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At least 253 records · Page 14

Effects of prolonged head-down bed rest on physiological responses to moderate hypoxia

To determine the effects of hypoxia on physiological responses to simulated zero-gravity cardiopulmonary and fluid balance measurements were made in 6 subjects before and during 5-degree head-down bed rest (HDBR) over 8 d at 10,678 ft and a second time at this altitude as controls (CON). The V-dot(O2)(max) increased by 9 percent after CON, but fell 3 percent after HDBR. This reduction in work capacity during HDBR could be accounted for by inactivity. The heart rate response to a head-up tilt was greatly enhanced following HDBR, while mean blood pressure was lower. No significant negative impact of HDBR was noted on the ability to acclimatize to hypoxia in terms of pulmonary mechanics, gas exchange, circulatory or mental function measurements. No evidence of pulmonary interstitial edema or congestion was noted during HDBR at the lower PIO2 and blood rheology properties were not negatively altered. Symptoms of altitude illness were more prevalent, but not marked, during HDBR and arterial blood gases and oxygenation were not seriously effected by simulated microgravity. Declines in base excess with altitude were similar in both conditions. The study demonstrated a minimal effect of HDBR on the ability to adjust to this level of hypoxia.

Loeppky, J. A.↗

Insulin and glucose responses during bed rest with isotonic and isometric exercise

The effects of daily intensive isotonic (68% maximum oxygen uptake) and isometric (21% maximum extension force) leg exercise on plasma insulin and glucose responses to an oral glucose tolerance test (OGTT) during 14-day bed-rest (BR) periods were investigated in seven young healthy men. The OGTT was given during ambulatory control and on day 10 of the no-exercise, isotonic, and isometric exercise BR periods during the 15-wk study. The subjects were placed on a controlled diet starting 10 days before each BR period. During BR, basal plasma glucose concentration remained unchanged with no exercise, but increased (P less 0.05) to 87-89 mg/100 ml with both exercise regimens on day 2, and then fell slightly below control levels on day 13. The fall in glucose content during BR was independent of the exercise regimen and was an adjustment for the loss of plasma volume. The intensity of the responses of insulin and glucose to the OGTT was inversely proportional to the total daily energy expenditure during BR. It was estimated that at least 1020 kcal/day must be provided by supplemental exercise to restore the hyperinsulinemia to control levels.

Dolkas, C. B.↗

Temporal Changes in Left Ventricular Mechanics: Impact of Bed Rest and Exercise

The use of more sensitive and specific echocardiographic techniques such as speckle tracking imaging may address the current limitations of conventional cardiac imaging techniques to provide insight into the extent and time course of cardiac deconditioning following spaceflight or headdown tilt bed rest (HDTBR). METHODS Speckle tracking assessment of longitudinal, radial, and circumferential strain and twist was used to evaluate the impact of 70 days of HDTBR (n=7) and HDTBR + exercise (n=11) on temporal changes in LV mechanics. Echocardiograms were performed pre (BR‐2), during (BR31, 70), and following (BR+4hr) HDTBR. Repeated measures ANOVA was used to evaluate the effect of HDTBR on cardiac variables in control and exercise subjects. RESULTS After sedentary HDTBR, longitudinal (‐19.0 +/- 1.8% vs. ‐14.9 +/- 2.4%) and radial (15.0 +/- 1.9% vs. 11.3 +/- 2.2%) strain and twist (18.0 +/- 4.0deg vs. 17.0 +/- 3.6deg) were significantly impaired. In contrast, exercise preserved LV mechanics, and there were non‐significant improvements from BR‐2 to BR70 in longitudinal strain (‐18.7 +/- 1.5% vs. ‐20.4 +/- 2.7%), radial strain (13.2 +/- 2.4% vs. 14.2 +/- 1.6%), and twist (16.3 +/- 3.6deg vs. 18.6 +/- 5.9deg). CONCLUSIONS Using speckle tracking echocardiography provides important new insights into temporal changes in LV mechanics during disuse and exercise training.

Scott, J. M.↗

Individual Variability in Aerobic Fitness Adaptations to 70-d of Bed Rest and Exercise Training

Change in maximal aerobic capacity (VO2pk) in response to exercise training and disuse is highly variable among individuals. Factors that could contribute to the observed variability (lean mass, daily activity, diet, sleep, stress) are not routinely controlled in studies. The NASA bed rest (BR) studies use a highly controlled hospital based model as an analog of spaceflight. In this study, diet, hydration, physical activity and light/dark cycles were precisely controlled and provided the opportunity to investigate individual variability. PURPOSE. Evaluate the contribution of exercise intensity and lean mass on change in VO2pk during 70-d of BR or BR + exercise. METHODS. Subjects completed 70-d of BR alone (CON, N=9) or BR + exercise (EX, N=17). The exercise prescription included 6 d/wk of aerobic exercise at 70 - 100% of max and 3 d/wk of lower body resistance exercise. Subjects were monitored 24 hr/d. VO2pk and lean mass (iDXA) were measured pre and post BR. ANOVA was used to evaluate changes in VO2pk pre to post BR. Subjects were retrospectively divided into high and low responders based on change in VO2pk (CON > 20% loss, n=5; EX >10% loss, n=4, or 5% gain, n=4) to further understand individual variability. RESULTS. VO2pk decreased from pre to post BR in CON (P<0.05) and was maintained in EX; however, significant individual variability was observed (CON: -22%, range: -39% to -.5%; EX: -1.8%, range: -16% to 12.6%). The overlap in ranges between groups included 3 CON who experienced smaller reduction in VO2pk (<16%) than the worst responding EX subjects. Individual variability was maintained when VO2pk was normalized to lean mass (range, CON: -33.7% to -5.7%; EX: -15.8% to 11%), and the overlap included 5 CON with smaller reductions in VO2pk than the worst responding EX subjects. High responders to disuse also lost the most lean mass; however, this relationship was not maintained in EX (i.e. the largest gains/losses in lean mass were observed in both high and low responders). Change in VO2pk was not related to exercise intensity. CONCLUSION. Change in VO2pk in response to disuse and exercise was highly variable among individuals, even in this tightly controlled study. Loss in lean mass accounts for a significant degree of variability in the CON; however, training induced gains in VO2pk appear unrelated to lean mass or exercise intensity.

Downs, Meghan↗

Orthostatic responses following 30-day bed rest deconditioning with isotonic and isokinetic exercise training

The effects of intensive exercise training on tilt tolerance following deconditioning of astronauts were investigated by studying orthostatic responses of 19 subjects who underwent two intensive exercise-training regimens during 30 days of -6-deg head-down bed rest (BR). Subjects were divided into no-exercise control group, and two exercise groups, one performing isotonic (Quinton ergometer) exercises, the other doing isokinetic (Lido ergometer) exercises. A 60-deg head-up tilt test was administered on the control day 1 and BR day 30; the test was terminated at 60 min or when presyncopal signs and/or symptoms occurred. It was found that exercise training did not affect tilt tolerance significantly.

Greenleaf, J. E.↗

Fuel utilization during exercise after 7 days of bed rest

Energy yield from carbohydrate, fat, and protein during physical activity is partially dependent on an individual's fitness level. Prolonged exposure to microgravity causes musculoskeletal and cardiovascular deconditioning; these adaptations may alter fuel utilization during space flight. Carbohydrate and fat metabolism during exercise were analyzed before and after 7 days of horizontal bed rest.

Barrows, Linda H.↗

Effect Of Bed Rest On Tolerance To Acceleration

Report describes experimental comparative study of tolerance of aerobically fit men and sedentary men to +Gz acceleration. Designed to confirm or deny previous observations that long-term aerobic training reduces tolerance to acceleration. Data accumulated in study showed decrease in tolerance to acceleration caused by deconditioning effect of bed rest more pronounced in fit men than in sedentary men. Suggests physically fit people need additional measures to reduce loss of tolerance to acceleration during microgravity exposure.

Goldwater, Danielle J.↗

The Effects of Spaceflight and Head Down Tilt Bed Rest on Neurocognitive Performance: Extent, Longevity, and Neural Bases

Spaceflight effects on gait, balance, & manual motor control have been well studied; some evidence for cognitive deficits. Rodent cortical motor & sensory systems show neural structural alterations with spaceflight. specific Aims: Aim 1-Identify changes in brain structure, function, and network integrity as a function of head down tilt bed rest and spaceflight, and characterize their time course. Aim 2-Specify relationships between structural and functional brain changes and performance and characterize their time course.

Seidler, Rachael D.↗

Effect of intermittent standing and walking on physiological changes induced by head-down bed rest

Continuous exposure to gravity may not be necessary to prevent compromised physiological function resulting from exposure to microgravity. However, minimum gravity (G) exposure requirements, effectiveness of passive Gz versus activity in a G field, and optimal G stimulus amplitude, duration, and frequency are unknown. To partially address these questions, a 4-day, 6 degree head-down bed rest (HDBR) study (one ambulatory control day, 4 full HDBR days, one recovery day) was conducted. Nine males, 30-50 yr, were subjected to four different +1 Gz (head-foot) exposure protocols (periodic standing or controlled walking for 2 or 4 h/day in 15 min doses), plus a continuous HDBR (0 Gz) control. Standing 4 h completely prevented and standing 2 h partially prevented post-HDBR orthostatic intolerance. Both walking conditions (2 h and 4 h) attenuated the decrease in peak VO2 and prevented the increased urinary Ca2+ excretion associated with HDBR. Both 4 h conditions (standing and walking) attenuated plasma volume loss during HDBR. It was concluded that various physiological systems benefit differentially from passive +1 Gz or activity in +1 Gz and the duration (2 h vs. 4 h) of the stimulus may be an important moderating factor.

Vernikos, J.↗

Countermeasures for Mitigation of Sensorimotor Decrements Following Head-Down Tilt Bed Rest

BACKGROUND Astronauts experience postflight disturbances in postural and locomotor control due to sensorimotor adaptations during spaceflight. These alterations may have adverse consequences if a rapid egress is required after landing. Although exercise is partially effective for mitigating cardiovascular and muscular deconditioning, additional countermeasures are needed to further preserve sensorimotor function. Proprioception training and electrical muscle stimulation (EMS) are two promising in-flight countermeasures. Since prolonged head down tilt bed rest (HDTBR) is a spaceflight analog for body unloading and causes postural and locomotor control decrements that parallel those observed after spaceflight, it can be used to facilitate the development of these countermeasures. METHODS This study will determine the effects of proprioception training and EMS on functional task performance and sensorimotor function following 60 days of 6° HDTBR. Subjects will be randomly assigned to one of four groups: 1) an EMS arm, 2) a proprioception training arm, 3) an exercise plus proprioceptive training arm, and 4) a control arm. The EMS countermeasure will include daily bilateral stimulation of selected bilateral lower extremity muscles (30 minutes per session). Proprioception training will be performed three days per week (25 minutes per session) consisting of body-loaded postural tasks in the horizontal position on an air bearing sled. Exercise training will mimic current protocols used on the International Space Station, but treadmill aerobic exercise will be replaced with additional cycling aerobic exercise. Primary outcome measures will include pre- and post- HDTBR functional tests that require high demand for dynamic control of postural stability. Secondary measures will be used to explore key physiological changes that underlie countermeasure benefits. All HDTBR and data collection activities will be completed by the German Aerospace Center (DLR) at the :envihab facility. Given the constrained samples size, a Bayesian modelling approach will be used to quantify the probability that there is an effect of a given magnitude. HARDWARE AND PROTOCOL DEVELOPMENT Final hardware modifications and protocol developments were completed in preparation for Campaign 1, which began in September 2024. These included shipment, setup, and operator training for the transportable gravity bed, horizontal squat device, foam obstacle course, EMS devices, leg dexterity system, foot sole skin sensitivity system, and Radiofrequency Echographic Multi Spectrometry (REMS) ultrasound device. In addition, specialized protocols were developed for data collection using DLR’s equipment, including muscle morphology magnetic resonance imaging (MRI), optical coherence tomography, venous blood flow MRI and ultrasound, muscle ultrasound and impedance, and skin blood flow ultrasound. We will present early data from the first campaign, which concluded in November, 2024. These will be compared with previous data from the recent 30-day HDTBR campaigns (Spaceflight associated neuro-ocular syndrome countermeasures (SANS-CM)) conducted at DLR. RELEVANCE The deliverable from this project will be proof-of-concept sensorimotor countermeasure designs for functional task performance with full assessment of efficacy in a spaceflight analog. If one or more countermeasures are effective, they will be translated for validation with the suite of operationally implemented in-flight countermeasures.

T R Macaulay↗

Bed-rest studies: Fluid and electrolyte responses

Confinement in the horizontal position for 2 to 3 weeks results in a chronic decrease in plasma volume, increased interstitial fluid volume, and unchanged or slightly increased extracellular fluid volume. Concentrations of blood electrolytes, glucose, and nitrogenous constituents remain within normal limits of variability when maintenance levels of isometric or isotonic exercise are performed for 1 hr/day. Hematocrit and plasma osmolality can be elevated significantly throughout bed rest (BR). Significant diuresis occurs on the first day, and increases in urine Na and Ca continue throughout BR, although voluntary fluid intake is unchanged. Urine Na and K are evaluated during the second week of BR in spite of stabilization of PV and extracellular volume. The initial diuresis probably arises from the extracellular fluid while subsequent urine loss above control levels must come from the intracellular fluid. Preservation of the extracellular volume takes precedance over maintenance of the intracellular fluid volume. The functioning of a natriuretic factor (hormone) to account for the continued increased loss of Na in the urine is suggested.

Greenleaf, J. E.↗

Bed-rest studies - Fluid and electrolyte responses

Confinement in the horizontal position for 2 to 3 weeks results in a chronic decrease in plasma volume, increased interstitial fluid volume, and unchanged or slightly increased extracellular fluid volume. Concentrations of blood electrolytes, glucose, and nitrogenous constituents remain within normal limits of variability when maintenance levels of isometric or isotonic exercise are performed for 1 hr/day. Hematocrit and plasma osmolality can be elevated significantly throughout bed rest (BR). Significant diuresis occurs on the first day, and increases in urine Na and Ca continue throughout BR, although voluntary fluid intake is unchanged. Urine Na and K are evaluated during the second week of BR in spite of stabilization of PV and extracellular volume. The initial diuresis probably arises from extracellular fluid while subsequent urine loss above control levels must come from the intracellular fluid. Preservation of the extracellular volume takes precedance over maintenance of the intracellular fluid volume. The functioning of a natriuretic factor (hormone) to account for the continued increased loss of Na in the urine is suggested. Previously announced in STAR as N83-24160

Greenleaf, J. E.↗

Countermeasures for Mitigation of Sensorimotor Decrements Following Head-Down Bed Rest

BACKGROUND Astronauts experience postflight disturbances in postural and locomotor control due to sensorimotor adaptations during spaceflight. These alterations may have adverse consequences if a rapid egress is required after landing. Although exercise is partially effective for mitigating cardiovascular and muscular deconditioning, additional countermeasures are needed to further preserve sensorimotor function for exploration missions. We have identified proprioceptive training and electrical muscle stimulation (EMS) as promising in-flight countermeasures. Since prolonged head down bed rest (HDBR) is a spaceflight analog for body unloading and causes postural and locomotor control decrements that parallel those observed after spaceflight, it can be used to accelerate the development of these countermeasures. METHODS This study will determine the effects of proprioceptive training and EMS on functional task performance and sensorimotor function following 60 days of 6° HDBR. Subjects will be randomly assigned to one of four groups: 1) an EMS arm, 2) a proprioceptive training arm, 3) an exercise plus proprioceptive training arm, and 4) a control arm. The EMS countermeasure will include daily bilateral stimulation of the quadriceps femoris muscle (30 minutes per session). Proprioceptive training will be performed three days per week (20 minutes per session) consisting of body-loaded postural tasks in the horizontal position on an air bearing sled. Exercise training will mimic current protocols used on the International Space Station, but treadmill aerobic exercise will be replaced with additional cycling aerobic exercise. Primary outcome measures will include pre and post HDBR functional tests that are representative of high priority exploration mission tasks and require high demand for dynamic control of postural stability. Additional measures will be used to identify the key physiological factors contributing to countermeasure benefits. Given the constrained samples size, a Bayesian modelling approach will be used to quantify the probability that there is an effect of a given magnitude. COUNTERMEASURE UPDATES Proprioceptive countermeasure design enhancements and human in the loop pilot testing continued through the Crew Health Countermeasures (CHC) Systems Capability Leadership Team (SCLT). The primary goals of this work were to enhance the visual feedback system’s capabilities and develop a proprioceptive training program for 60 days of HDBR. Six healthy non-astronaut volunteers participated in four pilot training sessions to systematically examine how each training variable (e.g., axial load, foot placement, and software profile) affects the overall proprioceptive challenge. The resulting training program will maintain an appropriate challenge during 60 days of HDBR by progressively decreasing the subject’s base of support, increasing tilt board target distances, and increasing axial loads using both subjective verbal feedback and objective performance data. RELEVANCE The deliverable from this project will be proof-of-concept sensorimotor countermeasure designs for functional task performance with full assessment of efficacy in a spaceflight analog. If the countermeasures are effective, they will be translated for validation with the suite of operationally implemented in-flight countermeasures.

T R Macaulay↗

Countermeasures for Mitigation of Sensorimotor Decrements Following Head-Down Bed Rest

BACKGROUND Astronauts experience postflight disturbances in postural and locomotor control due to sensorimotor adaptations during spaceflight. These alterations may have adverse consequences if a rapid egress is required after landing. Although exercise is partially effective for mitigating cardiovascular and muscular deconditioning, additional countermeasures are needed to further preserve sensorimotor function for exploration missions. We have identified proprioceptive training and electrical muscle stimulation (EMS) as promising in-flight countermeasures. Since prolonged head down bed rest (HDBR) is a spaceflight analog for body unloading and causes postural and locomotor control decrements that parallel those observed after spaceflight, it can be used to facilitate the development of these countermeasures. METHODS This study will determine the effects of proprioceptive training and EMS on functional task performance and sensorimotor function following 60 days of 6° HDBR. Subjects will be randomly assigned to one of four groups: 1)an EMS arm, 2) a proprioceptive training arm, 3) an exercise plus proprioceptive training arm, and 4) a control arm. The EMS countermeasure will include daily bilateral stimulation of selected bilateral lower extremity muscles (30 minutes per session). Proprioceptive training will be performed three days per week (20 minutes per session) consisting of body-loaded postural tasks in the horizontal position on an air bearing sled. Exercise training will mimic current protocols used on the International Space Station, but treadmill aerobic exercise will be replaced with additional cycling aerobic exercise. Primary outcome measures will include pre and post HDBR functional tests that are representative of high priority exploration mission tasks and require high demand for dynamic control of postural stability. Additional measures will be used to identify the key physiological factors contributing to countermeasure benefits. Given the constrained samples size, a Bayesian modelling approach will be used to quantify the probability that there is an effect of a given magnitude. HARDWARE AND PROTOCOL DEVELOPMENT Proprioceptive countermeasure design enhancements continued as part of the Mars Campaign Office (MCO) Crew Health and Performance (CHP) Crew Health Countermeasures (CHC). The primary goals of this work were to assemble a portable version of the countermeasure system that can be used at the :envihab facility, expand the software feedback system’s capabilities, and develop an actuator loading system that mimics what could be used on the International Space Station. In addition, one major piece of exercise hardware used in previous HDBR studies, the Horizontal Squat Device, was reassembled and restored to full functionality. Human-in-the-loop pilot testing is ongoing, prior to shipping both devices to the :envihab HDBR facility. Evaluations are also underway for the best EMS device technologies and specific methods. Finally, assessment techniques are being translated for administration in the horizontal position (e.g., leg dexterity and foot sole skin sensitivity). Our current goals are to refine the countermeasure training and assessment techniques and integrate protocols across multiple modalities. RELEVANCE The deliverable from this project will be proof-of-concept sensorimotor countermeasure designs for functional task performance with full assessment of efficacy in a spaceflight analog. If one or more countermeasures are effective, they will be translated for validation with the suite of operationally implemented in-flight countermeasures. ACKNOWLEDGEMENT This work is supported by NASA’s Human Research Program Human Health Countermeasures Element and by the Canadian Space Agency (L. Bent).

T R Macaulay↗

Development of optic disc edema during 30 days of hypercapnic head down tilt bed rest is associated with short sleep duration and blunted temperature amplitude

Consequences of sleep and circadian rhythm disturbances include many neurophysiological sequelae, especially when combined with spaceflight stressors, and are therefore hypothesized to contribute to the development of optic disc edema observed in astronauts. Additionally, chronically elevated carbon dioxide (CO 2 ) levels on the International Space Station may contribute to the observed sleep disturbances in astronauts. Here we determined if the spaceflight analogue head-down tilt bed rest (HDTBR) combined with elevated CO 2 levels influenced sleep and core temperature and was associated the development of optic disc edema. Healthy participants (5 female, 6 male) aged 25-50 years, underwent thirty days of strict 6° HDTBR in a mild hypercapnic environment (ambient PCO 2 = 4 mmHg) with measures of sleep, 24-hour core temperature, overnight arterialized CO2, and Frisén grade edema collected pre-HDTBR, on HDTBR days 4, 17, 28, and post-HDTBR days 4 and 10. During all HDTBR time points, sleep, core temperature, and overnight arterialized CO 2 were not statistically significantly different than the pre-HDTBR measurements. However, independent of the HDTBR intervention, the odds ratios (mean [95% CI]) for developing Frisén grade optic disc edema were statistically significant for each hour below the mean total sleep time (2.2 [1.1-4.4]) and stage 2 NREM sleep (4.8 [1.3-18.6]), and above the mean for wake after sleep onset (3.6 [1.2-10.6]) and for each 0.1°C decrease in core temperature amplitude below the mean (4.0 [1.4-11.7]).These data suggest that optic disc edema occurring during HDTBR was more likely to occur in those with short sleep duration and blunted temperature amplitude.

Kate H. Christian↗

Bone Metabolism During Strict Head-Down Tilt Bed Rest with and without CO2 Exposure

Spaceflight and spacecraft have many negative physiological effects on the human body. One such factor is the exposure to elevated levels of carbon dioxide (CO2). In fact, the CO2 levels on board the International Space Station (ISS) have often reached levels 10x higher than outdoor terrestrial levels (1). Among other effects of CO2, it is possible that this exposure alters bone metabolism, leading to an increase of bone tissue resorption and mineral efflux, thus jeopardizing bone fidelity and mission success. Bed rest is a common analog to simulate the effects of microgravity on bone as subjects are placed at a -6° head-down tilt (HDT) position which reduces the mechanical load on bone (2).

E R McGrath↗

Leg muscle volume during 30-day 6-degree head-down bed rest with isotonic and isokinetic exercise training

Magnetic resonance imaging (MRI) was used to compare the effect of two modes of lower-extremity exercise training on the mass (volume) of posterior leg group (PLG) muscles (soleus, flexor hallucis longus, tibialis posterior, lateral and medial gastrocnemius, and flexor digitorum longus) on 19 men (ages 32-42 years) subjected to intense dynamic-isotonic (ITE, cycle ergometer, number of subjects (N) = 7), isokinetic (IKE, torque egrometer, N = 7), and no exercise (NOE, N = 5) training for 60 min/day during head-down bed rest (HDBR). Total volume of the PLG muscles decreased (p less than 0.05) similarly: ITE = 4.3 +/- SE 1.6%, IKE = 7.7 +/- 1.6%, and NOE = 6.3 +/- 0.8%; combined volume (N = 19) loss was 6.1 +/- 0.9%. Ranges of volume changes were 2.6% to -9.0% (ITE), -2.1% to -14.9% (IKE), and -3.4% to -8/1% (NOE). Correlation coefficients (r) of muscle volume versus thickness measured with ultrasonography were: ITE r + 0.79 (p less than 0.05), IKE r = 0.27 (not significant (NS)), and NOE r = 0.63 (NS). Leg-muscle volume and thickness were highly correlated (r = 0.79) when plasma volume was maintained during HDBR with ITE. Thus, neither intensive lower extremity ITE nor IKE training influence the normal non-exercised posterior leg muscle atrophy during HDBR. The relationship of muscle volume and thickness may depend on the mode of exercise training associated with the maintenance of plasma volume.

Greenleaf, J. E.↗

Effects of 1-week head-down tilt bed rest on bone formation and the calcium endocrine system

The -6-deg head-down tilt (HDT) is employed in the study of 8 subjects to determine early responses in human bone and calcium endocrines during spaceflight. The average rates of bone formation in the iliac crest are determined by means of a single-dose labeling schedule and are found to decrease in 6 of the subjects. The decrease varies directly with walking miles, and increased excretion of urinary Ca and Na are observed preceding increased levels of ionized serum calcium on a bed-rest day late in the week. Reduced phosphorous excretions are also followed by increased serum phosphorous on day six, and reductions are noted in parathyroid hormone and vitamin D by the end of the experiment. The data demonstrate the responsiveness of the skeletal system to biomechanical stimuli such as the HDT.

Arnaud, Sara B.↗