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Proceedings from the 2001 NASA Occupational Health Conference: Risk Assessment and Management in 2001

This Conference convened approximately 86 registered participants of invited guest speakers, NASA presenters, and a broad spectrum of the Occupational Health disciplines representing NASA Headquarters and all NASA Field Centers. Two days' Professional Development Courses on Exposure Assessment Strategies and Statistics and on Advanced Cardiac Life Support training and recertification preceded the Conference. With the theme, 'Risk Assessment and Management in 2001,' conferees were first provided updates from the Program Principal Center Office and the Headquarters Office. Plenary sessions elaborated on several topics: biological terrorism, OSHA recordability, Workers' Compensation issues, Federal ergonomic standards, bridging aerospace medicine and occupational health-especially in management of risk in spaceflight, and EAP operations with mission failures. A keynote address dealt with resiliency skills for 21st century workers and two NASA astronaut speakers highlighted a tour of the Johnson Space Center. During discipline specific breakout sessions, current issues in occupational health management and policy, credentialing and privileging, health risk assessment, measurement and standardization, audits, database development, prevention and rehabilitation, international travel and infection control, employee assistance, nursing process, and environmental health were presented.

Roberson, Sheri↗

Biomedical Use of Aerospace Personal Cooling Garments

Personal thermoregulatory systems are required during extravehicular activity (EVA) to remove the metabolic heat generated by the suited astronaut. The Extravehicular and Protective Systems (STE) Branch of NASA Ames Research Center has developed advanced concepts or liquid cooling garments for both industrial and biomedical applications for the past 25 years. Examples of this work include: (1) liquid cooled helmets for helicopter pilots and race car drivers; (2) vests for fire and mine rescue personnel; (3) bras to increase the definition of tumors during thermography; (4) lower body garments for young women with erythomelaigia; and (5) whole body garments used by patients with multiple sclerosis (MS). The benefits of the biomedical application of artificial thermoregulation received national attention through two recent events: (1) the liquid-cooled garment technology was inducted into the United States Space Foundation's Space Technology Hall of Fame (1993); and (2) NASA has signed a joint Memorandum of Understanding with the Multiple Sclerosis Association (1994) to share this technology for use with MS patient treatment. The STE Branch is currently pursuing a program to refine thermoregulatory design in light of recent technology developments that might be applicable for use by several medical patient populations. Projects have been initiated to apply thermoregulatory technology for the treatment and/or rehabilitation of patients with spinal cord injuries, multiple sclerosis, migraine headaches, and to help prevent the loss of hair during chemotherapy.

Webbon, Bruce W.↗

Entrepreneurial Aspirations

Recom Technologies, Inc., was established in 1980 by Jack Lee, a former NASA contractor. After forming the new company, Recom was awarded NASA contracts, which eventually grew to 50 percent of the company's business. Two companies have spun-off from Recom, both of which have their basis in NASA technology. The first is Attention Control Systems, Inc. with utilizes intelligent planning software that Recom developed for NASA Ames Computational Sciences Division in a hand-held planner used as an aid in cognitive rehabilitation of brain injury patients. The second is MiraNet, Inc. who uses CLIPS as the foundation for WEXpert, the first rules based help system on the Web.

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Sit Up Straight

BioMetric Systems has an exclusive license to the Posture Video Analysis Tool (PVAT) developed at Johnson Space Center. PVAT uses videos from Space Shuttle flights to identify limiting posture and other human factors in the workplace that could be limiting. The software also provides data that recommends appropriate postures for certain tasks and safe duration for potentially harmful positions. BioMetric Systems has further developed PVAT for use by hospitals, physical rehabilitation facilities, insurance companies, sports medicine clinics, oil companies, manufacturers, and the military.

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Monitoring on the Move

The MyoMonitor EMG system was developed by Delsys, Inc. under SBIR funding from Johnson Space Center. It is a wearable four-channel device that can monitor muscle performance. Presently, its application include rehabilitative therapy, injury prevention, sports medicine, exercise training, and various other muscle monitoring activities. The MyoMonitor uses a two-bar single differential electrode. Due to the electrode-skin interface in traditional EMG equipment, during rigorous muscular activity, the movement of the skin causes the electrode detection surfaces to become compromised. The MyoMonitor eliminates this problem, enabling a wide array of applications and experiments during intense muscular activity. The ability to make such recordings, for example, enables novel experiments aboard the International Space Station for investigating the effect of microgravity on muscle performance. Product still commercially available as of March 2002.

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Cardio-Muscular Conditioner

In the mid-sixties, Gary Graham, a Boeing designer, developed a cardiovascular conditioner for a planned Air Force orbiting laboratory. After the project was cancelled, Graham participated in space station conditioning studies for the Skylab program. Twenty years later, he used this expertise to develop the Shuttle 2000-1, a physical therapy and athletic development conditioner, available through Contemporary Designs. The machine is used by football teams, sports clinics and medical rehabilitation centers. Cardiovascular fitness and muscular strength development are promoted through both kinetic and plyometric exercises.

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Orthopaedic Footwear Design

Although the need for orthopaedic shoes is increasing, the number of skilled shoemakers has declined. This has led to the development of a CAD/CAM system to design and fabricate, orthopaedic footwear. The NASA-developed RIM database management system is the central repository for CUSTOMLAST's information storage. Several other modules also comprise the system. The project was initiated by Langley Research Center and Research Triangle Institute in cooperation with the Veterans Administration and the National Institute for Disability and Rehabilitation Research. Later development was done by North Carolina State University and the University of Missouri-Columbia. The software is licensed by both universities.

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Balance System

TherEx Inc.'s AT-1 Computerized Ataxiameter precisely evaluates posture and balance disturbances that commonly accompany neurological and musculoskeletal disorders. Complete system includes two-strain gauged footplates, signal conditioning circuitry, a computer monitor, printer and a stand-alone tiltable balance platform. AT-1 serves as assessment tool, treatment monitor, and rehabilitation training device. It allows clinician to document quantitatively the outcome of treatment and analyze data over time to develop outcome standards for several classifications of patients. It can evaluate specifically the effects of surgery, drug treatment, physical therapy or prosthetic devices.

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Thermal Video Systems

Hughes Aircraft Corporation's Probeye Model 3300 Thermal Video System consists of tripod mounted infrared scanner that detects the degree of heat emitted by an object and a TV monitor on which results are displayed. Latest addition to Hughes line of infrared medical applications can detect temperature variations as fine as one-tenth of a degree centigrade. Thermography, proving to be a valuable screening tool in diagnosis, can produce information to preclude necessity of performing more invasive tests that may be painful and hazardous. Also useful in verifying a patient's progress through therapy and rehabilitation.

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Offsetting Gravity

The Coastal Center and the NASA Biomedical Team are working together to adapt a suspension device that simulates weightlessness. Attempts to approximate weightlessness have led astronauts underwater and into harnesses that suspend all or part of their weight. One such device, built at Langley Research Center, is being transferred to rehabilitation work. It can help a person walk and re-learn muscular coordination following a stroke. Hospitals could use it to lift handicapped persons.

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Recovery After Prolonged Bed-Rest Deconditioning

Recovery data were analyzed from normal healthy test subjects maintained in the horizontal or head-down body position in well-controlled bed rest (BR) studies in which adherence to the well-designed protocol was monitored. Because recovery data were almost always of secondary importance to the data collected during the BR period, there was little consistency in the recovery experimental designs regarding control factors (e.g., diet or exercise), duration, or timing of data collection. Thus, only about half of the BR studies that provided appropriate data were analyzed here. These recovery data were sorted into two groups: those from BR protocols of less than 37 days, and those from protocols greater than 36 days. There was great disparity in the unchanged responses at the end of BR in these two groups. Likewise with the variables that required more than 40 days for recovery; for example, some immune variables required more than 180 days. Knowledge of the recovery process after BR in healthy people should assist rehabilitation workers in differentiating "healthy" BR recovery responses from those of the infirmity of sick or injured patients; this should result in more appropriate and efficient health care.

Greenleaf, John E.↗

The Effect of Spaceflight on the Ultrastructure of the Cerebellum

In weightlessness, astronauts and cosmonauts may experience postural illusions as well as motion sickness symptoms known as the space adaptation syndrome. Upon return to Earth, they have irregularities in posture and balance. The adaptation to microgravity and subsequent re-adaptation to Earth occurs over several days. At the cellular level, a process called neuronal plasticity may mediate this adaptation. The term plasticity refers to the flexibility and modifiability in the architecture and functions of the nervous system. In fact, plastic changes are thought to underlie not just behavioral adaptation, but also the more generalized phenomena of learning and memory. The goal of this experiment was to identify some of the structural alterations that occur in the rat brain during the sensory and motor adaptation to microgravity. One brain region where plasticity has been studied extensively is the cerebellar cortex-a structure thought to be critical for motor control, coordination, the timing of movements, and, most relevant to the present experiment, motor learning. Also, there are direct as well as indirect connections between projections from the gravity-sensing otolith organs and several subregions of the cerebellum. We tested the hypothesis that alterations in the ultrastructural (the structure within the cell) architecture of rat cerebellar cortex occur during the early period of adaptation to microgravity, as the cerebellum adapts to the absence of the usual gravitational inputs. The results show ultrastructural evidence for neuronal plasticity in the central nervous system of adult rats after 24 hours of spaceflight. Qualitative studies conducted on tissue from the cerebellar cortex (specifically, the nodulus of the cerebellum) indicate that ultrastructural signs of plasticity are present in the cerebellar zones that receive input from the gravity-sensing organs in the inner ear (the otoliths). These changes are not observed in this region in cagematched ground control animals. The specific changes include the formation of lamellar bodies, profoundly enlarged Purkinje cell mitochondria, the presence of inter-neuronal cellular protrusions in the molecular layer, and signs of degeneration in the distal dendrites of the Purkinje cells. Since these morphologic signs are not apparent in the control animals, they are not likely to be due to caging or tissue processing effects. The particular nature of the structural alterations in the nodulus, most notably the formation of lamellar bodies and the presence of degeneration, further suggests that excitotoxicity (damaging overstimulation of neurons) may play a role in the short-term neural response to spaceflight. These findings suggest a structural basis for the neuronal and synaptic plasticity accompanying the central nervous system response to altered gravity and help identify the cellular bases underlying the vestibular abnormalities experienced by astronauts during periods of adaptation and re-adaptation to different gravitational forces. Also, since the short- and long-term changes in neural structure occurring during such periods of adaptation resemble the neuronal alterations that occur in some neurologic disorders such as stroke, these findings may offer guidance in the development of strategies for rehabilitation and treatment of such disorders.

Holstein, Gay R.↗

Striding Towards Better Physical Therapy

This paper presents a discussion on a new rehabilitative device that promises to improve physical therapy for patients working to regain the ability to walk after facing traumatic injuries or a degenerative illness. Produced by Enduro Medical Technology, of East Hartford, Connecticut, the Secure Ambulation Module (S.A.M.) creates a stable and secure environment for patients as they stand during ambulation therapy.

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Physiology, medicine, long-duration space flight and the NSBRI

The hazards of long-duration space flight are real and unacceptable. In order for humans to participate effectively in long-duration orbital missions or continue the exploration of space, we must first secure the health of the astronaut and the success of such missions by assessing in detail the biomedical risks of space flight and developing countermeasures to these hazards. Acquiring the understanding necessary for building a sound foundation for countermeasure development requires an integrated approach to research in physiology and medicine and a level of cooperative action uncommon in the biomedical sciences. The research program of the National Space Biomedical Research Institute (NSBRI) was designed to accomplish just such an integrated research goal, ameliorating or eliminating the biomedical risks of long-duration space flight and enabling safe and productive exploration of space. The fruits of these labors are not limited to the space program. We can also use the gained understanding of the effects and mechanisms of the physiological changes engendered in space and the applied preventive and rehabilitative methods developed to combat these changes to the benefit of those on Earth who are facing similar physiological and psychological difficulties. This paper will discuss the innovative approach the NSBRI has taken to integrated research management and will present some of the successes of this approach. c2003 International Astronautical Federation. Published by Elsevier Science Ltd. All rights reserved.

NASA Discipline General Space Life Sciences↗

What can posturography tell us about vestibular function?

Patients with balance disorders want answers to the following basic questions: (1) What is causing my problem? and (2) What can be done about my problem? Information to fully answer these questions must include status of both sensory and motor components of the balance control systems. Computerized dynamic posturography (CDP) provides quantitative assessment of both sensory and motor components of postural control along with how the sensory inputs to the brain interact. This paper reviews the scientific basis and clinical applications of CDP. Specifically, studies describing the integration of vestibular inputs with other sensory systems for postural control are briefly summarized. Clinical applications, including assessment, rehabilitation, and management are presented. Effects of aging on postural control along with prevention and management strategies are discussed.

NASA Discipline Neuroscience↗

Variable practice with lenses improves visuo-motor plasticity

Novel sensorimotor situations present a unique challenge to an individual's adaptive ability. Using the simple and easily measured paradigm of visual-motor rearrangement created by the use of visual displacement lenses, we sought to determine whether an individual's ability to adapt to visuo-motor discordance could be improved through training. Subjects threw small balls at a stationary target during a 3-week practice regimen involving repeated exposure to one set of lenses in block practice (x 2.0 magnifying lenses), multiple sets of lenses in variable practice (x 2.0 magnifying, x 0.5 minifying and up-down reversing lenses) or sham lenses. At the end of training, adaptation to a novel visuo-motor situation (20-degree right shift lenses) was tested. We found that (1) training with variable practice can increase adaptability to a novel visuo-motor situation, (2) increased adaptability is retained for at least 1 month and is transferable to further novel visuo-motor permutations and (3) variable practice improves performance of a simple motor task even in the undisturbed state. These results have implications for the design of clinical rehabilitation programs and countermeasures to enhance astronaut adaptability, facilitating adaptive transitions between gravitational environments.

NASA Discipline Neuroscience↗

Retraining the injured spinal cord

The present review presents a series of concepts that may be useful in developing rehabilitative strategies to enhance recovery of posture and locomotion following spinal cord injury. First, the loss of supraspinal input results in a marked change in the functional efficacy of the remaining synapses and neurons of intraspinal and peripheral afferent (dorsal root ganglion) origin. Second, following a complete transection the lumbrosacral spinal cord can recover greater levels of motor performance if it has been exposed to the afferent and intraspinal activation patterns that are associated with standing and stepping. Third, the spinal cord can more readily reacquire the ability to stand and step following spinal cord transection with repetitive exposure to standing and stepping. Fourth, robotic assistive devices can be used to guide the kinematics of the limbs and thus expose the spinal cord to the new normal activity patterns associated with a particular motor task following spinal cord injury. In addition, such robotic assistive devices can provide immediate quantification of the limb kinematics. Fifth, the behavioural and physiological effects of spinal cord transection are reflected in adaptations in most, if not all, neurotransmitter systems in the lumbosacral spinal cord. Evidence is presented that both the GABAergic and glycinergic inhibitory systems are up-regulated following complete spinal cord transection and that step training results in some aspects of these transmitter systems being down-regulated towards control levels. These concepts and observations demonstrate that (a) the spinal cord can interpret complex afferent information and generate the appropriate motor task; and (b) motor ability can be defined to a large degree by training.

NASA Discipline Musculoskeletal↗

Is skeletal muscle ready for long-term spaceflight and return to gravity?

It is now clear that prevention of muscle debilitation during spaceflight will require a broader approach than simple exercise aimed at strengthening of the muscle fibers. The levels of several hormones and receptors are altered by unloading and must be returned to homeostasis. Pharmacotherapy and gene transfer strategies to raise the relative level of structural proteins may minimize the problems faced by astronauts in readapting to Earth-gravity. Up to now, we have only minimally exploited microgravity for advancing our understanding of muscle biology. A research laboratory in the space station with a centrifuge facility (gravity control) is essential for conducting basic research in this field. Microgravity has proven an excellent tool for noninvasively perturbing the synthesis of muscle proteins in the search for molecular signals and gene regulatory factors influencing differentiation, growth, maintenance and atrophy of muscle. Understanding the relation between blood flow and interstitial edema and between workload and subsequent structural failure are but two important problems that require serious attention. The roles of hormones and growth factors in regulating gene expression and their microgravity-induced altered production are other urgent issues to pursue. These types of studies will yield information that advances basic knowledge of muscle biology and offers insights into countermeasure design. This knowledge is likely to assist rehabilitation of diseased or injured muscles in humans on Earth, especially individuals in the more vulnerable aging population and persons participating in strenuous sports. Will the skeletal muscle system be prepared for the increased exposure to microgravity and the return to gravity loading without injury when space station is operational? The answer depends in large part on continued access to space and funding of ground-based models and flight experiments. The previous two decades of spaceflight research have described the effects of microgravity on multiple systems. The next generation of experiments promises to be even more exciting as we are challenged to define the cellular and molecular mechanisms of microgravity-induced changes.

manned↗