefully against any performance benefit using Among the studies completed by the Neuro­behavioral tools to measure the performance improvement and clinical and Psychosocial Factors team, Shephard and Kosslyn measures to assess the overall effects of the intervention. (2005) developed a portable system to assess nine cognitive Such tools may need to be developed. Despite these con- functions, including problem solving, attention, and working cerns, it may be worthwhile to continue research on the use memory, to provide an early warning sign of stress-related of pharmacological agents to optimize performance if the deficits. Dinges et al. (2005, 2007) developed a system benefits to unique military circumstances clearly outweigh u ­ sing optical computer recognition to track changes in facial the risks. Future studies may discover enhancers with more expression of astronauts on long spaceflights, when such striking effects then those currently available (Narkar et al., changes may indicate increased stress. 2008). 

72 OPPORTUNITIES IN NEUROSCIENCE FOR FUTURE ARMY APPLICATIONS Neuropharmaceuticals might also be applied to influ- Hancock, P.A. 2007a. Procedure and dynamic display relocation on perfor- ence adversary behavior and decision making. Because phar- mance in a multitask environment. IEEE Transactions on Systems, Man, and Cybernetics—Part A: Systems and Humans 37(1): 47-57. maceuticals can no doubt modulate the neuro­physiological Hancock, P.A. 2007b. On the process of automation transition in multitask underpinnings of behavior and performance, they can in prin- human–machine systems. IEEE Transactions on Systems, Man, and ciple be used to weaken or incapacitate an adversary, just as Cybernetics—Part A: Systems and Humans 37(4): 586-598. they can be used to sustain and strengthen our own soldiers. Hancock, P.A. In press. The battle for time in the brain. In Time, Limits Although this might be a direction for long-term ­research, and Constraints: The Study of Time XIII. J.A. Parker, P.A. Harris, and C. Steineck, eds. Leiden, The Netherlands: Brill. it would also raise substantial ethical, legal (from the per- Hancock, P.A., and M.H. Chignell. 1987. Adaptive control in human– spectives of both U.S. and international law), and strategic m ­ achine systems. Pp. 305-345 in Human Factors Psychology. P.A. issues that should be addressed before the Army supports any Hancock, ed. Amsterdam, The Netherlands: North Holland. such research and before assessing the relevance for Army Hancock, P.A., and J.L. Szalma. 2003a. The future of neuroergonomics. applications of any non-Army research in this area. As with Theoretical Issues in Ergonomic Science 4(1-2): 238-249. Hancock, P.A., and J.L. Szalma. 2003b. Operator stress and display design. chemical and biological weapons, the most relevant opportu- Ergonomics in Design 11(2): 13-18. nity for the counteradversary use of pharmaceuticals may be Harada, H., H. Nashihara, K. Morozumi, H. Ota, and E.A. 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