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NASA NTRS2014

Effects of Long Duration Spaceflight on Venous and Arterial Compliance

The visual impairment and intracranial pressure syndrome (VIIP) is a newly described space flight-associated medical condition made up of a constellation of symptoms affecting at least 34% of American astronauts who have flown International Space Station (ISS) missions. VIIP is defined primarily by visual acuity deficits and anatomical changes to eye structures, and is thought to be related to elevated intracranial pressure secondary to space flightinduced cephalad fluid shifts. Loss of visual acuity could be a significant threat to crew health and performance and may be suggestive of other adaptations with implications for years post-flight. Our primary objective is to determine whether vascular compliance is altered by space flight and whether such adaptations are related to the incidence of VIIP. In particular, we will measure ocular parameters and vascular compliance in vessels of the head and neck in astronauts who have no space flight experience, in astronauts before, during, and after space flight, and in bed rest subjects with conditions similar to space flight. Additionally, we will analyze astronaut data from the Lifetime Surveillance of Astronaut Health (LSAH) archive to determine which factors might be predictive of the development of VIIP. The project will be conducted in four separate but related parts. To understand the baseline condition of astronauts without any prior space flight experience, we will study 10 astronauts who have never flown in space by performing a comprehensive evaluation of the vasculature of the head, neck and eyes. Hemodynamic data (stroke volume and blood pressure), ocular (tonometry and ocular ultrasound), venous and arterial parameters will be acquired across a range of tilt angles (20, 10, 0, -10, -20 degrees). Vessels to be studied include the temporal, jugular, and vertebral veins and the cerebral, carotid and vertebral arteries. Ophthalmic data from the annual physical will be obtained through data sharing. To examine the relation between vascular compliance in the head and neck and the development of VIIP after a long duration space flight, we will study 10 astronauts before, during, and after long-duration ISS missions. Pre- and post-flight testing will be identical to that described above. During flight, images of the same vessels of interest will be obtained for later analysis. Ophthalmic data including VIIP scores will be obtained through data sharing from medically-required tests. To investigate the effects of age and elevated sodium intake, two potential contributors to VIIP, we will study 24 men (in two age groups: 25-35 and 45-55) during a 14 day 6deg head-down bed rest, a well-accepted analog of space flight. Standard NASA bed rest conditions will be maintained except for dietary sodium. Sodium intake will be similar to that of ISS astronauts, which is higher than consumed in previous bed rest studies. Pre- and post-bed rest testing procedures will be identical to the testing protocol described above for astronauts. Ophthalmic testing (optical coherence tomography, fundoscopy, and tonometry) will be conducted on the same day that vascular compliance measures are obtained. To identify parameters that may relate to an increase in an astronaut's susceptibility to developing VIIP, we will use data mining techniques to evaluate astronaut data obtained from the LSAH. Medical history, family history, space flight history and its related exposures, and history of high performance jet aircraft exposure will be examined for their potential relationship to ocular data. We hypothesize that the cephalad fluid shift induced by space flight will result in structural and functional adaptations in head and neck vessels leading to decreased vascular compliance and related to the development of VIIP symptoms. Further, although VIIP has not been observed in previous bed rest studies, we hypothesize that an elevated sodium intake will increase the incidence of VIIP symptoms in this space flight analog. Finally, we hypothesize that data mining analyses will reveal relationships between health history, previous exposures (including space flight and high performance aircraft), and the development of VIIP in the astronaut population.

Ribeiro, L. C.↗

NASA NTRS2014

Effects of Long Duration Spaceflight on Venous and Arterial Compliance in Astronants

1. Project Overview Visual impairment and intracranial pressure (VIIP) is a spaceflight-associated medical condition affecting at least a third of American astronauts who have flown International Space Station (ISS) missions. VIIP is defined primarily by visual acuity deficits and anatomical changes to eye structures. In some astronauts, eye-related changes do not revert back to the preflight state upon return to Earth. Our team will study some of the possible causes for this syndrome. This will be achieved by reviewing previous astronaut data for factors that may predispose astronauts to higher rates of developing this syndrome or greater severity of symptoms. Additionally, we will conduct 3 separate experiments that will characterize vessels in the head and neck and measure the effects of the experimental conditions on ocular structures and function. 2. Technical Summary The primary objective of this study is to determine whether vascular compliance is altered by spaceflight and whether such adaptations are related to the incidence of the VIIP. In particular, we will measure ocular parameters and vascular compliance in vessels of the head and neck in astronauts who have no spaceflight experience (Ground), in astronauts before, during, and after spaceflight (Flight), and in bed rest subjects with conditions similar to spaceflight (Bed Rest). Additionally, we will analyze astronaut data from the Lifetime Surveillance of Astronaut Health (LSAH) archives to determine which factors might be predictive of the development of VIIP (Data Mining). The project will be conducted in four separate, but related parts. Hypothesis The central hypothesis of this proposal is that exposure to the spaceflight environment aboard the ISS may lead to development of the VIIP syndrome (increased intracranial pressure and impaired visual acuity) and that this may be related to alterations in venous and/or arterial compliance in the head and neck. Specific Aims 1. To determine whether noninvasive measures of venous and arterial compliance are altered by long-duration spaceflight exposure in ISS astronauts and whether these changes are related to the development of the VIIP syndrome. (Flight) 2. To determine whether previous spaceflight experience predispose astronauts to lower venous compliance and/or the development of the VIIP syndrome. (Ground + Flight) 3. To use a 14-day, 6deg head-down-tilt bed rest as a model of spaceflight, to evaluate the effect of aging on vascular compliance using a subject population similar to younger (25-35 yr) and older (45-55 yr) astronaut cohorts. (Bed Rest) 4. To determine what factors contribute to lower venous compliance and/or the development of the VIIP syndrome in astronauts. (Data Mining) 3. Earth Applications This research may inform the mechanisms that regulate blood/fluid flow in and out of the brain in the head and neck. This information may help with understanding of the mechanisms behind idiopathic intracranial hypertension. 4. Link to NASA Taskbook Entry Not Yet Available

Platts, Steven↗

NASA NTRS2010

Space Flight-Induced Intracranial Hypertension: An Ophthalmic Review

Background: Although physiologic and pathologic changes associated with microgravity exposure have been studied extensively, the effect of this environment on the eye is largely unknown. Over the last several years, NASA s Space Medicine Division has documented astronauts presenting with varying degrees of disc edema, globe flattening, choroidal folds, cotton wool spots, and hyperopic shifts after long-duration space flight. Methods: Before and after long-duration space flight, six astronauts underwent complete eye examinations to include cycloplegic and/or manifest refraction and fundus photography. Five of these astronauts had Optical Coherence Tomography (OCT) and Magnetic Resonance Imaging (MRI) performed following their missions. Results: Following exposure to space flight of approximately 6-months duration, six astronauts had neuro-ophthalmic findings. These consisted of disc edema in four astronauts, globe flattening in four astronauts, choroidal folds in four astronauts, cotton wool spots in three astronauts, nerve fiber layer thickening by OCT in five astronauts, and decreased near vision in five astronauts. Four of the astronauts with near vision complaints had a hyperopic shift equal to or greater than + 0.50D between pre- and post-mission spherical equivalent refraction in one or both eyes (range +0.50D to +1.50D). These same four had globe flattening by MRI. Conclusions: The findings we describe may have resulted from a rise in intracranial pressure caused by microgravity fluid shifts, and could represent parts of a spectrum of ocular and cerebral responses to extended microgravity.

Gibson, Charles Robert↗

NASA NTRS1996

Evaluation of an Anthropometric Human Body Model for Simulated EVA Task Assessment

One of the more mission-critical tasks performed in space is extravehicular activity (EVA) which requires the astronaut to be external to the station or spacecraft, and subsequently at risk from the many threats posed by space. These threats include, but are not limited to: no significant atmosphere, harmful electromagnetic radiation, micrometeoroids, and space debris. To protect the astronaut from this environment, a special EVA suit is worn which is designed to maintain a sustainable atmosphere (at 1/3 atmosphere) and provide protection against the hazards of space. While the EVA suit serves these functions well, it does impose limitations on the astronaut as a consequence of the safety it provides. Since the astronaut is in a virtual vacuum, any atmospheric pressure inside the suit serves to pressurize the suit and restricts mobility of flexible joints (such as fabric). Although some of the EVA suit joints are fixed, rotary-style joints, most of the mobility is achieved by the simple flexibility of the fabric. There are multiple layers of fabric, each of which serves a special purpose in the safety of the astronaut. These multiple layers add to the restriction of motion the astronaut experiences in the space environment. Ground-based testing is implemented to evaluate the capability of EVA-suited astronauts to perform the various tasks in space. In addition to the restriction of motion imposed by the EVA suit, most EVA activity is performed in a micro-gravity (weight less) environment. To simulate weightlessness EVA-suited testing is performed in a neutral buoyancy simulator (NBS). The NBS is composed of a large container of water (pool) in which a weightless environment can be simulated. A subject is normally buoyant in the pressurized suit; however he/she can be made neutrally buoyant with the addition of weights. In addition, most objects the astronaut must interface with in the NBS sink in water and flotation must be added to render them "weightless". The implementation of NBS testing has proven to invaluable in the assessment of EVA activities performed with the Orbiter and is considered to be a key step in the construction of the International Space Station (ISS). While the NBS testing is extremely valuable, it does require considerable overhead to maintain and operate. It has been estimated that the cost of utilizing the facility is approximately $10,000 per day. Therefore it is important to maximize the utility of NBS testing for optimal results. One important aspect to consider in any human/worksite interface is the considerable wealth of anthropometric and ergonomic data available. A subset of this information specific to EVA activity is available in NASA standard 3000. The difficulty in implementing this data is that most of the anthropometric information is represented in a two-dimensional format. This poses some limitations in complete evaluation of the astronaut's capabilities in a three-dimensional environment. Advances in computer hardware and software have provided for three-dimensional design and implementation of hardware with the advance of computer aided design (CAD) software. There are a number of CAD products available and most companies and agencies have adopted CAD as a fundamental aspect of the design process. Another factor which supports the use of CAD is the implementation of computer aided manufacturing (CAM) software and hardware which provides for rapid prototyping and decreases the time to product in the design process. It is probable that most hardware to be accessed by astronauts in EVA or IVA (intravehicular activity) has been designed by a CAD system, and is therefore represented in three-dimensional space for evaluation. Because of the implementation of CAD systems and the movement towards early prototyping, a need has arisen in industry and government for tools which facilitate the evaluation of ergonomic consideration in a three-dimensional environment where the hardware has been designed by the CAD tools. One such product is Jack which was developed by the University of Pennsylvania with funding from several government agencies, including NASA. While the primary purpose of Jack is to model human figures in a ground-based (gravity) environment, it can be utilized to evaluate EVA-suited activities as well. The effects of simulated gravity must be turned off by turning off "behaviors". Although Jack provides human figures for manipulation, the primary instrument to be evaluated for EVA mobility is the work envelope provided by the EVA suit. An EVA Jack suit model has been developed by NASA-JSC and was utilized in this study. This suit model provided a more restrictive motion environment as expected for an EVA suited subject. As part of this study, the anthropometric dimensions for a 50th percentile male were compared with basic anthropometric data and were found to be representative for the population group expected in the NASA flight program. The joints for the suit were created in a manner which provided consistent performance with EVA reach envelopes published in NASA standard #3000.

Etter, Brad↗

NASA NTRS2016

Post-Flight Back Pain Following International Space Station Missions: Evaluation of Spaceflight Risk Factors

INTRODUCTION Back pain during spaceflight has often been attributed to the lengthening of the spinal column due to the absence of gravity during both short and long-duration missions. Upon landing and re-adaptation to gravity, the spinal column reverts back to its original length thereby causing some individuals to experience pain and muscular spasms, while others experience no ill effects. With International Space Station (ISS) missions, cases of back pain and injury are more common post-flight, but little is known about the potential risk factors. Thus, the purpose of this project was to perform an initial evaluation of reported post-flight back pain and injury cases to relevant spaceflight risk factors in United States astronauts that have completed an ISS mission. METHODS All US astronauts who completed an ISS mission between Expeditions (EXP) 1 and 41 (2000-2015) were included in this evaluation. Forty-five astronauts (36 males and 9 females) completed 50 ISS missions during the study time period, as 5 astronauts completed 2 ISS missions. Researchers queried medical records of the 45 astronauts for occurrences of back pain and injury. A case was defined as any reported event of back pain or injury to the cervical, thoracic, lumbar, sacral, or coccyx spine regions. Data sources for the cases included the Flight Medicine Clinic's electronic medical record; Astronaut Strength, Conditioning and Rehabilitation electronic documentation; the Private Medical Conference tool; and the Space Medicine Operations Team records. Post-flight cases were classified as an early case if reported within 45 days of landing (R + 45) or a late case if reported from R + 46 to R + 365 days after landing (R + 1y). Risk factors in the astronaut population for back pain include age, sex, prior military service, and prior history of back pain. Additionally, spaceflight specific risk factors such as type of landing vehicle and onboard exercise countermeasures were included to evaluate their contribution to post-flight cases. Prior history of back pain included back pain recorded in the medical record within 3 years prior to launch. Landing vehicle was included in the model to discern if more astronauts experienced back pain or injury following a Shuttle or Soyuz landing. Onboard exercise countermeasures were noted for those astronauts who had a mission following 2009 deployment of the Advanced Resistive Exercise Device (aRED) (EXP 19 to 41). T-test and chi-squared tests were performed to evaluate the association between each individual risk factor and post-flight case. Logistic regression was used to evaluate the combined contribution of all the risk factors on post-flight cases. Separate models were calculated for cases reported by R + 45 and R + 1y. RESULTS During the study time period, there were 13 post-flight cases reported by R + 45 and an additional 5 reported by R + 1y. Most of these cases have been reported since EXP 19 with 10 cases by R + 45 and 4 by R + 1y. Individual risk factors of age, sex, landing vehicle, and prior military service were not significantly associated with post-flight cases identified at R + 45 or R + 1y (p greater than 0.05). Having back pain or injury within 3 years prior to launch significantly increased the likelihood of becoming a case by R + 1y (p = 0.041), but not at R+45 (p=0.204). Additionally, astronauts who experienced onboard exercise countermeasures that included aRED had a significantly increased risk of becoming a case at R + 45 (p = 0.024) and R + 1y (p=0.003). Multiple logistic regression evaluating all the risk factors for cases identified no significant risk factors at either the R + 45 or R + 1y time period (p greater than 0.05). Overall model fit was poor for both the R + 45 (R(exp 2) = 0.132) and R + 1y (R(exp 2) = 0.186) cases showing that there are risk factors not represented in our model. CONCLUSIONS Regardless of cause, post-flight cases are reported more often since aRED was deployed in 2009. This may reflect improved documentation or unidentified risk factors. No spaceflight risk factor explains the data fully. Post-flight cases are probably due to multi-faceted factors that are not easily elucidated in the medical data.

Laughlin, M. S.↗

NASA NTRS2024

Risk of Bone Fracture due to Spaceflight-induced Changes to Bone

The Human Research Program (HRP) is taking a biomechanical approach to assessing subsequent fracture risk in active astronauts as a consequence of spaceflight exposure. Triennial testing of active and retired astronauts continues as Space Medicine monitors for a premature diagnosis of primary osteoporosis, which is associated with age-related bone loss and skeletal fragility. This updated 2023 Fracture Evidence Report has expanded the description of skeletal changes to capture the full effects of spaceflight on bone: • Recent analysis of fractures from health records of the full astronaut cohort, suggests an increased incidence rate of hip and spine fractures in astronauts following longer spaceflight duration flights compared to incident rates found in shorter duration flights. • Routine preflight-to-postflight surveillance by DXA (dual-energy x-ray absorptiometry) does not provide the full detection of loss and recovery in the long-duration (LD) astronaut nor the full recovery of hip trabecular bone. • The inclusion of hip quantitative computed tomography (QCT) in flight studies delineates effects of spaceflight, of countermeasures, and of post-flight recovery on cortical and trabecular bone parameters—some of which are verified predictors of hip fracture in the aged. • QCT detects and compares the distinct countermeasure effects of the pharmaceutical alendronate and of resistive exercise (on the Advanced Resistive Exercise Device, ARED) in specific cortical and trabecular bone sub-regions during spaceflight. • A published comparison of QCT-determined loss rates of hip trabecular bone in LD astronauts compared to terrestrial cohorts suggest that accelerated loss rates in trabecular volumetric BMD (vBMD) during spaceflight might be analogous to skeletal effects of accelerated loss rates in females due to menopause, potentially leading to disruptions in trabecular microarchitecture. • A dataset of finite element (FE) estimates of hip bone strength in aging terrestrial cohorts (spanning astronaut age-range) provides comparative context for changes in the FE of hip bone strength in LD astronauts, including comparison (force unit of newton) to percentiles (50th, 75th, and 100th) of sex-matched aged humans with hip fractures. • Risk of fracture, due to the mechanical overloading of bones, is being updated with IMPACT, the next-generation tool suite for probabilistic risk assessment (PRA) for exploration missions being created by the Exploration and Medical Capability Element (ExMC) at NASA. IMPACT is currently in development and will not be included in this 2024 update. The risk for fracture necessitates understanding the relationship between applied loads to bone and the biomechanical competence of bone. The Risk for Early Onset Osteoporosis focuses on the weakened condition of bone (including development of new technologies, measurements of novel skeletal attributes, translation of multiple measures to an index of bone fragility, and interpretations of data used to reflect a weakened bone), while the Risk for Fracture assesses factors that influence the probability an astronaut would encounter applied loads exceeding the biomechanical competence of bones, resulting in fracture. This Evidence Report combines the research gaps and tasks associated with both risks.

Fracture↗

NASA NTRS2004

Microgravity Investigation of Crew Reactions in 0-G (MICRO-G)

There is a need for a human factors, technology-based bioastronautics research effort to develop an integrated system that reduces risk and provides scientific knowledge of astronaut-induced loads and motions during long-duration missions on the International Space Station (ISS), which will lead to appropriate countermeasures. The primary objectives of the Microgravity Investigation of Crew Reactions in 0-G (MICRO-GI research effort are to quantify astronaut adaptation and movement as well as to model motor strategies for differing gravity environments. The overall goal of this research program is to improve astronaut performance and efficiency through the use of rigorous quantitative dynamic analysis, simulation and experimentation. The MICRO-G research effort provides a modular, kinetic and kinematic capability for the ISS. The collection and evaluation of kinematics (whole-body motion) and dynamics (reacting forces and torques) of astronauts within the ISS will allow for quantification of human motion and performance in weightlessness, gathering fundamental human factors information for design, scientific investigation in the field of dynamics and motor control, technological assessment of microgravity disturbances, and the design of miniaturized, real-time space systems. The proposed research effort builds on a strong foundation of successful microgravity experiments, namely, the EDLS (Enhanced Dynamics Load Sensors) flown aboard the Russian Mir space station (19961998) and the DLS (Dynamic Load Sensors) flown on Space Shuttle Mission STS-62. In addition, previously funded NASA ground-based research into sensor technology development and development of algorithms to produce three-dimensional (3-0) kinematics from video images have come to fruition and these efforts culminate in the proposed collaborative MICRO-G flight experiment. The required technology and hardware capitalize on previous sensor design, fabrication, and testing and can be flight qualified for a fraction of the cost of an initial spaceflight experiment. Four dynamic load sensors/restraints are envisioned for measurement of astronaut forces and torques. Two standard ISS video cameras record typical astronaut operations and prescribed IVA motions for 3-D kinematics. Forces and kinematics are combined for dynamic analysis of astronaut motion, exploiting the results of the detailed dynamic modeling effort for the quantitative verification of astronaut IVA performance, induced-loads, and adaptive control strategies for crewmember whole-body motion in microgravity. This comprehensive effort, provides an enhanced human factors approach based on physics-based modeling to identify adaptive performance during long-duration spaceflight, which is critically important for astronaut training as well as providing a spaceflight database to drive countermeasure design.

Newman, Dava↗

NASA NTRS2010

Latent Virus Reactivation: From Space to Earth

Reactivation of latent viruses is a recognized consequence of decreased immunity. More recently viral reactivation has been identified as an important in vivo indicator of clinically relevant immune changes. Viral reactivation can be determined quickly and easily by the presence of virus in saliva and other body fluids. Real-time polymerase chain reaction (PCR) is a highly sensitive and specific molecular method to detect the presence of specific viral DNA. Studies in astronauts demonstrated that herpes simplex virus type 1(HSV-1), Epstein-Barr Virus (EBV), cytomegalovirus (CMV), and varicella zoster virus (VZV) reactivate at rates above normal during and after spaceflight in response to moderately decreased T-cell immunity. This technology was expanded to patients on Earth beginning with human immune deficiency virus (HIV) immuno-compromised patients. The HIV patients shed EBV in saliva at rates 9-fold higher than observed in astronauts demonstrating that the level of EBV shedding reflects the severity of impaired immunity. Whereas EBV reactivation is not expected to produce serious effects in astronauts on missions of 6 months or less, VZV reactivation in astronauts could produce shingles. Reactivation of live, infectious VZV in astronauts with no symptoms was demonstrated in astronauts during and after spaceflight. We applied our technology to study VZV-induced shingles in patients. In a study of 54 shingles patients, we showed salivary VZV was present in every patient on the day antiviral (acyclovir) treatment was initiated. Pain and skin lesions decreased with antiviral treatment. Corresponding decreases in levels of VZV were also observed and accompanied recovery. Although the level of VZV in shingles patients before the treatment was generally higher than those found in astronauts, lower range of VZV numbers in shingles patients overlapped with astronaut s levels. This suggests a potential risk of shingles to astronauts resulting from reactivation of VZV. In another clinical study of 25 shingles patients, PCR technology detected VZV in the serum and peripheral blood mononuclear cells of all 25 patients demonstrating for the first time that viremia is a common manifestation of herpes shingles.

Mehta, Satish K.↗

NASA NTRSDate not supplied

Validation of A Sensorimotor Disorientation Ground Analog

INTRODUCTION Simulating the sensorimotor disorientation effects of gravity transitions after prolonged stays in microgravity is exceedingly challenging on Earth. In a previous study [1], a Sensorimotor Disorientation Analog (SDA) was developed based on subjective feedback from previously flown astronauts. The purpose of this study was to validate this SDA by comparing performance in movement tasks that have a wealth of spaceflight data against task performance while using the SDA. METHODS Thirty healthy non-astronaut subjects (17 males, 13 females; Mean ± SD, Age: 33.5 ± 7.2 years, Height: 68.0 ± 3.4 in, Weight: 164 ± 26 lbs.) volunteered to participate in this study. Subjects performed three movement tasks: computerized dynamic posturography (CDP), obstacle walk, and tandem walk. For CDP, subjects maintained an upright stance for 20s with eyes closed on an unstable pitch sway-referenced platform with head erect (sensory organization test (SOT)-5) and with head pitch ±20° to an auditory cue(SOT-5M). The obstacle walk involved a sit-to-stand with 10s of quiet stance followed by walking to and around a cone placed 4m away while navigating a 30cm obstacle to the cone and back. The tandem walk involved walking heel-to-toe for approximately 10-12 steps with eyes open and eyes closed. Subjects performed the three movement tasks under three levels of the SDA replicating different time points of recovery: none (preflight), low (Return (R)+24- 48hours), and high (R+0- 24hours). The SDA included galvanic vestibular stimulation (GVS) to disorient the vestibular system and a weighted suit (trunk, wrists, and ankles) to alter proprioceptive feedback and replicate subjective heaviness. RESULTS As the SDA magnitude increased, overall performance outcomes decreased. However, the ability of the SDA to replicate the range of astronaut postflight performance was task dependent. CDP SOT-5 performance across SDA levels closely replicated astronaut performance at all time points. SOT-5M, however, had minimal performance changes across SDA levels and was unable to replicate astronaut performance. The obstacle walk showed performance changes across SDA levels and matched astronaut performance preflight and at R+24-48hrs (low). Obstacle walk performance at the high SDA level was reduced in comparison to the low level; however, it was not replicative of astronaut performance immediately after landing. Last, tandem walk had distinct groupings of performance across SDA levels and was able to elicit a high level of disorientation consistent with R+0-24 hours (high) postflight performance for eyes open and eyes closed. The low SDA level for both eyes open and eyes closed was more disruptive than previous crewmember performance at the R+24-48 hours timepoint. CONCLUSION The SDA was developed to replicate postflight sensorimotor disruptions. However, it is well-known that immediately post-landing, astronauts can experience motion sickness, dehydration, fatigue, orthostatic intolerance, illusory sensations, lumbar pain, etc. This multi-system response to return to 1G varies widely across astronauts and, as such, it was not unexpected that the extreme ends of responses in the R+0-24hrs time period were the most difficult to replicate. These results suggest that the SDA levels are able to elicit distinct performance groupings and, although not able to perfectly replicate R+0-24hrs, the SDA did replicate a large range of performance after return to Earth.

S C Moudy↗

NASA NTRS1988

Don/doff support stand for use with rear entry space suits

A don/doff support stand for use with rear entry space suits is disclosed. The support stand is designed for use in one-g environments; however, certain features of the stand can be used on future spacecraft, lunar, or planetary bases. The present invention has a retainer which receives a protrucing lug fixed on the torso section of the space suit. When the lug is locked in the retainer, the space suit is held in a generally upright position. In a one-g environment a portable ladder is positioned adjacent to the rear entry of the space suit supported by the stand. The astronaut climbs up the ladder and grasps a hand bar assembly positioned above the rear entry. The astronaut then slips his legs through the open rear entry and down into the abdominal portion of the suite. The astronaut then lowers himself fully into the suit. The portable ladder is then removed and the astronaut can close the rear entry door. The lug is then disengaged from the retainer and the astronaut is free to engage in training exercises in the suit. When suit use is over, the astronaut returns to the stand and inserts the lug into the retainer. A technician repositions the ladder. The astronaut opens the rear entry door, grasps the hand bar assembly and does a chin-up to extricate himself from the suit. The astronaut climbs down the movable ladder while the suit is supported by the stand.

Kosmo, Joseph J.↗

NASA NTRS1998

Relationship between selected orientation rest frame, circular vection and space motion sickness

Space motion sickness (SMS) and spatial orientation and motion perception disturbances occur in 70-80% of astronauts. People select "rest frames" to create the subjective sense of spatial orientation. In microgravity, the astronaut's rest frame may be based on visual scene polarity cues and on the internal head and body z axis (vertical body axis). The data reported here address the following question: Can an astronaut's orientation rest frame be related and described by other variables including circular vection response latencies and space motion sickness? The astronaut's microgravity spatial orientation rest frames were determined from inflight and postflight verbal reports. Circular vection responses were elicited by rotating a virtual room continuously at 35 degrees/s in pitch, roll and yaw with respect to the astronaut. Latency to the onset of vection was recorded from the time the crew member opened their eyes to the onset of vection. The astronauts who used visual cues exhibited significantly shorter vection latencies than those who used internal z axis cues. A negative binomial regression model was used to represent the observed total SMS symptom scores for each subject for each flight day. Orientation reference type had a significant effect, resulting in an estimated three-fold increase in the expected motion sickness score on flight day 1 for astronauts who used visual cues. The results demonstrate meaningful classification of astronauts' rest frames and their relationships to sensitivity to circular vection and SMS. Thus, it may be possible to use vection latencies to predict SMS severity and duration.

short duration↗

NASA NTRS1989

Don/Doff support stand for use with rear entry space suits

A don/doff support stand for use with rear entry space suits is disclosed. The support stand is designed for use in one-g environments; however, certain features of the stand can be used on future space-craft, lunar or planetary bases. The present invention has a retainer which receives a protruding lug fixed on the torso section of the space suit. When the lug is locked in the retainer, the space suit is held in a generally upright position. In a one-g environment a portable ladder is positioned adjacent to the rear entry of the space suit supported by the stand. The astronaut climbs up the ladder and grasps a hand bar assembly positioned above the rear entry. The astronaut then slips his legs through the open rear entry and down into the abdominal portion of the suit. The astronaut then lowers himself fully into the suit. The portable ladder is then removed and the astronaut can close the rear entry door. The lug is then disengaged from the retainer and the astronaut is free to engage in training exercises in the suit. When suit use is over, the astronaut returns to the stand and inserts the lug into the retainer. A technician repositions the ladder. The astronaut opens the rear entry door, grasps the hand bar assembly and does a chin-up to extricate himself from the suit. The astronaut climbs down the movable ladder while the suit is supported by the stand.

Kosmo, Joseph J.↗

NASA NTRS2013

Next-Generation Maneuvering System with Control-Moment Gyroscopes for Extravehicular Activities Near Low-Gravity Objects

Looking ahead to the human exploration of Mars, NASA is planning for exploration of near-Earth asteroids and the Martian moons. Performing tasks near the surface of such low-gravity objects will likely require the use of an updated version of the Manned Maneuvering Unit (MMU) since the surface gravity is not high enough to allow astronauts to walk, or have sufficient resistance to counter reaction forces and torques during movements. The extravehicular activity (EVA) Jetpack device currently under development is based on the Simplified Aid for EVA Rescue (SAFER) unit and has maneuvering capabilities to assist EVA astronauts with their tasks. This maneuvering unit has gas thrusters for attitude control and translation. When EVA astronauts are performing tasks that require ne motor control such as sample collection and equipment placement, the current control system will re thrusters to compensate for the resulting changes in center-of-mass location and moments of inertia, adversely affecting task performance. The proposed design of a next-generation maneuvering and stability system incorporates control concepts optimized to support astronaut tasks and adds control-moment gyroscopes (CMGs) to the current Jetpack system. This design aims to reduce fuel consumption, as well as improve task performance for astronauts by providing a sti er work platform. The high-level control architecture for an EVA maneuvering system using both thrusters and CMGs considers an initial assessment of tasks to be performed by an astronaut and an evaluation of the corresponding human-system dynamics. For a scenario in which the astronaut orbits an asteroid, simulation results from the current EVA maneuvering system are compared to those from a simulation of the same system augmented with CMGs, demonstrating that the forces and torques on an astronaut can be significantly reduced with the new control system actuation while conserving onboard fuel.

Carpenter, Michele↗

NASA NTRS2016

Pilot Field Test: Performance of a Sit-to-Stand Test After Long-Duration Space Flight

BACKGROUND: Astronauts returning from the International Space Station are met by a team of recovery personnel typically providing physical assistance and medical support immediately upon landing. That is because long-duration spaceflight impacts astronauts' functional abilities. Future expeditions to planets or asteroids beyond the low Earth orbit, however, may require crewmembers to egress the vehicle and perform other types of physical tasks unassisted. It is therefore important to characterize the extent and longevity of functional deficits experienced by astronauts in order to design safe exploration class missions. Pilot Field Test (PFT) experiment conducted with participation of ISS crewmembers traveling on Soyuz expeditions 34S - 41S comprised several tasks designed to study the recovery of sensorimotor abilities of astronauts during the first 24 hours after landing and beyond. METHODS: The first test in the PFT battery sequence, and also the least demanding one from the sensorimotor perspective, was a Sit-to-Stand test. Test subjects were seated in the chair and had to stand up on command and remain standing for ten seconds. The subjects were instructed to stand up unassisted as quickly as they were able to, while maintaining postural control. Synchronized wireless inertial sensors mounted on the head, chest, lower back, wrists, and ankles were used to continuously log body kinematics. Crewmembers' blood pressure and heart rate were monitored and recorded with the Portapres and Polar systems. Each session was recorded with a digital video camera. During data collections occurring within the 24-hour postflight period, crewmembers were also asked to (1) evaluate their perceived motion sickness symptoms on a 20-point scale before and after completion of the test and (2) estimate how heavy they felt compared to their normal (preflight) body weight. Consent to participate in PFT was obtained from 18 crewmembers (11 US Orbital Segment [USOS] astronauts and 7 Russian cosmonauts). For 10 subjects, the first set of data was collected in the medical tent in Soyuz landing zone (1-2 hours after landing); the other 8 subjects were tested at the Kazakhstan deployment airport (4-5 hours after landing). 8 of the 11 astronauts were tested twice more within the first 24 hours postflight, at a refueling stop on the way to Houston (approximately 13 hours after landing) and at the Johnson Space Center (approximately 24 hours after landing). Later postflight data were collected in the first two weeks on some crewmembers. Finally, 6 astronauts were tested 60+ days after landing to establish a delayed baseline. RESULTS/DISCUSSION: Two of the 18 PFT participants felt too ill to attempt any tests in Kazakhstan (at either the landing zone or deployment airport). The remaining test subjects completed the Sit-to-Stand test and their reported motion sickness scores were unaffected by this task. The task completion times and body kinematics data analysis are currently underway. Preliminary analysis of astronaut data shows a steep improvement in the time to complete the task on the second data take, and in some cases, the trend continues through day six postflight. Head and trunk pitch angles and pitch rates were also examined and increases in all measures are evident throughout the observed recovery period (60+ days postflight). Interesting patterns of head and trunk pitch coordination have also emerged. One of the data analysis objectives is comparison of initial postflight performance and recovery of experienced crewmembers and first-time fliers. Another one - possible differences in performance between USOS and Russian crewmembers.

Kofman, I. S.↗

NASA NTRS2019

Maintaining Skeletal Health During the Mission to Mars

Understanding how the effects of long-duration spaceflight (~6-months) might increase fracture risk in the younger-aged, physically-fit astronaut is challenging. Most of our skeletal data have been acquired from long-duration astronauts, crewmembers who typically serve on 120-180 day missions aboard the International Space Station (ISS). Astronaut biomedical data are predominantly 2-d measurements from DXA scans because this is a required clinical test at Johnson Space Center. Data from these clinical tests, and some data from research studies, are what NASA evaluates to define a risk for fracture in astronauts, both during a mission and long-term health. To date, the agency considers the risk for fracture during spaceflight to be of high (severe) consequence but of low probability (<0.1%) while the risk for fracture in during long-term health to be of medium consequence (interventions available) and medium probability (<1%). These risks are considered acceptable. Notably, there are minimal data to suggest that postflight fractures in long-duration astronauts are directly due to spaceflight exposure. Analyses by NASA epidemiologists and by biomedical engineers suggest that postflight fracture incidence in astronauts is consistent with a physically-active terrestrial population with no exposure to spaceflight. The epidemiological data to-date may be considered insufficient (low # and younger-aged subjects, limited follow-up time) to assess a fracture risk with reliability. In the absence of fracture evidence to substantiate a risk, it may be more useful to maintain astronauts at baseline (preflight) level of skeletal health during a mission. This lecture will present data from astronauts that affirms that 1) the maintenance of skeletal health during the future 3-year Mars mission will require an anti-resorptive therapy and 2) the risk for fracture during long-term health cannot be defined by the DXA clinical test alone.

Sibonga, Jean↗

NASA NTRSDate not supplied

Improving Efficacy and Safety of Pharmacological Treatment Through Precision Medicine and Pharmacogenomics for Human Deep Space Exploration

INTRODUCTION: Future spaceflight will require increased crew medical autonomy as exploration class missions expanding duration and distance from Earth, especially for Mars missions. As mission duration increases, it will be even more essential to have appropriate amounts of effective medication to ensure the maintenance of crew health and performance. Conversely, mass and volume constraints will become more severe as future spaceflight expands beyond low Earth orbit, where resupply is difficult or becomes impossible. These constraints thus convey an urgency to further tailor medications included in the spacecraft formulary and increased examination of appropriate dosing regimens. BACKGROUND: Precision Health is an exciting area of cutting-edge research and medicine focused on maintaining an individual’s health and performance through in-depth understanding of an individual’s unique factors and molecular profiles. This approach can be adapted to better predict, monitor, and address physiological responses to the spaceflight environment. One example is the field of pharmacogenomics (PGX),the study of how the expressed genome impacts drug responses with the goal of prescribing the right dose of the right drug at the right time. Specifically, PGX testing provides valuable information on an individual’s precise allelic variations to guide physicians in making informed decisions on pharmaceutical choice and dosing to avoid adverse drug events and maximize pharmacological efficacy. The goal of this study was to evaluate which drugs in the current space pharmacy could be evaluated using PGX testing and to understand the potential impact on the health and wellness of the astronaut population. Additionally, we sought to evaluate clinically available FDA-approved PGX testing solutions to better understand its applicability. METHODS: A complete list of drugs onboard the International Space Station (ISS) was analyzed for risk and likelihood of drug failure and PGX actionability. This analysis encompassed both personal astronaut medications, including supplements and over the counter drugs (n=151) and ISS MedKit formulary medications (n=95). Duplicate medications and different formulations were removed, which resulted in 157 total drugs used in the subsequent analysis. A 5x5 risk assessment table was produced by examining the likelihood of drug failure compared to the consequence of drug failure. Likelihood of individual drug failure was defined by whether existing processes are sufficient to prevent adverse events, as ranked from 1 (very low, can easily be prevented) to 5 (very high, cannot be prevented) during a Mars mission. In contrast, the consequence of drug failure was defined by impact to safety, schedule, cost or technical and ranked from 1 (very low) to 5 (very high).A comprehensive assessment of commercially available PGX solutions is currently underway to evaluate specimen requirements, cost/benefit analysis (cost vs. number of alleles assessed), utility of variant analysis, relevance to inflight medication usage, quality of reporting in enabling clinical application, and ease of integration into electronic medical records. RESULTS: Risk assessments(LxC 5x5 table) indicated29medicationswere in the yellow or red zone driven predominantly by drug failure or safety concerns, with the remainder(n=128)of the medications in the green zone where risk is acceptable. We found that current PGX testing results could impact 21% of the total medications in the ISS MedKit and IMAK; of these, 9 medications currently have direct clinically actionable guidance available. Results of the clinical PGX solution evaluations as related to these medications will be presented. CONCLUSION: PGX testing has demonstrated clear benefits in terrestrial medicine and clinical environments for the selection of proper medications, avoiding adverse drug reactions, and maximizing drug efficacy. We propose that similar benefits would be bestowed on the astronaut and commercial spaceflight passenger population by performing preemptive pre-flight PGX testing to reduce risk of mission failure due to ineffective or toxic medications, improve targeting drug efficacy and safety, and further open the door to countermeasure research exploring PGX-related allelic variants. For example, PGX results could allow tailoring of specific medications at optimal doses more precisely to each individual astronaut, particularly in areas of space motion sickness, sleep aids, and analgesics. An additional benefit is that PGX results could provide information for better planning of the components of a space pharmacy for deep space missions to be more cost effective and more efficient in the utilization of limited pharmaceutical resources. Finally, while PGX testing of the astronaut corps is not currently conducted, this approach could provide immediate impact in support of mission success by reducing risks, optimizing astronaut performance, and providing valuable insights into long-term astronaut health. Such advancements in clinical decision making are important next steps in building dynamic individual risk profiles for astronauts, increasing crew autonomy and providing tailored countermeasures

Alice R W Tang↗

NASA NTRSDate not supplied

Improving Efficacy and Safety of Pharmacological Treatment Through Precision Health and Pharmacogenomics

INTRODUCTION: Future spaceflight will require increased crew medical autonomy as exploration class missions expand in duration and distance from Earth, especially for Mars missions. As mission duration increases, it will be essential to have appropriate amounts of effective medication to ensure the maintenance of crew health and performance. Conversely, mass and volume constraints will become more severe as future spaceflight expands beyond low Earth orbit, where resupply is difficult or becomes impossible. These constraints thus convey an urgency to tailor medications for individual crewmembers and further examine appropriate dosing regimens. BACKGROUND: Precision Health is an exciting area of medicine focused on maintaining an individual’s health and performance through in-depth understanding of an individual’s unique clinical and environmental history, genetic makeup, and molecular profiles. This approach can be adapted to better predict, monitor, and address physiological responses to the spaceflight environment. A subset of this field is pharmacogenomics (PGX), the study of how the expressed genome impacts drug responses with the goal of prescribing the right dose of the right drug at the right time. Specifically, PGX testing provides valuable information on an individual’s precise allelic variations to guide physicians in making informed decisions on drug choice and dosing to avoid adverse events and maximize efficacy. The study goal was to identify which current space pharmacy drugs could be evaluated using PGX testing and to understand the potential impact on the health and wellness of the astronaut population. Additionally, we sought to evaluate clinically available FDA-approved PGX testing solutions to better understand its applicability. METHODS: A complete list of drugs on the ISS was analyzed for risk and likelihood of drug failure and PGX actionability. This analysis encompassed both astronauts’ personal medications, including supplements and over the counter drugs (n=151) contained in the ISS medical accessory kit (IMAK), and ISS MedKit formulary medications (n=95). Duplicate medications and different formulations were removed, which resulted in a total of 157 drugs used in the subsequent analysis. A 5x5 risk assessment table was produced by examining the likelihood of drug failure compared to the consequence of drug failure (LxC). Likelihood of individual drug failure was defined by whether existing processes are sufficient to prevent ineffective treatment or impactful side effect events, as ranked from 1 (very low, can easily be prevented) to 5 (very high, cannot be prevented) during a Mars mission. In contrast, the consequence of drug failure was defined by impact to safety, schedule, cost, or technical criteria and ranked from 1 (very low) to 5 (very high). An assessment of PGX reference laboratories is currently underway to evaluate sample requirements, benefit analysis (cost vs. utility of allele variant analysis), relevance to inflight medication usage, quality of reporting in enabling clinical application, and ease of integration into electronic medical records. RESULTS: Risk assessments (LxC 5x5 table) indicated 128 medications were in the green zone where risk is acceptable, with the remaining 29 of the medications in the yellow or red zone driven predominantly due to drug failure or safety concerns. We found that current PGX testing results could impact 21% of the total medications in the ISS MedKit and IMAK; of these, 9 medications currently have direct clinically actionable guidance available. Results of the clinical PGX solution evaluations as related to these medications will be presented. CONCLUSION: PGX testing has demonstrated clear benefits in terrestrial medicine and clinical environments for the selection of proper medications, avoiding adverse drug reactions, and maximizing drug efficacy. We propose that similar benefits would be bestowed on the astronaut and commercial spaceflight passenger population by performing preemptive preflight PGX testing to reduce risk of mission failure due to ineffective or toxic medications, improve drug efficacy, and further open the door to countermeasure research. For example, PGX results could allow tailoring of specific medications at optimal doses more precisely to each individual astronaut, particularly in areas of space motion sickness, sleep aids, and analgesics. An additional benefit is that PGX results could provide information for better planning of the components of a space pharmacy for deep space missions to be more effective and efficient in the utilization of limited pharmaceutical resources. Finally, while PGX testing of the astronaut corps is not currently conducted, this approach could provide immediate impact in support of mission success by reducing risks, optimizing astronaut performance, and providing valuable insights into long-term astronaut health. Such advancements in clinical decision making are important next steps in building dynamic individual risk profiles for astronauts, increasing selection of the best treatment choice, and providing tailored countermeasures for individual crewmembers.

Pharmacogenomics↗

NASA NTRS2024

NASA Spaceflight Medical Selection, Recertification and Mission Evaluation Standards

This NASA Technical Standard provides medical requirements and clinical procedures designed to ensure crew health and safety and occupational longevity of NASA career astronauts. This NASA Technical Standard used for selection and annual recertification of astronauts reflects the medical requirements to successfully complete specific mission tasks and the multifaceted training and performance required of a NASA astronaut. These include, but are not limited to, flying in high performance aircraft, exposure to hypobaric and hyperbaric conditions, exposure to unique environments (e.g., microgravity), and conducting specialized operations (e.g., extra-vehicular activities, robotic arm operations). NASA policy for establishing standards to protect the health and safety of crew and for providing health and medical programs for astronauts during all phases of space flight is authorized by NPD 1000.3 - The NASA Organization, and by NPD 8900.5B - NASA Health and Medical Policy for Human Space Exploration. This document includes medical evaluations for private astronauts and NASA Suborbital Research Specialist (NSRS). Private astronauts are defined as a crew member who is not a NASA career (U.S. government) astronaut or international partner astronaut. NASA Suborbital Research Specialist is an individual who is employed by NASA or funded by NASA to conduct research, technology testing, training, or other activities onboard a sub-orbital vehicle. This excludes those individuals who are the commercially employed crew of the suborbital vehicle. This NASA Technical Standard also provides mission specific medical evaluations which include both clinical and occupational requirements that may be tailored for future missions.

Standards↗