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Inadequate Loading Stimulus on ISS Results in Bone and Muscle Loss

INTRODUCTION Exercise has been the primary countermeasure to combat musculoskeletal changes during International Space Station (ISS) missions. However, these countermeasures have not been successful in preventing loss of bone mineral density (BMD) or muscle volume in crew members. METHODS We examined lower extremity loading during typical days on-orbit and on Earth for four ISS crew members. In-shoe forces were monitored using force-measuring insoles placed inside the shoes. BMD (by DXA), muscle volumes (by MRI), and strength were measured before and after long-duration spaceflight (181 +/- 15 days). RESULTS The peak forces measured during ISS activity were significantly less than those measured in 1g for the same activities. Typical single-leg loads on-orbit during walking and running were 0.89 +/- 0.17 body weights (BW) and 1.28 +/- 0.18 BW compared to 1.18 +/- 0.11 BW and 2.36 +/- .22 BW in 1g, respectively [2]. Crew members were only loaded for an average of 43.17 +/- 14.96 min a day while performing exercise on-orbit even though 146.8 min were assigned for exercise each day. Areal BMD decreased in the femoral neck and total hip by 0.71 +/- 0.34% and 0.81 +/- 0.21% per month, respectively. Changes in muscle volume were observed in the lower extremity (-10 to -16% calf; -4 to -7% thigh) but there were no changes in the upper extremity (+0.4 to -0.8%). Decrements in isometric and isokinetic strength at the knee (range: -10.4 to -24.1%), ankle (range: -4 to -22.3%), and elbow (range: -7.5 to - 16.7%) were also observed. Knee extension endurance tests showed an overall decline in total work (-14%) but an increased resistance to fatigue post-flight. DISCUSSION AND CONCLUSIONS Our findings support the conclusion that the measured exercise durations and/or loading stimuli were insufficient to protect bone and muscle health.

Rice, A. J.↗

Postural Stability When Leaning from Perceived Upright

The transition between quiet stance and gait requires the volitional movement of one?s center of mass (COM) toward a limit of stability (LOS). The goal of this study was to measure the effect of leaning from perceived upright on postural stability when voluntarily maintaining fixed stance positions and during perturbations of the support surface. The COM was derived from force plate data in 12 healthy subjects while standing with feet positioned so that lateral base of support was equal to foot length. For all conditions, arms were folded and subjects were instructed to lean without bending at the hips or lifting their feet. The LOS was determined during maximal voluntary leans with eyes open and closed. The COM was then displayed on a monitor located in front of the subject. Subjects were visually guided to lean toward a target position, maintain this position for 10s, return to upright, and then repeat the same targeted lean maneuver with eyes closed. Targets were randomly presented at 2? in 8 directions and between 2-6? in these same directions according to the asymmetric LOS. Subjects were then verbally guided to lean between 2? back and 4? forward prior to a perturbation of the support surface in either a forward or backward direction. The average LOS was 5.8? forward, 2.9? back, and 4.8? in left/right directions, with no significant difference between eyes open and closed. Center of pressure (COP) velocity increased as subjects maintained fixed stance positions farther from upright, with increased variability during eyes closed conditions. The time to stability and COP path length increased as subjects leaned opposite to the direction of the support surface perturbations. We conclude that postural stability is compromised as subjects lean away from perceived upright, except for perturbations that induce sway in the direction opposite the lean. The asymmetric LOS relative to perceived upright favors postural stability for COM movements in the forward direction.

Vanya, Robert D.↗

Hybrid Image-Plane/Stereo Manipulation

Hybrid Image-Plane/Stereo (HIPS) manipulation is a method of processing image data, and of controlling a robotic manipulator arm in response to the data, that enables the manipulator arm to place an end-effector (an instrument or tool) precisely with respect to a target (see figure). Unlike other stereoscopic machine-vision-based methods of controlling robots, this method is robust in the face of calibration errors and changes in calibration during operation. In this method, a stereoscopic pair of cameras on the robot first acquires images of the manipulator at a set of predefined poses. The image data are processed to obtain image-plane coordinates of known visible features of the end-effector. Next, there is computed an initial calibration in the form of a mapping between (1) the image-plane coordinates and (2) the nominal three-dimensional coordinates of the noted end-effector features in a reference frame fixed to the main robot body at the base of the manipulator. The nominal three-dimensional coordinates are obtained by use of the nominal forward kinematics of the manipulator arm that is, calculated by use of the currently measured manipulator joint angles and previously measured lengths of manipulator arm segments under the assumption that the arm segments are rigid, that the arm lengths are constant, and that there is no backlash. It is understood from the outset that these nominal three-dimensional coordinates are likely to contain possibly significant calibration errors, but the effects of the errors are progressively reduced, as described next. As the end-effector is moved toward the target, the calibration is updated repeatedly by use of data from newly acquired images of the end-effector and of the corresponding nominal coordinates in the manipulator reference frame. By use of the updated calibration, the coordinates of the target are computed in manipulator-reference-frame coordinates and then used to the necessary manipulator joint angles to position and orient the end-effector at the target with respect to the same kinematic model from the calibration step. As the end-effector/target distance decreases, the computed coordinates of the end-effector and target become more nearly affected by the same errors, so that the differences between their coordinates become increasingly precise. When the end-effector reaches the target, the remaining effective position error is the distance that corresponds to more than about one pixel in the stereoscopic images of the target.

Baumgartner, Eric↗

Retrospective Study of Serum Sclerostin Measurements in Bed Rest Subjects

Animal models and human studies suggest that osteocytes regulate the skeleton s response to mechanical unloading at the cellular level in part by an increase in sclerostin, an inhibitor of the anabolic Wnt pathway. However, few studies have reported changes in serum sclerostin in humans exposed to reduced mechanical loading. Thus, we determined changes in serum sclerostin and bone turnover markers in healthy adult men who participated in a controlled bed rest study. Seven healthy adult men (31 +/- 3 yrs old) underwent 90-day six-degree head down tilt bed rest at the University of Texas Medical Branch in Galveston's Institute for Translational Sciences - Clinical Research Center (ITS-CRC). Serum sclerostin, PTH, serum markers of bone turnover (bone specific alkaline phosphatase, RANKL/OPG, and osteocalcin), urinary calcium and phosphorus excretion, and 24 hour pooled urinary markers of bone resorption (NTX, DPD, PYD) were evaluated pre-bed rest (BL), bed rest day 28 (BR-28), bed rest day 60 (BR-60), and bed rest day 90 (BR-90). In addition, bone mineral density (BMD) was assessed by dual-energy X-ray absorptiometry (DXA) at BL, BR-60, and post bed rest day 5 (BR+5). Data are reported as mean +/- standard deviation. We used repeated measures ANOVA to compare baseline values to BR-28, BR-60, and BR-90. RESULTS Consistent with prior reports, BMD declined significantly (1-2% per month) at weight-bearing skeletal sites (spine, hip, femur neck, and calcaneus). Serum sclerostin levels were elevated above BL at BR-28 (+29% +/- 20%, p = 0.003), BR-60 (+42% +/- 31%, p < 0.001), and BR-90 (22% +/- 21%, p = 0.07). Serum PTH levels were reduced at BR-28 (-17% +/- 16%, p = 0.02), BR-60 (-24% +/- 14%, p = 0.03), and returned to baseline at BR-90 (-21% +/- 21%, p = 0.14). Serum bone turnover markers did not change, however urinary bone resorption markers and calcium were significantly elevated following bed rest (p < 0.01). CONCLUSION We observed an increase of serum sclerostin associated with decreased serum PTH and elevated bone resorption markers in otherwise healthy men subjected to long-term immobilization.

Spatz, J. M.↗

Air Force Reusable Booster System: A Quick-look, Design Focused Modeling and Cost Analysis Study

This paper presents a method and an initial analysis of the costs of a reusable booster system (RBS) as envisioned by the US Department of Defense (DoD) and numerous initiatives that form the concept of Operationally Responsive Space (ORS). This paper leverages the knowledge gained from decades of experience with the semi-reusable NASA Space Shuttle to understand how the costs of a military next generation semi-reusable space transport might behave in the real world - and how it might be made as affordable as desired. The NASA Space Shuttle had a semi-expendable booster, that being the reusable Solid Rocket MotorslBoosters (SRMlSRB) and the expendable cryogenic External Tank (ET), with a reusable cargo and crew capable orbiter. This paper will explore DoD concepts that invert this architectural arrangement, using a reusable booster plane that flies back to base soon after launch, with the in-space elements of the launch system being the expendable portions. Cost estimating in the earliest stages of any potential, large scale program has limited usefulness. As a result, the emphasis here is on developing an approach, a structure, and the basic concepts that could continue to be matured as the program gains knowledge. Where cost estimates are provided, these results by necessity carry many caveats and assumptions, and this analysis becomes more about ways in which drivers of costs for diverse scenarios can be better understood. The paper is informed throughout with a design-for-cost philosophy whereby the design and technology features of the proposed RBS (who and what, the "architecture") are taken as linked at the hip to a desire to perform a certain mission (where and when), and together these inform the cost, responsiveness, performance and sustainability (how) of the system. Concepts for developing, acquiring, producing or operating the system will be shown for their inextricable relationship to the "architecture" of the system, and how these too relate to costs. Design and technology features bear special relevance to early program research and development directions. Given the uncertainties involved in both their actual performance promise and their relation to costs of operational systems, this later relationship is also given special attention.

Zapata, Edgar↗

Lightweight Metal Matrix Composite Segmented for Manufacturing High-Precision Mirrors

High-precision mirrors for space applications are traditionally manufactured from one piece of material, such as lightweight glass sandwich or beryllium. The purpose of this project was to develop and test the feasibility of a manufacturing process capable of producing mirrors out of welded segments of AlBeMet(Registered Trademark) (AM162H). AlBeMet(Registered Trademark) is a HIP'd (hot isostatic pressed) material containing approximately 62% beryllium and 38% aluminum. As a result, AlBeMet shares many of the benefits of both of those materials for use in high performance mirrors, while minimizing many of their weaknesses.

Vudler, Vladimir↗

Z-1 Prototype Space Suit Testing Summary

The Advanced Space Suit team of the NASA-Johnson Space Center performed a series of test with the Z-1 prototype space suit in 2012. This paper discusses, at a summary level, the tests performed and results from those tests. The purpose of the tests were two -fold: 1) characterize the suit performance so that the data could be used in the downselection of components for the Z -2 Space Suit and 2) develop interfaces with the suitport and exploration vehicles through pressurized suit evaluations. Tests performed included isolated and functional range of motion data capture, Z-1 waist and hip testing, joint torque testing, CO2 washout testing, fit checks and subject familiarizations, an exploration vehicle aft deck and suitport controls interface evaluation, delta pressure suitport tests including pressurized suit don and doff, and gross mobility and suitport ingress and egress demonstrations in reduced gravity. Lessons learned specific to the Z -1 prototype and to suit testing techniques will be presented.

Ross, Amy J.↗

Analog Exercise Hardware to Implement a High Intensity Exercise Program During Bed Rest

Background: In order to evaluate novel countermeasure protocols in a space flight analog prior to validation on the International Space Station (ISS), NASA's Human Research Program (HRP) is sponsoring a multi-investigator bedrest campaign that utilizes a combination of commercial and custom-made exercise training hardware to conduct daily resistive and aerobic exercise protocols. This paper will describe these pieces of hardware and how they are used to support current bedrest studies at NASA's Flight Analog Research Unit in Galveston, TX. Discussion: To implement candidate exercise countermeasure studies during extended bed rest studies the following analog hardware are being utilized: Stand alone Zero-Gravity Locomotion Simulator (sZLS) -- a custom built device by NASA, the sZLS allows bedrest subjects to remain supine as they run on a vertically-oriented treadmill (0-15 miles/hour). The treadmill includes a pneumatic subject loading device to provide variable body loading (0-100%) and a harness to keep the subject in contact with the motorized treadmill to provide a ground reaction force at their feet that is quantified by a Kistler Force Plate. Supine Cycle Ergometer -- a commercially available supine cycle ergometer (Lode, Groningen, Netherlands) is used for all cycle ergometer sessions. The ergometer has adjustable shoulder supports and handgrips to help stabilize the subject during exercise. Horizontal Squat Device (HSD) -- a custom built device by Quantum Fitness Corp (Stafford, TX), the HSD allows for squat exercises to be performed while lying in a supine position. The HSD can provide 0 to 600 pounds of force in selectable 5 lb increments, and allows hip translation in both the vertical and horizontal planes. Prone Leg Curl -- a commercially available prone leg curl machine (Cybex International Inc., Medway, MA) is used to complete leg curl exercises. Horizontal Leg Press -- a commercially available horizontal leg press (Quantum Fitness Corporation) is used for leg press and heel raise exercises. Minor modifications were made to the device including adding 200 lbs to the weight stack, raising the frame by 12 inches, making the footplate adjustable, and providing removable handles. Conclusion: A combination of novel and commercial exercise hardware are used to mimic the exercise hardware capabilities aboard the ISS, allowing scientific investigation of new countermeasure protocols in a space flight analog prior to flight validation

Loerch, Linda↗

Z-1 Prototype Space Suit Testing Summary

The Advanced Space Suit team of the NASA-Johnson Space Center performed a series of test with the Z-1 prototype space suit in 2012. This paper discusses, at a summary level, the tests performed and results from those tests. The purpose of the tests were two-fold: 1) characterize the suit performance so that the data could be used in the downselection of components for the Z-2 Space Suit and 2) develop interfaces with the suitport and exploration vehicles through pressurized suit evaluations. Tests performed included isolated and functional range of motion data capture, Z-1 waist and hip testing, joint torque testing, CO2 washout testing, fit checks and subject familiarizations, an exploration vehicle aft deck and suitport controls interface evaluation, delta pressure suitport tests including pressurized suit don and doff, and gross mobility and suitport ingress and egress demonstrations in reduced gravity. Lessons learned specific to the Z-1 prototype and to suit testing techniques will be presented.

Ross, Amy↗

X1: A Robotic Exoskeleton for In-Space Countermeasures and Dynamometry

Bone density loss and muscle atrophy are among the National Aeronautics and Space Administration's (NASA) highest concerns for crew health in space. Countless hours are spent maintaining an exercise regimen aboard the International Space Station (ISS) to counteract the effect of zero-gravity. Looking toward the future, NASA researchers are developing new compact and innovative exercise technologies to maintain crew health as missions increase in length and take humans further out into the solar system. The X1 Exoskeleton, initially designed for assisted mobility on Earth, was quickly theorized to have far-reaching potential as both an in-space countermeasures device and a dynamometry device to measure muscle strength. This lower-extremity device has the ability to assist or resist human movement through the use of actuators positioned at the hips and knees. Multiple points of adjustment allow for a wide range of users, all the while maintaining correct joint alignment. This paper discusses how the X1 Exoskeleton may fit NASA's onorbit countermeasures needs.

Rea, Rochelle↗

Next-Generation MKIII Lightweight HUT/Hatch Assembly

The MK III (H-1) carbon-graphite/ epoxy Hard Upper Torso (HUT)/Hatch assembly was designed, fabricated, and tested in the early 1990s. The spacesuit represented an 8.3 psi (≈58 kPa) technology demonstrator model of a zero prebreathe suit. The basic torso shell, brief, and hip areas of the suit were composed of a carbon-graphite/epoxy composite lay-up. In its current configuration, the suit weighs approximately 120 lb (≈54 kg). However, since future planetary suits will be designed to operate at 0.26 bar (≈26 kPa), it was felt that the suit's re-designed weight could be reduced to 79 lb (≈35 kg) with the incorporation of lightweight structural materials. Many robust, lightweight structures based on the technologies of advanced honeycomb materials, revolutionary new composite laminates, metal matrix composites, and recent breakthroughs in fullerene fillers and nanotechnology lend themselves well to applications requiring materials that are both light and strong. The major problem involves the reduction in weight of the HUT/ Hatch assembly for use in lunar and/or planetary applications, while at the same time maintaining a robust structural design. The technical objective is to research, design, and develop manufacturing methods that support fa b rica - tion of a lightweight HUT/Hatch assembly using advanced material and geometric redesign as necessary. Additionally, the lightweight HUT/Hatch assembly will interface directly with current MK III hardware. Using the new operating pressure and current MK III (H-1) interfaces as a starting block, it is planned to maximize HUT/Hatch assembly weight reduction through material selection and geometric redesign. A hard upper torso shell structure with rear-entry closure and corresponding hatch will be fabricated. The lightweight HUT/Hatch assembly will retrofit and interface with existing MK III (H-1) hardware elements, providing NASA with immediate "plug-andplay" capability. NASA crewmembers will have a lightweight, robust, life-support system that will minimize fatigue during extraterrestrial surface sojourns. Its unique feature is the utilization of a new and innovative family of materials used by the aerospace industry, which at the time of this reporting has not been used for the proposed application.

McCarthy, Mike↗

TBS (Trabecular Bone Score) Expands Understanding of Spaceflight Effects on the Lumbar Spine of Long Duration Astronauts

Background: Bone loss due to long-duration spaceflight has been characterized by both DXA and QCT serial scans. It is unclear if these spaceflight-induced changes in bone mineral density and structure result in increased fracture incidence. NASA astronauts currently fly on 5-6-month missions on the International Space Station (ISS) and at least one 12-month mission is planned. While NASA has measured areal BMD (by DXA) and volumetric BMD (by QCT), and has estimated hip strength (by finite element models of QCT data, no method has yet been used to examine bone microarchitecture from lumbar spine (LS). DXA scans are routinely performed pre- and post-flight on all ISS astronauts to follow BMD changes associated with space flight. Trabecular Bone Score (TBS) is a relatively new method that measures grey-scale-level texture information extracted from lumbar spine DXA images and correlates with 3D parameters of bone micro-architecture. We evaluated the ability of LS TBS to discriminate changes in astronauts who have flown on ISS missions and to determine if TBS can provide additional information compared to DXA. Methods: LS (L1-4) DXA scans from 51 astronauts (mean age, 47 +/- 4) were divided into 3 groups based on the exercise regimes performed while onboard the ISS. Pre-ARED (exercise using a load-limited resistive exercise device, <300lb), ARED (exercise with a high-load resistive exercise device, up to 600lb) and a Bisphos group (ARED exercise and a 70-mg alendronate tablet once a week before and during flight, starting 17 days before launch). DXA scans were performed and analyzed on a Hologic Discovery W using the same technician for the pre- and postflight scans. LSC for the LS in our laboratory is 0.025 g/cm2. TBS was performed at the Mercy Hospital, Cincinnati, Ohio on a similar Hologic computer. TBS precision was calculated from 16 comparable test subjects (0.0XX g/cm2). Data were preliminary analyzed using a paired, 2-tailed t-test for the difference between pre- and postflight means.

Sibonga, Jean D.↗

The Digital Astronaut Project Computational Bone Remodeling Model (Beta Version) Bone Summit Summary Report

Under the conditions of microgravity, astronauts lose bone mass at a rate of 1% to 2% a month, particularly in the lower extremities such as the proximal femur [1-3]. The most commonly used countermeasure against bone loss in microgravity has been prescribed exercise [4]. However, data has shown that existing exercise countermeasures are not as effective as desired for preventing bone loss in long duration, 4 to 6 months, spaceflight [1,3,5,6]. This spaceflight related bone loss may cause early onset of osteoporosis to place the astronauts at greater risk of fracture later in their lives. Consequently, NASA seeks to have improved understanding of the mechanisms of bone demineralization in microgravity in order to appropriately quantify this risk, and to establish appropriate countermeasures [7]. In this light, NASA's Digital Astronaut Project (DAP) is working with the NASA Bone Discipline Lead to implement well-validated computational models to help predict and assess bone loss during spaceflight, and enhance exercise countermeasure development. More specifically, computational modeling is proposed as a way to augment bone research and exercise countermeasure development to target weight-bearing skeletal sites that are most susceptible to bone loss in microgravity, and thus at higher risk for fracture. Given that hip fractures can be debilitating, the initial model development focused on the femoral neck. Future efforts will focus on including other key load bearing bone sites such as the greater trochanter, lower lumbar, proximal femur and calcaneus. The DAP has currently established an initial model (Beta Version) of bone loss due to skeletal unloading in femoral neck region. The model calculates changes in mineralized volume fraction of bone in this segment and relates it to changes in bone mineral density (vBMD) measured by Quantitative Computed Tomography (QCT). The model is governed by equations describing changes in bone volume fraction (BVF), and rates of changes in bone cell populations that remove and replace bone in packets within the bone region. The DAP bone model is unique in several respects. In particular in takes former models of volume fraction changes one step higher in fidelity and separates BVF into separate equations for mineralized and osteoid volume fractions governed by a mineralization rate. This more closely follows the physiology of the remodeling unit cycles where bone is first resorbed and then followed by the action of osteoblasts to lay down collagen matrix which eventually becomes mineralized. In another respect, the modules allow the functional description of the time rate of change of other parameters and variables in the model during a computational simulation. More detailed description of the model, preliminary validation results, current limitation and caveats, and planned advancements are provided in sections 2 through 5. The DAP bone model is being developed primarily as a research tool, and not as a clinical tool like QCT. Even if it transitions to a clinical tool, it is not intended to replace QCT or any other clinical tool. Moreover, the DAP bone model does not predict bone fracture. Its purpose is to provide valuable additional data via "forward prediction" simulations for during and after spaceflight missions to gain insight on, (1) mechanisms of bone demineralization in microgravity, and (2) the volumetric changes at the various bone sites in response to in-flight and post-flight exercise countermeasures. This data can then be used as input to the Keyak [8] (or equivalent) FE analysis method to gain insight on how bone strength may change during and after flight. This information can also be useful to help optimize exercise countermeasure protocols to minimize changes in bone strength during flight, and improve regain of bone strength post-flight. To achieve this goal, the bone model will be integrated with DAP's exercise countermeasure models to simulate the effect of exercise prescriptions on preserving bone. More specifically, the model will accept loading history due to muscle and joint force on bone and produce quantified remodeling within the bone region under influence of the applied stress. Furthermore, because they tend to respond differently, the bone remodeling model includes both trabecular bone and cortical bone.

Pennline, James↗

Biomechanics of the Treadmill Locomotion on the International Space Station

Exercise prescriptions completed by International Space Station (ISS) crewmembers are typically based upon evidence obtained during ground-based investigations, with the assumption that the results of long-term training in weightlessness will be similar to that attained in normal gravity. Coupled with this supposition are the assumptions that exercise motions and external loading are also similar between gravitational environments. Normal control of locomotion is dependent upon learning patterns of muscular activation and requires continual monitoring of internal and external sensory input [1]. Internal sensory input includes signals that may be dependent on or independent of gravity. Bernstein hypothesized that movement strategy planning and execution must include the consideration of segmental weights and inertia [2]. Studies of arm movements in microgravity showed that individuals tend to make errors but that compensation strategies result in adaptations, suggesting that control mechanisms must include peripheral information [3-5]. To date, however, there have been no studies examining a gross motor activity such as running in weightlessness other than using microgravity analogs [6-8]. The objective of this evaluation was to collect biomechanical data from crewmembers during treadmill exercise before and during flight. The goal was to determine locomotive biomechanics similarities and differences between normal and weightless environments. The data will be used to optimize future exercise prescriptions. This project addresses the Critical Path Roadmap risks 1 (Accelerated Bone Loss and Fracture Risk) and 11 (Reduced Muscle Mass, Strength, and Endurance). Data were collected from 7 crewmembers before flight and during their ISS missions. Before launch, crewmembers performed a single data collection session at the NASA Johnson Space Center. Three-dimensional motion capture data were collected for 30 s at speeds ranging from 1.5 to 9.5 mph in 0.5 mph increments with a 12-camera system. During flight, each crewmember completed up to 6 data collection sessions spread across their missions, performing their normal exercise prescription for the test day, resulting in varying data collection protocols between sessions. Motion data were collected by a single HD video camera positioned to view the crewmembers' left side, and tape markers were placed on their feet, legs, and neck on specific landmarks. Before data collection, the crewmembers calibrated the video camera. Video data were collected during the entire exercise session at 30 Hz. Kinematic data were used to determine left leg hip, knee, and ankle range of motion and contact time, flight time, and stride time for each stride. 129 trials in weightlessness were analyzed. Mean time-normalized strides were found for each trial, and cross-correlation procedures were used to examine the strength and direction of relationships between segment movement pattern timing in each gravitational condition. Cross-correlation analyses between gravitational conditions revealed highly consistent movement patterns at each joint. Peak correlation coefficients occurred at 0% phase, indicating there were no lags in movement timing. Joint ranges of motion were similar between gravitational conditions, with some slight differences between subjects. Motion patterns in weightlessness were highly consistent at a given speed with those occurring in 1G, indicating that despite differing sensory input, subjects maintain running kinematics. The data suggest that individuals are capable of compensating for loss of limb weight when creating movement strategies. These results have important implications for creating training programs for use in weightlessness as practitioners can have greater confidence in running motions transferring across gravitational environments. Furthermore, these results have implications for use by researchers investigating motor control mechanisms and investigating hypotheses related to movement strategies when using sensory input that is dependent upon gravity.

DeWitt, John↗

Expanding the Description of Spaceflight Effects beyond Bone Mineral Density [BMD]: Trabecular Bone Score [TBS] in ISS Astronauts

Dual-energy x-ray absorptiometry [DXA] is the widely-applied bone densitometry method used to diagnose osteoporosis in a terrestrial population known to be at risk for age-related bone loss. This medical test, which measures areal bone mineral density [aBMD] of clinically-relevant skeletal sites (e.g., hip and spine), helps the clinician to identify which persons, among postmenopausal women and men older than 50 years, are at high risk for low trauma or fragility fractures and might require an intervention. The most recognized osteoporotic fragility fracture is the vertebral compression fracture which can lead to kyphosis or hunched backs typically seen in the elderly. DXA measurement of BMD however is recognized to be insufficient as a sole index for assessing fracture risk. DXA's limitation may be related to its inability to monitor changes in structural parameters, such as trabecular vs. cortical bone volumes, bone geometry or trabecular microarchitecture. Hence, in order to understand risks to human health and performance due to space exposure, NASA needs to expand its measurements of bone to include other contributors to skeletal integrity. To this aim, the Bone and Mineral Lab conducted a pilot study for a novel measurement of bone microarchitecture that can be obtained by retrospective analysis of DXA scans. Trabecular Bone Score (TBS) assesses changes to trabecular microarchitecture by measuring the grey color "texture" information extracted from DXA images of the lumbar spine. An analysis of TBS in 51 ISS astronauts was conducted to assess if TBS could detect 1) an effect of spaceflight and 2) a response to countermeasures independent of DXA BMD. In addition, changes in trunk body lean tissue mass and in trunk body fat tissue mass were also evaluated to explore an association between body composition, as impacted by ARED exercise, and bone microarchitecture. The pilot analysis of 51 astronaut scans of the lumbar spine suggests that, following an ISS mission, DXA BMD and TBS are detecting different effects of ARED exercise and of ARED + Bisphosphonate on the lumbar spine of astronauts. There is emerging evidence associating reduced TBS with terrestrial metabolic bone disorders where a TBS <1.200 is associated with "degraded" while > 1.350 is associated with "normal." However, it is not possible to conclude how the spaceflight-induced changes in TBS increase risk for vertebral fractures in the astronaut or if changes in body composition of the trunk region could be an indirect method of assessing exercise effect on bone microarchitecture. More importantly, this pilot analysis demonstrates a new, minimal risk approach for monitoring changes to vertebral bone microarchitecture. This method could help assess the combined skeletal effects of spaceflight with the effects of aging in the astronaut after return to Earth.

Sibonga, J. D.↗

TBS (Trabecular Bone Score) Expands Understanding of Spaceflight Effects on the Lumbar Spine of Long-Duration Astronauts

Bone loss due to long‐duration spaceflight has been characterized by both DXA and QCT serial scans. It is unclear if these spaceflight‐induced changes in bone mineral density (BMD) and structure result in increased fracture incidence. NASA astronauts currently fly 5 to 6‐month missions on the International Space Station (ISS) and at least one 12‐month mission is planned. While NASA has measured areal BMD (by DXA) and volumetric BMD (by QCT) and has estimated hip strength (by finite element models of QCT data, no method has yet been used to examine bone micro‐architecture from lumbar spine (LS). DXA scans are routinely performed pre‐ and postflight on all ISS astronauts to follow BMD changes associated with spaceflight. Trabecular Bone Score (TBS) is a relatively new method that measures grey‐scale‐level texture information extracted from LS DXA images and correlates with 3D parameters of bone micro‐architecture. We evaluated the ability of LS TBS to discriminate changes in astronauts who have flown on ISS missions and to determine if TBS can provide additional information compared to DXA. Methods: Lumbar Spine (L1‐4) DXA scans from 51 astronauts (mean age, 47 +/- 4 yrs) were divided into 3 groups based on the exercise regimens performed onboard the ISS. "Pre‐ARED" (exercise using a load‐limited resistive exercise device, <300 lb), "ARED" (exercise with a high‐load resistive exercise device, up to 600 lb) and "Bisphos+ARED" group (ARED exercise and a 70‐mg alendronate tablet once a week before and during flight, starting 17 days before launch). DXA scans were performed and analyzed on a Hologic Discovery W using the same technician for the pre‐ and post‐flight scans. LSC for the LS in our laboratory is 0.025 g/sq. cm. TBS was performed at the Mercy Hospital, Cincinnati, Ohio on a similar Hologic computer. Data were analyzed using a paired, 2‐tailed Student's t‐test for the difference between pre‐ and postflight means. Percent change and % change per month are noted. Interpretation: Our data suggest that: TBS and DXA both detected significant decrements in the LS in these pre‐ ARED astronauts, not unexpected given the insufficient loads provided by this early exercise device. TBS did not detect significant changes in the ARED or Bisphos+ARED groups while DXA did detect significant changes in the ARED astronauts. These findings suggest that DXA and TBS are detecting independent effects of bone loss interventions tested in ISS astronauts in space, which may be due to distinct effects of interventions on mineral content of separate cortical vs. trabecular bone. Conclusion: TBS, in conjunction with DXA BMD, may provide additional insight into the nature of changes (or lack thereof) in the microstructure of trabecular bone and the areal BMD of vertebral bodies.

Smith, Scott A.↗

A Computational Model for Simulating Spaceflight Induced Bone Remodeling

An overview of an initial development of a model of bone loss due to skeletal unloading in weight bearing sites is presented. The skeletal site chosen for the initial application of the model is the femoral neck region because hip fractures can be debilitating to the overall performance health of astronauts. The paper begins with the motivation for developing such a model of the time course of change in bone in order to understand the mechanism of bone demineralization experienced by astronauts in microgravity, to quantify the health risk, and to establish countermeasures. Following this, a general description of a mathematical formulation of the process of bone remodeling is discussed. Equations governing the rate of change of mineralized bone volume fraction and active osteoclast and osteoblast are illustrated. Some of the physiology of bone remodeling, the theory of how imbalance in remodeling can cause bone loss, and how the model attempts to capture this is discussed. The results of a preliminary validation analysis that was carried out are presented. The analysis compares a set of simulation results against bone loss data from control subjects who participated in two different bed rest studies. Finally, the paper concludes with outlining the current limitations and caveats of the model, and planned future work to enhance the state of the model.

Pennline, James A.↗

Quantification of In-flight Physical Changes: Anthropometry and Neutral Body Posture

Currently, NASA does not have sufficient in-flight anthropometric data gathered to assess the impact of physical body shape and size changes on suit sizing. For developing future planetary and reduced gravity suits, NASA needs to quantify the impacts of microgravity on anthropometry, body posture, and neutral body postures (NBP) to ensure optimal crew performance, fit, and comfort. To obtain these impacts, anthropometric data, circumference, length, height, breadth, and depth for body segments (i.e. chest, waist, bicep, thigh, calf) from astronauts for pre, in-, and postflight conditions needs to be collected. Once this data has been collected, a comparison between pre, in-, and postflight anthropometric values will be analyzed, yielding microgravity factors. The NBP will be used to determined body posture (joint angle) changes between subjects throughout the duration of a mission. Data collection, starting with Increments 37/38, is still in progress with the completion of 3 out of 12 subjects. NASA suit engineers and NASA's Extravehicular Activity (EVA) Project Office have identified that suit fit in microgravity could become an issue. It has been noted that crewmembers often need to adjust their suit sizing once they are in orbit. This adjustment could be due to microgravity effects on anthropometry and postural changes, and is necessary to ensure optimal crew performance, fit, and comfort in space. To date, the only data collected to determine the effects of microgravity on physical human changes have been during Skylab, STS-57, and a recent HRP study on seated height changes due to spinal elongation (Spinal Elongation, Master Task List [MTL] #221). The Skylab and the STS-57 studies found that there is a distinct neutral body posture (NBP) based on photographs. The still photographs showed that there is a distinguishable posture with the arms raised and the shoulder abducted; and, in addition, the knees were flexed with noticeable hip flexion and the foot plantar flexed [1,2]. This is the one standard set of body joint angles for a NBP in microgravity. A recent simulated microgravity NBP study [3] has shown an individual variability and inconsistencies in defining NBP. This variation may be influenced by spinal growth, the type of suit fit, and other potential anthropometry factors such as spinal curvature, age, and gender. The variation aspect of this essential data is required for all kinds of space device designs (e.g. suits, habitat, mobility aids, etc.). The method proposed considers the dynamic nature of body movement and will use a measurement technique to continually monitor posture and develop a probability likelihood of the natural posture and how the NBP postures are affected by anthropometry. Additionally, Skylab studies found that crewmembers experienced a stature growth of up to 3%. The data included 3 crewmembers that showed that there is a bi-phasic stature growth once the crew enters into weightlessness. However, the Spinal Elongation study identified that the crewmembers could experience about a 6% growth in seated height and a 3% stature growth, when exposed to microgravity. The results prove that not all anthropometric measurements have the same microgravity percent growth factor. For EVA and suit engineers to properly update the sizing protocol for microgravity, they need additional anthropometric data from space missions. Hence, this study is aimed to gather additional in-flight anthropometric measurements, such as length, depth, breadth, and circumference, to determine the changes to body shape and size due to microgravity effects. It is anticipated that by recording the potential changes to body shape and size, a better suit sizing protocol will be developed for ISS and other space missions. In essence, this study will help NASA quantify the impacts of microgravity on anthropometry to ensure optimal crew performance, fit, and comfort. This study will use simplistic data collection techniques, 3D laser scanning, digital still, and video data, and perform photogrammetric analyses to determine the changes that occur to the body shape, size, and NBP when exposed to a microgravity environment.

Young, K. S.↗