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At least 73 records · Page 4

The functional status of the human vestibular analysor following 56 days in an aqueous immersion medium

Two male volunteers were kept hypokinetic in the immersion and physiological parameters were evaluated following the experiment. Prophylactic measures (g-forces, physical exercises, and supplementary salt and water) were applied daily. Caloric and equilibrium tests were utilized to evaluate the physiological responses. The functional changes observed after the 56 day immersion were found to be of a moderate type which normalized quite quickly.

Matsnev, E. I.

Precision contact of the fingertip reduces postural sway of individuals with bilateral vestibular loss

Contact of the hand with a stationary surface attenuates postural sway in normal individuals even when the level of force applied is mechanically inadequate to dampen body motion. We studied whether subjects without vestibular function would be able to substitute contact cues from the hand for their lost labyrinthine function and be able to balance as well as normal subjects in the dark without finger contact. We also studied the relative contribution of sight of the test chamber to the two groups. Subjects attempted to maintain a tandem Romberg stance for 25 s under three levels of fingertip contact: no contact; light-touch contact, up to 1 N (approximately 100 g) force; and unrestricted contact force. Both eyes open and eyes closed conditions were evaluated. Without contact, none of the vestibular loss subjects could stand for more than a few seconds in the dark without falling; all the normals could. The vestibular loss subjects were significantly more stable in the dark with light touch of the index finger than the normal subjects in the dark without touch. They also swayed less in the dark with light touch than when permitted sight of the test chamber without touch, and less with sight and touch than just sight. The normal subjects swayed less in the dark with touch than without, and less with sight and touch than sight alone. These findings show that during quiet stance light touch of the index finger with a stationary surface can be as effective or even more so than vestibular function for minimizing postural sway.

NASA Discipline Neuroscience

Development of a Protocol to Test Proprioceptive Utilization as a Predictor for Sensorimotor Adaptability

Astronauts returning from space flight show significant inter-subject variations in their abilities to readapt to a gravitational environment because of their innate sensory weighting. The ability to predict the manner and degree to which each individual astronaut will be affected would improve the effectiveness of countermeasure training programs designed to enhance sensorimotor adaptability. We hypothesize participant's ability to utilize individual sensory information (vision, proprioception and vestibular) influences adaptation in sensorimotor performance after space flight. The goal of this study is to develop a reliable protocol to test proprioceptive utilization in a functional postural control task. Subjects "stand" in a supine position while strapped to a backpack frame holding a friction-free device using air-bearings that allow the subject to move freely in the frontal plane, similar to when in upright standing. The frame is attached to a pneumatic cylinder, which can provide different levels of a gravity-like force that the subject must balance against to remain "upright". The supine posture with eyes closed ensures reduced vestibular and visual contribution to postural control suggesting somatosensory and/or non-otolith vestibular inputs will provide relevant information for maintaining balance control in this task. This setup is called the gravity bed. Fourteen healthy subjects carried out three trials each with eyes open alternated with eyes closed, "standing" on their dominant leg in the gravity bed environment while loaded with 60 percent of their body weight. Subjects were instructed to: "use your sense of sway about the ankle and pressure changes under the foot to maintain balance." Maximum length of a trial was 45 seconds. A force plate underneath the foot recorded forces and moments during the trial and an inertial measurement unit (IMU) attached on the backpack's frame near the center of mass of the subject recorded upper body postural responses. Series of linear and non-linear analyses were carried out on several force plate and IMU data including stabilogram diffusion analysis on the center of pressure (COP) to find a subset of parameters that were sensitive to detect differences in postural performance between eyes open and closed conditions. Results revealed that seven parameters (root mean square (RMS) of medio-lateral (ML) COP, range of ML COP, RMS of roll moment, range of trunk roll, minimum time-to-boundary (TTB), integrated TTB, and critical mean square planar displacement (delta r (sup 2) (sub c)) were significantly different between eyes open and closed conditions. We will present data to show the efficacy of using performance in single leg stance with eyes closed on the gravity bed to assess individuals' ability to utilize proprioceptive information in a functional postural control task to predict re-adaptation for sensorimotor and functional performance.

Goel, R.

Spatial Reorientation of Sensorimotor Balance Control in Altered Gravity

Sensorimotor coordination of body segments following space flight are more pronounced after landing when the head is actively tilted with respect to the trunk. This suggests that central vestibular processing shifts from a gravitational frame of reference to a head frame of reference in microgravity. A major effect of such changes is a significant postural instability documented by standard head-erect Sensory Organization Tests. Decrements in functional performance may still be underestimated when head and gravity reference frames remained aligned. The purpose of this study was to examine adaptive changes in spatial processing for balance control following space flight by incorporating static and dynamic tilts that dissociate head and gravity reference frames. A second aim of this study was to examine the feasibility of altering the re-adaptation process following space flight by providing discordant visual-vestibular-somatosensory stimuli using short-radius pitch centrifugation.

Paloski, W. H.

Assessing the Relationships Between Sensorimotor Biomarkers and Post-Landing Functional Task Performance

Spaceflight drives adaptive changes in healthy individuals appropriate for sensorimotor function in a microgravity environment. These changes are maladaptive for return to earth's gravity. The inter-individual variability of sensorimotor decrements is striking, although poorly understood. The goal of this study is to identify a set of behavioral, neuroimaging and genetic measures that can be used to predict early post-flight performance on a set of sensorimotor tasks. Astronauts are recruited who previously participated in sensorimotor field tests and/or posturography soon after long-duration spaceflight. Behavioral tests include assessments of sensory dependency and adaptability. Visual dependency involves treadmill walking while viewing a moving virtual visual scene. Vestibular perceptual thresholds are measured while seated during lateral translations. Proprioception dependency is measured during one-legged stance on a horizontal air-bearing surface. Ground assessment of adaptability is performed(1) during treadmill walking with a virtual linear hallway and a moving walking surface, and (2) during multiple trials of navigating an obstacle course while wearing reversing prisms(adaptive Functional Mobility Test, aFMT). The neuroimaging tests will characterize individual differences in regional brain volumes (using Structural MRI) and white matter microstructure(using Diffusion Tensor Imaging) to serve as potential predictors of adaptive capacity. The genetic tests will utilize saliva samples to examine variations in four genes chosen because of their ability to differentiate sensorimotor adaptation ability in a normative population, including Catechol-O-methyltransferase (COMT), Dopamine Receptor D2 (DRD2), Brain-derived neurotrophic factor (BDNF) and the α2-adrenergic receptor. Twenty-seven ISS crewmembers have been tested to date, including 6 from this past year. This cohort includes 10first-time fliers, 6F, and mission durations lasting 178.6 ± 30.5 days, mean ± std. We are utilizing a combination of three post-flight functional task outcomes: tandem walk, recovery from fall and dynamic posturography. There is considerable variability among the post-flight performance outcomes for the 27participants to date. Based on a partial sample using an ordinal scale survey, 70% indicated their ability to perform functional tasks were more impacted postflight relative to inflight with 50% indicating they needed to restrict movements for a longer period postflight relative to inflight. While there is a strong association within tests obtained at different R+0 timepoints, by R+24 hr performance on one post-flight test does not necessarily correlate with performance on other post-flight tests. There are apparent relationships between individual measures and specific post-flight outcome measures, e.g., the cumulative time to complete the aFMT is significantly correlated to pre-to-post-flight changes in tandem walk (rho= 0.64, p = 0.001). Preliminary statistical analysis indicates combining biomarkers will increase predictive power and this will be explored with future analyses. Our preliminary findings underscore the importance of a comprehensive post-flight test battery including different types of tasks with varying sensory feedback. We expect that understanding the relationships between these sensorimotor biomarkers and post-flight functional task performance will improve both our understanding of the individual variability and our strategy to optimize sensorimotor countermeasures

S J Wood

Assessing the Relationships Between Sensorimotor Biomarkers and Post-Landing Functional Task Performance

Spaceflight drives adaptive changes in healthy individuals appropriate for sensorimotor function in a microgravity environment. These changes are maladaptive for return to earth's gravity. The inter-individual variability of sensorimotor decrements is striking, although poorly understood. The goal of this study was to identify a set of behavioral, neuroimaging and genetic measures that can be used to predict early post-flight performance on a set of sensorimotor tasks. Astronauts were recruited who previously participated in sensorimotor field tests and/or posturography soon after long-duration spaceflight. Behavioral tests included assessments of sensory dependency and adaptability. Visual dependency involved treadmill walking while viewing a moving virtual visual scene. Vestibular perceptual thresholds were measured while seated during lateral translations. Proprioception dependency was measured during one-legged stance on a horizontal air-bearing surface. Ground assessment of adaptability was performed (1) during treadmill walking with a virtual linear hallway and a moving walking surface, and (2) during multiple trials of navigating an obstacle course while wearing reversing prisms (adaptive Functional Mobility Test, aFMT). The neuroimaging tests characterized individual differences in regional brain volumes (using Structural MRI) and white matter microstructure (using Diffusion Tensor Imaging) to serve as potential predictors of adaptive capacity. The genetic tests utilized saliva samples to examine variations in four genes chosen because of their ability to differentiate sensorimotor adaptation ability in a normative population, including Catechol-O-methyltransferase (COMT), Dopamine Receptor D2 (DRD2), Brain-derived neurotrophic factor (BDNF) and the α2-adrenergic receptor. Thirty ISS crewmembers were recruited, including 12 first-time fliers, 6F, and mission durations lasting 185.5 ± 45.5 days, mean ± std. We utilized a combination of three post-flight functional task outcomes: tandem walk, recovery from fall and dynamic posturography. There was considerable variability among all post-flight performance outcomes. Based on an ordinal scale survey, 72% indicated their ability to perform functional tasks were more impacted postflight relative to inflight with 50% indicating they needed to restrict movements for a longer period postflight relative to inflight. While there is a strong association within tests obtained at different R+0 timepoints, by R+24 hr performance on one post-flight test does not necessarily correlate with performance on other post-flight tests. Preliminary statistical analysis indicates combining biomarkers will increase predictive power and this will be explored with future analyses. Our preliminary findings underscore the importance of a comprehensive post-flight test battery including different types of tasks with varying sensory feedback. Understanding the relationships between these sensorimotor biomarkers and post-flight functional task performance improve both our understanding of the individual variability and our strategy to optimize sensorimotor countermeasures.

biomarkers

Functional changes in systemic and regional (intracranial) circulation accompanying low accelerations

Functional changes in systemic and cerebral hemodynamics were studied with respect to vestibular stresses. The main types of responses, differing qualitatively with respect to the tolerance of test subjects to low accelerations (particularly to Coriolis accelerations), were established. This is of practical importance in the selection of aircraft and space pilots. The data presented sheds light on the physiological mechanisms of adaptation and disturbed compensation during vestibular stimulation. Further studies in this important field of aerospace medicine are outlined.

Usachev, V. V.

Angular velocities, angular accelerations, and coriolis accelerations

Weightlessness, rotating environment, and mathematical analysis of Coriolis acceleration is described for man's biological effective force environments. Effects on the vestibular system are summarized, including the end organs, functional neurology, and input-output relations. Ground-based studies in preparation for space missions are examined, including functional tests, provocative tests, adaptive capacity tests, simulation studies, and antimotion sickness.

Ashton Graybiel

Effects of adaptation of vestibulo-ocular reflex function on manual target localization

The goal of the present study was to determine if adaptive modulation of vestibulo-ocular reflex (VOR) function is associated with commensurate alterations in manual target localization. To measure the effects of adapted VOR on manual responses we developed the Vestibular-Contingent Pointing Test (VCP). In the VCP test, subjects pointed to a remembered target following passive whole body rotation in the dark. In the first experiment, subjects performed VCP before and after wearing 0.5X minifying lenses that adaptively attenuate horizontal VOR gain. Results showed that adaptive reduction in horizontal VOR gain was accompanied by a commensurate change in VCP performance. In the second experiment, bilaterally labyrinthine deficient (LD) subjects were tested to confirm that vestibular cues were central to the spatial coding of both eye and hand movements during VCP. LD subjects performed significantly worse than normal subjects. These results demonstrate that adaptive change in VOR can lead to alterations in manual target localization.

NASA Center JSC

A reevaluation of the vestibulo-ocular reflex: new ideas of its purpose, properties, neural substrate, and disorders

Conventional views of the vestibulo-ocular reflex (VOR) have emphasized testing with caloric stimuli and by passively rotating patients at low frequencies in a chair. The properties of the VOR tested under these conditions differ from the performance of this reflex during the natural function for which it evolved--locomotion. Only the VOR (and not visually mediated eye movements) can cope with the high-frequency angular and linear perturbations of the head that occur during locomotion; this is achieved by generating eye movements at short latency (< 16 msec). Interpretation of vestibular testing is enhanced by the realization that, although the di- and trisynaptic components of the VOR are essential for this short-latency response, the overall accuracy and plasticity of the VOR depend upon a distributed, parallel network of neurons involving the vestibular nuclei. Neurons in this network variously upon a distributed, parallel network of neurons involving the vestibular nuclei. Neurons in this network variously encode inputs from the labyrinthine semicircular canals and otoliths, as well as from the visual and somatosensory systems. The central vestibular pathways branch to contact vestibular cortex (for perception) and the spinal cord (for control of posture). Thus, the vestibular nuclei basically coordinate the stabilization of gaze and posture, and contribute to the perception of verticality and self-motion. Consequently, brainstem disorders that disrupt the VOR cause not just only nystagmus, but also instability of posture (eg, increased fore-aft sway in patients with downbeat nystagmus) and disturbance of spatial orientation (eg, tilt of the subjective visual vertical in Wallenberg's syndrome).

Review

Sensitive Quantitative Assessment of Balance Disorders

Computerized dynamic posturography (CDP) has become a standard technique for objectively quantifying balance control performance, diagnosing the nature of functional impairments underlying balance disorders, and monitoring clinical treatment outcomes. We have long used CDP protocols to assess recovery of sensory-motor function in astronauts following space flight. The most reliable indicators of post-flight crew performance are the sensory organization tests (SOTs), particularly SOTs 5 and 6, which are sensitive to changes in availability and/or utilization of vestibular cues. We have noted, however, that some astronauts exhibiting obvious signs of balance impairment after flight are able to score within clinical norms on these tests, perhaps as a result of adopting competitive strategies or by their natural skills at substituting alternate sensory information sources. This insensitivity of the CDP protocol could underestimate of the degree of impairment and, perhaps, lead to premature release of those crewmembers to normal duties. To improve the sensitivity of the CDP protocol we have introduced static and dynamic head tilt SOT trials into our protocol. The pattern of postflight recovery quantified by the enhanced CDP protocol appears to more aptly track the re-integration of sensory-motor function, with recovery time increasing as the complexity of sensory-motor/biomechanical task increases. The new CDP protocol therefore seems more suitable for monitoring post-flight sensory-motor recovery and for indicating to crewmembers and flight surgeons fitness for return to duty and/or activities of daily living. There may be classes of patients (e.g., athletes, pilots) having motivation and/or performance characteristics similar to astronauts whose sensory-motor treatment outcomes would also be more accurately monitored using the enhanced CDP protocol. Furthermore, the enhanced protocol may be useful in early detection of age-related balance disorders.

Paloski, Willilam H.

Using Tests Designed to Measure Individual Sensorimotor Subsystem Perfomance to Predict Locomotor Adaptability

Astronauts experience sensorimotor disturbances during the initial exposure to microgravity and during the readapation phase following a return to a gravitational environment. These alterations may lead to disruption in the ability to perform mission critical functions during and after these gravitational transitions. Astronauts show significant inter-subject variation in adaptive capability following gravitational transitions. The way each individual's brain synthesizes the available visual, vestibular and somatosensory information is likely the basis for much of the variation. Identifying the presence of biases in each person's use of information available from these sensorimotor subsystems and relating it to their ability to adapt to a novel locomotor task will allow us to customize a training program designed to enhance sensorimotor adaptability. Eight tests are being used to measure sensorimotor subsystem performance. Three of these use measures of body sway to characterize balance during varying sensorimotor challenges. The effect of vision is assessed by repeating conditions with eyes open and eyes closed. Standing on foam, or on a support surface that pitches to maintain a constant ankle angle provide somatosensory challenges. Information from the vestibular system is isolated when vision is removed and the support surface is compromised, and it is challenged when the tasks are done while the head is in motion. The integration and dominance of visual information is assessed in three additional tests. The Rod & Frame Test measures the degree to which a subject's perception of the visual vertical is affected by the orientation of a tilted frame in the periphery. Locomotor visual dependence is determined by assessing how much an oscillating virtual visual world affects a treadmill-walking subject. In the third of the visual manipulation tests, subjects walk an obstacle course while wearing up-down reversing prisms. The two remaining tests include direct measures of knee and ankle proprioception and a functional movement assessment that screens for movement restrictions and asymmetries. To assess each subject's locomotor adaptability subjects walk for twenty minutes on a treadmill that oscillates laterally at 0.3 Hz. Throughout the test metabolic cost provides a measure of exertion and step frequency provides a measure of stability. Additionally, at four points during the perturbation period, reaction time tests are used to probe changes in the amount of mental effort being used to perform the task. As with the adaptive capability observed in astronauts during gravitational transitions, our data shows significant variability between subjects. To aid in the analysis of the results, custom software tools have been developed to enhance in the visualization of the large number of output variables. Preliminary analyses of the data collected to date do not show a strong relationship between adaptability and any single predictor variable. Analysis continues to identify a multifactorial predictor outcome "signature" that do inform us of locomotor adaptability.

Peters, B. T.

A Reevaluation of the Vestibulo-Ocular Reflex: New Ideas of its Purpose, Properties, Neural Substrate, and Disorders

Conventional views of the Vestibulo-Ocular Reflex (VOR) have emphasized testing with caloric stimuli and by passively rotating patients at low frequencies in a chair. The properties of the VOR tested under these conditions differ from the performance of this reflex during the natural function for which it evolved-locomotion. Only the VOR (and not visually mediated eye movements) can cope with the high-frequency angular and linear perturbations of the head that occur during locomotion; this is achieved by generating eye movements at short latency (less than 16 msec). Interpretation of vestibular testing is enhanced by the realization that, although the di- and trisynaptic components of the VOR are essential for this short-latency response, the overall accuracy and plasticity of the VOR depend upon a distributed, parallel network of neurons involving the vestibular nuclei. Neurons in this network variously encode inputs from the labyrinthine semicircular canals and otoliths, as well as from the visual and somatosensory systems. The central vestibular pathways branch to contact vestibular cortex (for perception) and the spinal cord (for control of posture). Thus, the vestibular nuclei basically coordinate the stabilization of gaze and posture, and contribute to the perception of verticality and self-motion. Consequently, brainstem disorders that disrupt the VOR cause not just only nystagmus, but also instability of posture (eg, increased fore-aft sway in patients with downbeat nystagmus) and disturbance of spatial orientation (eg, tilt of the subjective visual vertical in Wallenberg's syndrome).

Leigh, R. John

Kinematid Parameters of Corrective Postural Responses Differ between Upper and Lower Body Perturbations

Balance control is disrupted following prolonged microgravity exposure, and to better understand this, both upper and lower body perturbations have been used to study postural control in space flight crewmembers. However, differences between several postural response indicators observed using the two techniques suggest that different sensory systems may be involved in organizing responses to these different perturbation approaches. The present study sought to compare differences in parameters of corrective postural responses between upper body perturbations (pushes to the chest) and forward translations of the support surface. Nine subjects participated in this study. Forward translations were performed using a NeuroCom EquiTest(TM) CDP system, which was synchronized with a Northern Digital OptoTrak motion tracking system (3 subjects). Chest pushes were applied using a hand-held force transducer device and were performed using a stabilometric system (6 subjects). Analysis of EMG has shown that: i) the earliest response of the leg muscles was registered significantly later during forward translation of the support surface than during chest pushes, and ii) there was a tendency for the different order of leg muscles activation during the translation tests. Analysis of the kinematic data showed a significant difference in the subject's body segments inclinations during corrective postural responses to upper and lower body perturbations. It appears that upper body perturbations likely engage the vestibular system more rapidly, while lower body perturbations likely engage somatosensory systems more rapidly. These differences must be taken into account when choosing the type of perturbation for testing postural function.

Sayenko, G.

PILOT REACTION TO HIGH SPEED ROTATION

Ten pilots subjected to high speed rotation to determine their susceptibility to motion sickness, vestibular nystagmus and performance of complex functions

ROTATING VEHICLE

Advanced Techniques for Assessment of Postural and Locomotor Ataxia, Spatial Orientation, and Gaze Stability

In addition to adapting to microgravity, major neurovestibular problems of space flight include postflight difficulties with standing, walking, turning corners, and other activities that require stable upright posture and gaze stability. These difficulties inhibit astronauts' ability to stand or escape from their vehicle during emergencies. The long-ter7n goal of the NSBRI is the development of countermeasures to ameliorate the effects of long duration space flight. These countermeasures must be tested with valid and reliable tools. This project aims to develop quantitative, parametric approaches for assessing gaze stability and spatial orientation during normal gait and when gait is perturbed. Two of this year's most important findings concern head fixation distance and ideal trajectory analysis. During a normal cycle of walking the head moves up and down linearly. A simultaneous angular pitching motion of the head keeps it aligned toward an imaginary point in space at a distance of about one meter in front of a subject and along the line of march. This distance is called the head fixation distance. Head fixation distance provides the fundamental framework necessary for understanding the functional significance of the vestibular reflexes that couple head motion to eye motion. This framework facilitates the intelligent design of counter-measures for the effects of exposure to microgravity upon the vestibular ocular reflexes. Ideal trajectory analysis is a simple candidate countermeasure based upon quantifying body sway during repeated up and down stair stepping. It provides one number that estimates the body sway deviation from an ideal sinusoidal body sway trajectory normalized on the subject's height. This concept has been developed with NSBRI funding in less than one year. These findings are explained in more detail below. Compared to assessments of the vestibuo-ocular reflex, analysis of vestibular effects on locomotor function is relatively less well developed and quantified. We are improving this situation by applying methodologies such as nonlinear orbital stability to quantify responses and by using multivariate statistical approaches to link together the responses across separate tests. In this way we can exploit the information available and increase the ability to discriminate between normal and pathological responses. Measures of stability and orientation are compared to measures such as dynamic visual acuity and with balance function tests. The responses of normal human subjects and of patients having well documented pathophysiologies are being characterized. When these studies are completed, we should have a clearer idea about normal and abnormal patterns of eye, head, and body movements during locomotion and their stability in a wide range of environments. We plan eventually to use this information to validate the efficacy of candidate neurovestibular and neuromuscular rehabilitative techniques. Some representative studies made during this year are summarized.

Wall, Conrad., III

Integrated Locomotor Function Tests for Countermeasure Evaluation

Following spaceflight crewmembers experience locomotor dysfunction due to inflight adaptive alterations in sensorimotor function. Countermeasures designed to mitigate these postflight gait alterations need to be assessed with a new generation of tests that evaluate the interaction of various sensorimotor sub-systems central to locomotor control. The goal of the present study was to develop new functional tests of locomotor control that could be used to test the efficacy of countermeasures. These tests were designed to simultaneously examine the function of multiple sensorimotor systems underlying the control of locomotion and be operationally relevant to the astronaut population. Traditionally, gaze stabilization has been studied almost exclusively in seated subjects performing target acquisition tasks requiring only the involvement of coordinated eye-head movements. However, activities like walking involve full-body movement and require coordination between lower limbs and the eye-head-trunk complex to achieve stabilized gaze during locomotion. Therefore the first goal of this study was to determine how the multiple, interdependent, full-body sensorimotor gaze stabilization subsystems are functionally coordinated during locomotion. In an earlier study we investigated how alteration in gaze tasking changes full-body locomotor control strategies. Subjects walked on a treadmill and either focused on a central point target or read numeral characters. We measured: temporal parameters of gait, full body sagittal plane segmental kinematics of the head, trunk, thigh, shank and foot, accelerations along the vertical axis at the head and the shank, and the vertical forces acting on the support surface. In comparison to the point target fixation condition, the results of the number reading task showed that compensatory head pitch movements increased, peak head acceleration was reduced and knee flexion at heel-strike was increased. In a more recent study we investigated the adaptive remodeling of the full-body gaze control systems following exposure to visual-vestibular conflict. Subjects walked on a treadmill before and after a 30- minute exposure to 0.5X minifying during which self-generated sinusoidal vertical head rotations were performed while seated. Following exposure to visual-vestibular conflict subjects showed a restriction in compensatory head movements, increased knee and ankle flexion after heel-strike and a decrease in the rate of body loading during the rapid weight transfer phase after the heel strike event. Taken together, results from both studies provide evidence that the full body contributes to gaze stabilization during locomotion, and that different functional elements are responsive to changes in visual task constraints and are subject to adaptive alterations following exposure to visual-vestibular conflict. This information provides the basis for the design of a new generation of integrative tests that incorporate the evaluation of multiple neural control systems relevant to astronaut operational performance.

Bloomberg, J. J.