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Countermeasures and Functional Testing in Head-Down Tilt Bed Rest (CFT 70)

This 70‐day bed rest campaign was comprised of 6 integrated studies and conducted at the NASA Flight Analogs Research Unit (FARU). The FARU is located at the University of Texas Medical Branch, Galveston, Texas and is a satellite unit of the Institute for Translational Sciences - Clinical Research Center. This presentation will describe the FARU, discuss the utility of the bed rest platform for use in these studies, and introduce the studies that participated in the CFT 70 bed rest campaign. Information in this presentation will serve as the background for subsequent talks from each individual study. Individual study presentations will discuss preliminary results from completed subjects. Studies included in CFT70 were:  Physiological Factors Contributing to Post Flight Changes in Functional Performance. J. Bloomberg, NASA  Integrated Resistance and Aerobic Training Study. L. Ploutz‐Snyder, USRA  Testosterone Supplementation as a Countermeasure Against Musculoskeletal losses during Space Exploration. R. Urban, University of Texas Medical Branch  Effects of Retronasal Smelling, Variety and Choice on Appetite & Satiety. J. Hunter, Cornell University  AD ASTRA: Automated Detection of Attitudes and States through Transaction Recordings Analysis. C. Miller, Smart Information Flow Technologies, LLC  Bed Rest as a Spaceflight Analog to Study Neuro‐cognitive Changes: Extent, Longevity, and Neural Bases. R. Seidler, University of Michigan

Cromwell, Ronita L.↗

Virtual Reality as a Medium for Sensorimotor Adaptation Training and Spaceflight Countermeasures

Astronauts experience a profound sensorimotor adaptation during transition to and from the microgravity environment of space. With the upcoming shift to extra‐long duration missions (upwards of 1 year) aboard the International Space Station, the immediate risks to astronauts during these transitory periods become more important than ever to understand and prepare for. Recent advances in virtual reality technology enable everyday adoption of these tools for entertainment and use in training. Embedding an individual in a virtual environment (VE) allows the ability to change the perception of visual flow, elicit automatic motor behavior and produce sensorimotor adaptation, not unlike those required during long duration microgravity exposure. The overall goal of this study is to determine the feasibility of present head mounted display technology (HMD) to produce reliable visual flow information and the expected adaptation associated with virtual environment manipulation to be used in future sensorimotor adaptability countermeasures. To further understand the influence of visual flow on gait adaptation during treadmill walking, a series of discordant visual flow manipulations in a virtual environment are proposed. Six healthy participants (3 male and 3 female) will observe visual flow information via HMD (Oculus Rift DK2) while walking on an instrumented treadmill at their preferred walking speed. Participants will be immersed in a series of VE's resembling infinite hallways with different visual characteristics: an office hallway, a hallway with pillars and the hallway of a fictional spacecraft. Participants will perform three trials of 10 min. each, which include walking on the treadmill while receiving congruent or incongruent visual information via the HMD. In the first trial, participants will experience congruent visual information (baseline) where the hallway is perceived to move at the same rate as their walking speed. The final two trials will be randomized among participants where the hallway is perceived to move at either half (0.5x) or twice (2.0x) their preferred walking speed. Participants will remain on the treadmill between trials and will not be warned of the upcoming change to visual flow to minimize preparatory adjustments. Stride length, step frequency and dual‐support time will be quantified during each trial. We hypothesize that participants will experience a rapid modification in gait performance during periods of adaptive change, expressed as a decrease in step length, an increase in step frequency and an increase in dual‐support time, followed by a period of adaptation where these movement parameters will return to near‐baseline levels. As stride length, step frequency and dual support times return to baseline values, an adaptation time constant will be derived to establish individual time‐to‐adapt (TTA). HMD technology represents a paradigm shift in sensorimotor adaptation training where gait adaptability can be stressed using off‐the‐shelf consumer products and minimal experimental equipment, allowing for greater training flexibility in astronaut and terrestrial applications alike.

Madansingh, S.↗

Computational Analysis of Artificial Gravity as a Possible Countermeasure to Spaceflight Induced Bone Loss

During exploration class missions, such as to asteroids and Mars, astronauts will be exposed to reduced gravity for extended periods. Data has shown that astronauts lose bone mass at a rate of 1% to 2% a month in microgravity, particularly in lower extremities such as the proximal femur. Exercise countermeasures have not completely eliminated bone loss from long duration spaceflight missions, which leaves astronauts susceptible to early onset osteoporosis and greater risk of fracture. Introduction of the Advanced Resistive Exercise Device and other large exercise devices on the International Space Station (ISS), coupled with improved nutrition, has further minimized bone loss. However, unlike the ISS, exploration vehicles will have very limited volume and power available to accommodate such capabilities. Therefore, novel concepts like artificial gravity systems are being explored as a means to provide sufficient load stimulus to the musculoskeletal system to mitigate bone changes that may lead to early onset osteoporosis and increased risk of fracture. Currently, there is minimal data available to drive further research and development efforts to appropriately explore such options. Computational modeling can be leveraged to gain insight on the level of osteoprotection that may be achieved using artificial gravity produced by a spinning spacecraft or centrifuge. With this in mind, NASA's Digital Astronaut Project (DAP) has developed a bone remodeling model that has been validated for predicting volumetric bone mineral density (vBMD) changes of trabecular and cortical bone both for gravitational unloading condition and the equivalent of 1g daily load stimulus. Using this model, it is possible to simulate vBMD changes in trabecular and cortical bone under different gravity conditions. In this presentation, we will discuss our preliminary findings regarding if and how artificial gravity may be used to mitigate spaceflight induced bone loss.

Mulugeta, L.↗

NASA's Functional Task Test: Providing Information for an Integrated Countermeasure System

Exposure to the microgravity conditions of spaceflight causes astronauts to experience alterations in multiple physiological systems. These physiological changes include sensorimotor disturbances, cardiovascular deconditioning, and loss of muscle mass and strength. Some or all of these changes might affect the ability of crewmembers to perform critical mission tasks immediately after landing on a planetary surface. The goals of the Functional Task Test (FTT) study were to determine the effects of spaceflight on functional tests that are representative of critical exploration mission tasks and to identify the key physiological factors that contribute to decrements in performance. The FTT was comprised of seven functional tests and a corresponding set of interdisciplinary physiological measures targeting the sensorimotor, cardiovascular and muscular changes associated with exposure to spaceflight. Both Shuttle and ISS crewmembers participated in this study. Additionally, we conducted a supporting study using the FTT protocol on subjects before and after 70 days of 6 head-down bed rest. The bed rest analog allowed us to investigate the impact of body unloading in isolation on both functional tasks and on the underlying physiological factors that lead to decrements in performance, and then to compare them with the results obtained in our spaceflight study. Spaceflight data were collected on three sessions before flight, on landing day (Shuttle only) and 1, 6 and 30 days after landing. Bed rest subjects were tested three times before bed rest and immediately after getting up from bed rest as well as 1, 6, and 12 days after reambulation. We have shown that for Shuttle, ISS and bed rest subjects, functional tasks requiring a greater demand for dynamic control of postural equilibrium (i.e. fall recovery, seat egress/obstacle avoidance during walking, object translation, jump down) showed the greatest decrement in performance. Functional tests with reduced requirements for postural stability (i.e. hatch opening, ladder climb, manual manipulation of objects and tool use) showed little reduction in performance. These changes in functional performance were paralleled by similar decrements in sensorimotor tests designed to specifically assess postural equilibrium and dynamic gait control. Bed rest subjects experienced similar deficits both in functional tests with balance challenges and in sensorimotor tests designed to evaluate postural and gait control as spaceflight subjects indicating that body support unloading experienced during spaceflight plays a central role in post-flight alteration of functional task performance. To determine how differences in body-support loading experienced during in-flight treadmill exercise affect postflight functional performance, the loading history for each subject during in-flight treadmill (T2) exercise was correlated with postflight measures of performance. ISS crewmembers who walked on the treadmill with higher pull-down loads had enhanced post-flight performance on tests requiring mobility. Taken together the spaceflight and bed rest data point to the importance of supplementing inflight exercise countermeasures with balance and sensorimotor adaptability training. These data also support the notion that inflight treadmill exercise performed with higher body loading provides sensorimotor benefits leading to improved performance on functional tasks that require dynamic postural stability and mobility.

Bloomberg, J. J.↗

Human Research Program Human Health Countermeasures Element: Evidence Report - Artificial Gravity

The most serious risks of long-duration flight involve radiation, behavioral stresses, and physiological deconditioning. Artificial gravity (AG), by substituting for the missing gravitational cues and loading in space, has the potential to mitigate the last of these risks by preventing the adaptive responses from occurring. The rotation of a Mars-bound spacecraft or an embarked human centrifuge offers significant promise as an effective, efficient multi-system countermeasure against the physiological deconditioning associated with prolonged weightlessness. Virtually all of the identified risks associated with bone loss, muscle weakening, cardiovascular deconditioning, and sensorimotor disturbances might be alleviated by the appropriate application of AG. However, experience with AG in space has been limited and a human-rated centrifuge is currently not available on board the ISS. A complete R&D program aimed at determining the requirements for gravity level, gravity gradient, rotation rate, frequency, and duration of AG exposure is warranted before making a decision for implementing AG in a human spacecraft.

Clement, Gilles↗

Developing Sensorimotor Countermeasures to Mitigate Post-Flight Locomotor Dysfunction

Following spaceflight, crewmembers experience postural and locomotor instability. The magnitude and duration of post-flight sensorimotor disturbances increase with longer duration exposure to microgravity. These post-flight postural and locomotor alterations can pose a risk to crew safety and to mission objectives if nominal or emergency vehicle egress is required immediately following long-duration spaceflight. Gait instabilities could prevent or extend the time required to make an emergency egress from the Orbiter, Crew Return Vehicle or a future Martian lander leading to compromised mission objectives. We propose a countermeasure that aids in maintaining functional locomotor performance. This includes retaining the ability to perform vehicular egress and meet early mission objectives soon after landing on a planetary surface.

Bloomberg, J. J.↗

Practical Applications of Cables and Ropes in the ISS Countermeasures System

As spaceflight durations have increased over the last four decades, the effects of weightlessness on the human body are far better understood, as are the countermeasures. A combination of aerobic and resistive exercise devices contribute to countering the losses in muscle strength, aerobic fitness, and bone strength of today's astronauts and cosmonauts that occur during their missions on the International Space Station. Creation of these systems has been a dynamically educational experience for designers and engineers. The ropes and cables in particular have experienced a wide range of challenges, providing a full set of lessons learned that have already enabled improvements in on-orbit reliability by initiating system design improvements. This paper examines the on-orbit experience of ropes and cables in several exercise devices and discusses the lessons learned from these hardware items, with the goal of informing future system design.

Moore, Cherice↗

Stroboscopic Goggles as a Countermeasure for Dynamic Visual Acuity and Landing Sickness in Crewmembers Returning from Long-Duration Spaceflight

Long-term exposure to microgravity causes sensorimotor adaptations that result in functional deficits upon returning to a gravitational environment. At landing, the vestibular system and the central nervous system, responsible for coordinating head and eye movements via the vestibulo-occular reflex (VOR), are adapted to microgravity and must re-adapt to the Earth's gravitational environment. This re-adaptation causes decrements in gaze control and dynamic visual acuity, with astronauts reporting oscillopsia and blurred vision. These effects are caused by retinal slip, or the inability to keep an image focused on their retina, which is thought to drive motion sickness symptoms experienced upon landing. Retinal slip can be estimated by dynamic visual acuity (DVA); visual acuity while in motion. Peters et al. (2011) find that DVA is worsened in astronauts by an average of 0.75 eye-chart lines one day after landing. Previously, the use of stroboscopic goggles has shown to be effective in minimizing motion sickness symptoms due to retinal slip (Reschke et al. 2007). In this study, we simulated the decrement in DVA caused by sensorimotor re-adaptation by using minifying lenses and then testing the efficacy of stroboscopic goggles in preventing retinal slip and improving DVA. Dynamic visual acuity is assessed using an oscillating chair developed in the Neuroscience Laboratory at JSC. This chair is motor-driven and oscillates vertically at 2 Hz with a vertical displacement of +/- 2 cm to simulate the vertical translations that occur while walking. As the subject is being oscillated, they are asked to discern the direction of Landolt-C optotypes of varying sizes and record their direction using a gamepad. The visual acuity thresholds are determined using an algorithm that alters the size of the optotype based on the previous responses of the subject using a forced-choice best parameter estimation that is able to rapidly converge on the threshold value. Visual acuity thresholds were determined both for static (seated) and dynamic (oscillating) conditions. Dynamic visual acuity is defined as the difference between the dynamic and static conditions. We found that healthy subjects (n=20) have a significantly impaired DVA while wearing the minifying lenses, demonstrating that the VOR is in an adaptive state and retinal slip is occurring. When subjects' acuity was tested wearing the stroboscopic goggles with the minifying lenses, there was no significant difference in their DVA compared to their baseline DVA. This suggests that stroboscopic goggles are preventing retinal slip and would function as an efficient countermeasure for VOR adaptations and thus help mitigate landing sickness symptoms experienced by long-duration crewmembers. These goggles might also be used to counter blurred vision (caused by retinal slip) experienced by crewmembers during launch where the vehicle vibrations are greatest. The stroboscopic effect could be built into a section of their head mounted displays on the visor of their helmets to be used in these high vibration situation if a mission critical task is necessary.

Rosenberg, M. J. F.↗

Development of an Integrated Sensorimotor Countermeasure Suite for Spaceflight Operations

Astronauts experience Postflight disturbances in postural and locomotor control due to sensorimotor adaptation to the unique environment of spaceflight. These alterations might have adverse consequences if a rapid egress were required following a Mars landing or on return to Earth after a water landing. Currently, no operational countermeasure is targeted to mitigate Postflight balance and locomotor dysfunction.

Bloomberg, J. J.↗

Assessment of Intraocular and Systemic Vasculature Pressure Parameters in Simulated Microgravity with Thigh Cuff Countermeasure

Changes in vision have been well documented among astronauts during and after long-duration space flight. One hypothesis is that the space flight induced headward fluid alters posterior ocular pressure and volume and may contribute to visual acuity decrements. Therefore, we evaluated venoconstrictive thigh cuffs as a potential countermeasure to the headward fluid shift-induced effects on intraocular pressure (IOP) and cephalic vascular pressure and volumes.

Huang, Alex S.↗

Overview and Evaluation of a Computational Bone Physiology Modeling Toolchain and Its Application to Testing of Exercise Countermeasures

Prolonged microgravity exposure disrupts natural bone remodeling processes and can lead to a significant loss of bone strength, increasing injury risk during missions and placing astronauts at a greater risk of bone fracture later in life. Resistance-based exercise during missions is used to combat bone loss, but current exercise countermeasures do not completely mitigate the effects of microgravity. To address this concern, we present work to develop a personalizable, site-specific computational modeling toolchain of bone remodeling dynamics to understand and estimate changes in volumetric bone mineral density (BMD) in response to microgravity-induced bone unloading and in-flight exercise. The toolchain is evaluated against data collected from subjects in a 70-day bed rest study and is found to provide insight into the amount of exercise stimulus needed to minimize bone loss, quantitatively predicting post-study volumetric BMD of control subjects who did not perform exercise, and qualitatively predicting the effects of exercise. Results suggest that, with additional data, the toolchain could be improved to aid in developing customized in-flight exercise regimens and predict exercise effectiveness.

Schepelmann, Alexander↗

MPLA as an Innovative Immune Countermeasure

Spaceflight perturbs the human immune system. Among other manifestations, crewmembers may experience latent herpes viruses reactivation due to impaired lymphocyte function, as well as allergic/hypersensitivity reactions. Considering future space travel will be of longer duration (thereby increasing stress, exposure to radiation, etc…) with no rapid return option, it is of paramount importance to develop a countermeasure(s) to immune dysregulation. Monophosphoryl lipid A (MPLA) is a derivative of lipopolysaccharide (LPS), a potent inflammatory agent that can cause septic shock. MPLA possesses the immune-stimulatory effects of LPS without the adverse inflammatory effects. We hypothesize that treating immune cells with MPLA will boost their function enough to overcome the inhibitory effects of microgravity. While MPLA has been tested as an adjuvant extensively in mice and preliminarily for human vaccines, it has never been assessed for efficacy in microgravity.

Makedonas, George↗

Overview and Evaluation of a Computational Bone Physiology Modeling Toolchain and Its Application to Testing of Exercise Countermeasures

Prolonged microgravity exposure disrupts natural bone remodeling processes and can lead to a significant loss of bone strength, increasing injury risk during missions and placing astronauts at a greater risk of bone fracture later in life. Resistance-based exercise during missions is used to combat bone loss, but current exercise countermeasures do not completely mitigate the effects of microgravity. To address this concern, we present work to develop a personalizable, site-specific computational modeling toolchain of bone remodeling dynamics to understand and estimate changes in volumetric bone mineral density (BMD) in response to microgravity-induced bone unloading and in-flight exercise. The toolchain is evaluated against data collected from subjects in a 70-day bedrest study and is found to provide insight into the amount of exercise stimulus needed to minimize bone loss, quantitatively predicting post-study volumetric BMD of control subjects who did not perform exercise, and qualitatively predicting the effects of exercise. Results suggest that, with additional data, the toolchain could be improved to aid in developing customized in-flight exercise regimens and predict exercise effectiveness.

Schepelmann, Alexander↗

Effect of Loading Configuration on Kinematics and Kinetics for Deadlift and Squat Exercises: Case Study in Modeling Exercise Countermeasure Device for Astronauts

This study compares squat and deadlift exercises performed with two different loading configurations: 1) on a novel single-cable resistance exercise countermeasure device (ECD) for spaceflight and 2) with free weights. The results compare joint kinematics and kinetics between different loading configurations for each exercise, and also between the two exercises for each loading configuration. Single-cable versions of the squat (using a harness) and deadlift (using a T-bar) performed on the Hybrid Ultimate Lifting Kit (HULK) ECD have significantly different sagittal plane joint angle kinematics (both peak angle and range of motion) as well as joint kinetics (both peak joint moment and joint impulse) vs. their free weight equivalents at the same load. Differences also exist in hip abduction and rotation. Overall, the single-cable configurations tend to reduce peak joint angles, ranges of motion, peak joint moment and joint impulse vs. free weights. A notable exception is the lumbar joint, which is more heavily loaded for single-cable squats vs. free weight squats. This may have implications for both training benefit and possible risk of injury. Deadlift and squat exercises work the lower body musculature in different ways, with the deadlift emphasizing hip and lumbar extension and the squat emphasizing knee extension. Based on these findings, we would advocate the use of both movements in the exercise prescriptions of astronaut crews on deep-space missions.

Resistance Exercise↗

Medical Countermeasures for Radiation Induced Health Effects: Reports of an Interagency Panel Session Held at the NASA Human Research Program Investigator's Workshop, January 26, 2017

An Interagency Panel Session organized by the NASA Human Research Program Space Radiation Program Element (SRPE) was held during the NASA Human Research Program (HRP) Investigator’s Workshop (IWS) in Galveston, Texas on January 26, 2017 to identify complementary research areas that will advance the testing and development of medical countermeasures (MCM) in support of radioprotection and radiation mitigation on the ground and in space. There were several areas of common interest identified among the various participating agencies. This report provides a summary of the topics discussed by each agency along with potential areas of intersection for mutual collaboration opportunities. Common goals included repurposing of pharmaceuticals, neutraceuticals for use as radioprotectors and/or mitigators, low-dose/chronic exposure paradigms, late effects post-radiation exposure, mixed-field exposures of gamma-neutron, performance decrements, and methods to determine individual exposure levels.

Carnell, Lisa S.↗

Medical Countermeasure Requirements for Meeting Permissible Radiation Exposure Limits in Space

The space radiation environment consists of ionizing radiation that poses healthrisks to crew members who embark on a mission to Mars. NASA requiresthat astronaut career radiation limits for the Risk of Exposure Induced Death(REID) should not exceed 3% at the upper 95% confidence level for cancermortality. However, the lifetime career limit is likely to be exceeded for eventhe shortest round-trip mission scenario to Mars. As such, approaches fordirectly reducing the radiation risk, despite the large uncertainties, are beinginvestigated. A recent study showed that medical countermeasures (MCM)which reduced background cancer mortality rates may be effective in mitigatingthe REID, where the data employed in the sensitivity analysis were limited tocohort studies of aspirin and warfarin. The present work addresses the generalMCM requirements that are needed to meet the lifetime career exposure limitsby examining modifications to the background cancer mortality rates, radiationquality factor, and low-LET radiation risk models for a Mars mission scenario.These results may be used to help inform decision-makers about potentialexperimental measurements that facilitate the greatest propensity for MCM risk reduction.

Charles M Werneth↗

Overview of the Translational Radiation Research and Countermeasures (TRRaC) Project in Space Radiation

The Translational Radiation Research and Countermeasures (TRRaC) Project was initiated by the Space Radiation (SR) Element within NASA’s Human Research Program (HRP) to support the SR mission to understand and characterize the space radiation environment, understand and quantify radiation-associated risks, and mitigate the impacts of radiation-induced adverse health outcomes to enable human space exploration. TRRaC’s mission is to translate radiation research results from experimental studies and epidemiological data to humans and astronauts using bioinformatics and computational modeling. TRRaC will leverage existing datasets such as those available from NASA’s GeneLab repository and human medical radiation exposure registries, along with relevant data generated from ground-based research at molecular, cellular, tissue, and system levels, to: (1) refine the radiation dose rate effectiveness factor, (2) characterize radiation quality effects to improve estimates of the risk of exposure-induced death (REID) from space-relevant radiation exposures, and (3) identify pathways and biomarkers for cancer, cardiovascular disease, and central nervous system changes that are impacted by space radiation exposure.

Parastou Eslami↗

NASA Ames Fatigue Countermeasures Laboratory and AA FRMS - A Working Relationship

American Airlines and NASA Ames Research Center have a long-standing partnership to conduct human factors fatigue research in airline operations. Since 2016, using a mechanism known as a Space Act Agreement, NASA Ames’ Fatigue Countermeasures Laboratory has worked with the American’s Fatigue Risk Management team to gather sleep and alertness data from volunteer flight crew members. Operations studied include long-range transpacific flights, timing of inflight rest breaks during augmented flights, and rates of acclimation related to flights making theater changes. This mutually beneficial collaborative working arrangement allows American to conduct operations of specific interest under the FAA’s Alternative Means of Compliance process and provides NASA with a means to gather and analyze data that can be used to inform operational safety-related decisions. Earlier this year, results from the study of inflight rest breaks was published in the journal Aerospace Medicine and Human Performance. A total of 500 American pilots responded to a survey with landing crew reporting more and better-quality sleep during break 2 than break 3. Subsequent ratings of sleepiness and alertness at TOD were significantly better for crew who used break 2. Findings from this study were reported to the FAA leading to an inflight fatigue mitigation capability for many pilots in the industry. An upcoming study is to evaluate workload and alertness levels during Caribbean Turn (DFW-SJO-DFW) operations. For this study, the FRMS team and NASA will ask volunteers to collect data on sleep, workload, performance, and alertness using scientifically valid methods The information gained in this study will help inform how workload and fatigue interact with duty duration during short-haul, daytime operations.

in-flight rest↗