Stretch Reflex as a Simple Measure to Evaluate the Efficacy of Potential Flight Countermeasures Using the Bed Rest Environment

INTRODUCTION: Spaceflight is acknowledged to have significant effects on the major postural muscles. However, it has been difficult to separate the effects of ascending somatosensory changes caused by the unloading of these muscles during flight from changes in sensorimotor function caused by a descending vestibulo-cerebellar response to microgravity. It is hypothesized that bed rest is an adequate model to investigate postural muscle unloading given that spaceflight and bed rest may produce similar results in both nerve axon and muscle tissue. METHODS: To investigate this hypothesis, stretch reflexes were measured on 18 subjects who spent 60 to 90 days in continuous 6 head-down bed rest. Using a motorized system capable of rotating the foot around the ankle joint (dorsiflexion) through an angle of 10 deg at a peak velocity of approximately 250 deg/sec, a stretch reflex was recorded from the subject's left triceps surae muscle group. Using surface electromyography, about 300 reflex responses were obtained and ensemble-averaged on 3 separate days before bed rest, 3 to 4 times in bed, and 3 times after bed rest. The averaged responses for each test day were examined for reflex latency and conduction velocity (CV) across gender and compared with spaceflight data. RESULTS: Although no gender differences were found, bed rest induced changes in reflex latency and CV similar to the ones observed during spaceflight. Also, a relationship between CV and loss of muscle strength in the lower leg was observed for most bed rest subjects. CONCLUSION: Even though bed rest (limb unloading) alone may not mimic all of the synaptic and muscle tissue loss that is observed as a result of spaceflight, it can serve as a working analog of flight for the evaluation of potential countermeasures that may be beneficial in mitigating unwanted changes in the major postural muscles that are observed post flight

Walk on Floor Eyes Closed Test: A Unique Test of Spaceflight Induced Ataxia

Measurement and quantification of posture and locomotion following spaceflight is an evolving process. Based on the data obtained from the current investigation we believe that the walk on the floor line test with the eyes closed (WOFEC) provides a unique procedure for quantifying postflight ataxia. As a part of an ongoing investigation designed to look at functional changes in astronauts returning from spaceflight seven astronauts (5 short duration with flights of 12-16 days; 2 long duration crewmembers with flights of 6 months) were tested twice before flight, on landing day (short duration only), and 1, 6, and 30 days after flight. The WOFEC consisted of walking for 10 steps (repeated twice) with the feet heel to toe in tandem, arms folded across the chest and the eyes closed. The performance metric (scored by three examiners from video) was the percentage of correct steps completed over the three trials. A step was not counted as correct if the crewmember side-stepped, opened their eyes, or paused for more than three seconds between steps. The data reveled a significant decrease in percentage of correct steps on landing day (short duration crew) and on the first day following landing (long duration) with partial recovery the following day, and full recovery beginning on day sixth after flight. Both short and long duration fliers appeared to be unaware of foot position relative to their bodies or the floor. Postflight, deviation from a straight path was common, and seemed to be determined by the angle of foot placement relative to their body. While deviation from a straight line could be either left or right, primary deviations were observed to occur to the right. Furthermore, the test for two crewmembers elicited motion sickness symptoms. These data clearly demonstrate the sensorimotor challenges facing crewmembers after returning from spaceflight. The WOFEC test has value providing the investigator or crew surgeon with a simple method to quantify vestibular ataxia, as well as providing instant feedback of postural ataxia without the use of complex test equipment

Walk on Floor Eyes Closed Test as a Measure of Postflight Ataxia

INTRODUCTION: Astronauts returning from space flight universally exhibit impaired posture and locomotion. Measurement of this impairment is an evolving process. The walk on the floor line test with the eyes closed (WOFEC) provides a unique procedure for quantifying postflight ataxia. Data from a modified WOFEC were obtained as part of an ongoing NASA interdisciplinary pre- and postflight study (Functional Task Test, FTT) designed to evaluate astronaut postflight functional performance. METHODS: Seven astronauts (5 short duration with flights of 12-16 days; 2 long duration crewmembers with flights of 6 months) were tested twice before flight, on landing day (short duration only), and 1, 6, and 30 days after flight. The WOFEC consisted of walking for 10 steps (repeated twice) with the feet heel to toe in tandem, arms folded across the chest and the eyes closed. The performance metric (scored by three examiners from video) was the percentage of correct steps completed over the three trials. A step was not counted as correct if the crewmember sidestepped, opened their eyes, or paused for more than three seconds between steps. RESULTS/ CONCLUSIONS: There was a significant decrease in percentage of correct steps on landing day (short duration crew) and on first day following landing (long duration) with partial recovery the following day, and full recovery beginning on day sixth after flight. Both short and long duration fliers appeared to be unaware of foot position relative to their bodies or the floor. Postflight, deviation from a straight path was common, and the test for two crewmembers elicited motion sickness symptoms. These data clearly demonstrate the sensorimotor challenges facing crewmembers after returning from spaceflight. The WOFEC test has value providing the investigator or crew surgeon with a simple method to quantify vestibular ataxia, as well as providing instant feedback of postural ataxia without the use of complex test equipment

The Walk on Floor Eyes Closed Tandem Step Test as a Quantitative Measure of Ataxia After Space Flight

INTRODUCTION Posture and locomotion are among the functions most affected by space flight. Postflight ataxia can be quantified easily by using the walk on the floor line test with the eyes closed (WOFEC). Data from a modified WOFEC were obtained as part of an ongoing interdisciplinary pre- and postflight study (Functional Task Test, FTT) designed to evaluate both postflight functional performance of astronauts and related physiological changes. METHODS Five astronauts with flight durations of 12 to 16 days participated in this study. Performance measurements were obtained in 2 preflight sessions, on landing day, and 1, 6, and 30 days after landing. The WOFEC test consisted of walking with the feet placed heel to toe in tandem, arms folded across the chest and eyes closed, for 10 steps. A trial was initiated after the eyes were closed and the front foot was aligned with the rear foot. The performance metric was the average percentage of correct steps completed over 3 trials. A step was not counted as correct if the crewmember sidestepped, opened eyes, or paused for more than 3 seconds between steps. Step accuracy was scored independently by 3 examiners. RESULTS Immediately after landing subjects seemed to be unaware of their foot position relative to their body or the floor. The percentage of correct steps was significantly decreased on landing day. Partial recovery was observed the next day, and full recovery to baseline on the sixth day post landing. CONCLUSION These data clearly demonstrate the sensorimotor challenges facing crewmembers after they return from space flight. Although this simple test is intended to complement the FTT battery of tests, it has some stand-alone value as it provides investigators with a means to quantify vestibular ataxia as well as provide instant feedback on postural stability without the use of complex test equipment

Jump-Down Performance Alterations after Space Flight

INTRODUCTION: Successful jump performance requires functional coordination of visual, vestibular, and somatosensory systems, which are affected by prolonged exposure to microgravity. Astronauts returning from space flight exhibit impaired ability to coordinate effective landing strategies when jumping from a platform to the ground. This study compares jump strategies used by astronauts before and after flight, changes to those strategies within a test session, and recoveries in jump-down performance parameters across several postflight test sessions. These data were obtained as part of an ongoing interdisciplinary study (Functional Task Test, FTT) designed to evaluate both astronaut postflight functional performance and related physiological changes. METHODS: Seven astronauts from short-duration (Shuttle) and three from long-duration (International Space Station) flights performed 3 two-footed jumps from a platform 30 cm high onto a force plate that measured the ground reaction forces and center-of-pressure displacement from the landings. Neuromuscular activation data were collected from the medial gastrocnemius and anterior tibialis of both legs using surface electromyography electrodes. Two load cells in the platform measured the load exerted by each foot during the takeoff phase of the jump. Data were collected in 2 preflight sessions, on landing day (Shuttle only), and 1, 6, and 30 days after flight. RESULTS: Postural settling time was significantly increased on the first postflight test session and many of the astronauts tested were unable to maintain balance on their first jump landing but recovered by the third jump, showing a learning progression in which performance improvements could be attributed to adjustments in takeoff or landing strategy. Jump strategy changes were evident in reduced air time (time between takeoff and landing) and also in increased asymmetry in foot latencies on takeoff. CONCLUSIONS: The test results revealed significant decrements in astronauts abilities to maintain balance and achieve a postural stability upon landing from a jump early after flight. However, the jump landing adaptation process often begins after the first jump with full recovery of most performance parameters within days after space flight. As expected, performance of ISS astronauts on the first day after flight was similar to that of Shuttle crewmembers on landing day

Effects of Bed Rest on Conduction Velocity of the Triceps Surae Stretch Reflex and Postural Control

Despite rigorous exercise and nutritional management during space missions, astronauts returning from microgravity exhibit neuromuscular deficits and a significant loss in muscle mass in the postural muscles of the lower leg. Similar changes in the postural muscles occur in subjects participating in long-duration bed rest studies. These adaptive muscle changes manifest as a reduction in reflex conduction velocity during head-down bed rest. Because the stretch reflex encompasses both the peripheral (muscle spindle and nerve axon) and central (spinal synapse) components involved in adaptation to calf muscle unloading, it may be used to provide feedback on the general condition of neuromuscular function, and might be used to evaluate the effectiveness of countermeasures aimed at preserving muscle mass and function during periods of unloading. Stretch reflexes were measured on 18 control subjects who spent 60 to 90 days in continuous 6 deg head-down bed rest. Using a motorized system capable of rotating the foot around the ankle joint (dorsiflexion) through an angle of 10 degrees at a peak velocity of about 250 deg/sec, a stretch reflex was recorded from the subject's left triceps surae muscle group. Using surface electromyography, about 300 reflex responses were obtained and ensemble-averaged on 3 separate days before bed rest, 3 to 4 times in bed, and 3 times after bed rest. The averaged responses for each test day were examined for reflex latency and conduction velocity (CV) across gender. Computerized posturography was also conducted on these same subjects before and after bed rest as part of the standard measures. Peak-to-peak sway was measured during Sensory Organization Tests (SOTs) to evaluate changes in the ability to effectively use or suppress visual, vestibular, and proprioceptive information for postural control. Although no gender differences were found, a significant increase in reflex latency and a significant decrease in CV were observed during the bed rest period, with a return to baseline 3 to 5 days after bed rest, depending on the duration of bed rest. In addition, a relationship between CV and loss of muscle strength in the lower leg was observed post bed rest for most subjects. Immediately post-bed rest, most subjects showed decreased performance on SOTs, with the greater decrements on sway-referenced support and head movement conditions. Post-bed rest decrements were less than typically observed following spaceflight. Decrements in postural control and the stretch reflex can be primarily attributed to the unloading mechanisms this ground-based analog provides. The stretch reflex is a concise test measurement that can be obtained during the head-down phase of bed rest, as it does not interfere with the bed rest paradigm. This makes it an ideal tool that can detect, early on, whether a countermeasure is successful in preserving muscle function

Functional Sensory-Motor Performance Following Long Term Space Flight: The First Results of "Field Test" Experiment

The effect that extended-duration space flights may have on human space travelers, including exploration missions, is widely discussed at the present time. Specifically, there is an increasing amount of evidence showing that the physical capacity of cosmonauts is significantly reduced after long-duration space flights. It is evident that the most impaired functions are those that rely on gravity, particularly up right posture and gait. Because of the sensorimotor disturbances manifested in the neurology of the posture and gait space flight and postflight changes may also be observed in debilitating motion sickness. While the severity of particular symptoms varies, disturbances in spatial orientation and alterations in the accuracy of voluntary movements are persistently observed after long-duration space flights. At this time most of the currently available data are primarily descriptive and not yet suitable for predicting operational impacts of most sensorimotor decrements observed upon landing on planetary surfaces or asteroids. In particular there are no existing data on the recovery dynamics or functionality of neurological, cardiovascular or muscle performance making it difficult to model or simulate the cosmonauts' activity after landing and develop the appropriate countermeasure that will ensure the rapid and safe recovery of crewmembers immediately after landing in what could be hostile environments. However and as a starting position, the videos we have acquired during recent data collection following the long duration flights of cosmonauts and astronauts walking and performing other tasks shortly after return from space flight speak volumes about their level of deconditioning. A joint Russian-American team has developed a new study specifically to address the changes in crewmembers performance and the recovery of performance with the intent of filling the missing data gaps. The first (pilot) phase of this study includes recording body kinematics and quantifying the coordination and timing of relatively simple basic movements - transition from seated and prone positions to standing, walking, stepping over obstacles, tandem walking, muscle compliance, as well as characteristics of postural sway and orthostatic tolerance. Testing for changes in these parameters have been initiated in the medical tent at the landing site. The first set of experiments showed that during the first hour after landing, cosmonauts and astronauts were able to execute (although slower and with more effort than preflight) simple movements such as egress from a seated or prone position and also to remain standing for 3.5 minutes without exhibiting pronounced cardiovascular changes. More challenging tests, however, demonstrated a prominent reduction in coordination - the obstacle task, for example, was performed at much slower speed and with a marked overestimation of the obstacle height and tandem walking was greatly degraded suggesting significant changes in proprioception, brainstem and vestibular function. There is some speculation that the neural changes, either from the bottom-up or top down may be long lasting; requiring compensatory responses that will modify or mask the adverse responses we have observed. Furthermore, these compensatory responses may actually be beneficial, helping achieve a more rapid adaptation to both weightlessness and a return to earth

Postflight Quiet Stance Stability of Astronauts Following Recovery From a Simulated Fall

INTRODUCTION: Astronauts returning from space flight universally present with postural ataxia. Throughout the Space Shuttle Program, measurement of ataxia has concentrated on sway in the anterior-posterior plane. Implementation of an interdisciplinary pre- and postflight study (Functional Task Test, FTT) designed to evaluate both astronaut postflight functional performance and related physiological changes has allowed the investigation of postural instability by characterizing dynamic stabilographic sway patterns. METHODS: Six astronauts from short-duration (Shuttle) and three from long-duration (ISS) flights were required to recover from a simulated fall. Subjects with eyes open, wearing running shoes lay prone on the floor for 2 minutes and then quickly stood up, maintained a quiet stance for 3 minutes, arms relaxed along the side of the body, and feet comfortably placed on the force plate. Crewmembers were tested twice before flight, on landing day (Shuttle only), and 1, 6, and 30 days after flight. Anterior-posterior (AP) and medial-lateral (ML) center-of-pressure (COP) coordinates were calculated from the ground reaction forces collected at 500 Hz. The 3-minute quiet stance trial was broken into three 1-minute segments for stabilogram diffusion analysis. A mean sway speed (rate of change of COP displacement) was also calculated as an additional postural stability parameter. RESULTS/CONCLUSION: While there was considerable variation, most of crewmembers tested exhibited increased stochastic activity evidenced by larger short-term COP diffusion coefficients postflight in both the AP and ML planes, suggesting significant changes in postural control mechanisms, particularly control of lower limb muscle function. As expected, postural instability of ISS astronauts on the first day postflight was similar to that of Shuttle crewmembers on landing day. Recoveries of stochastic activity and mean sway speed to baseline levels were typically observed by the 30th day postflight for both long-duration and short-duration crewmembers. Dynamic postural stability characteristics obtained in this low-impact study complement the data measured with computerized dynamic posturography

Pilot Field Test: Results of Tandem Walk Performance Following Long-Duration Spaceflight

Coordinated locomotion has proven to be challenging for many astronauts following long duration spaceflight. As NASA's vision for spaceflight points toward interplanetary travel and missions to distant objects, astronauts will not have assistance once they land. Thus, it is vital to develop a knowledge base from which operational guidelines can be written that define when astronauts can be expected to safely perform certain tasks. Data obtained during the Field Test experiment will add important insight to this knowledge base. Specifically, we aim to develop a recovery timeline of functional sensorimotor performance during the first 24 hours and several days after landing. A forerunner of the full Field Test study, the Pilot Field Test (PFT) comprised a subset of the tasks and measurements to be included in the ultimate set

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

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