Challenges to Health During Deep Space Exploration Missions

Long duration missions outside of low Earth orbit will present unique challenges to the maintenance of human health. Stressors with physiologic and psychological impacts are inherent in exploration missions, including reduced gravity, increased radiation, isolation, limited habitable volume, circadian disruptions, and cabin atmospheric changes. Operational stressors such as mission timeline and extravehicular activities must also be considered, and these varied stressors may act in additive or synergistic fashions. Should changes to physiology or behavior manifest as a health condition, the rendering of care in an exploration environment must also be considered. Factors such as the clinical background of the crew, inability to evacuate to Earth in a timely manner, communication delay, and limitations in available medical resources will have an impact on the assessment and treatment of these conditions. The presentations associated with this panel will address these unique challenges from the perspective of several elements of the NASA Human Research Program, including Behavioral Health and Performance, Human Health Countermeasures, Space Radiation, and Exploration Medical Capability

Bringing Gravity to Space

This panel will present NASA's plans for ongoing and future research to define the requirements for Artificial Gravity (AG) as a countermeasure against the negative health effects of long-duration weightlessness. AG could mitigate the gravity-sensitive effects of spaceflight across a host of physiological systems. Bringing gravity to space could mitigate the sensorimotor and neuro-vestibular disturbances induced by G-transitions upon reaching a planetary body, and the cardiovascular deconditioning and musculoskeletal weakness induced by weightlessness. Of particular interest for AG during deep-space missions is mitigation of the Visual Impairment Intracranial Pressure (VIIP) syndrome that the majority of astronauts exhibit in space to varying degrees, and which presumably is associated with weightlessness-induced fluid shift from lower to upper body segments. AG could be very effective for reversing the fluid shift and thus help prevent VIIP. The first presentation by Dr. Charles will summarize some of the ground-based and (very little) space-based research that has been conducted on AG by the various space programs. Dr. Paloski will address the use of AG during deep-space exploration-class missions and describe the different AG scenarios such as intra-vehicular, part-of-vehicle, or whole-vehicle centrifugations. Dr. Clement will discuss currently planned NASA research as well as how to coordinate future activities among NASA's international partners. Dr. Barr will describe some possible future plans for using space- and ground-based partial-G analogs to define the relationship between physiological responses and G levels between 0 and 1. Finally, Dr. Stenger will summarize how the human cardiovascular system could benefit from intermittent short-radius centrifugations during long-duration missions

The Visual Impairment Intracranial Pressure Syndrome in Long Duration NASA Astronauts: An Integrated Approach

The Visual Impairment Intracranial Pressure (VIIP) syndrome is currently NASA's number one human space flight risk. The syndrome, which is related to microgravity exposure, manifests with changes in visual acuity (hyperopic shifts, scotomas), changes in eye structure (optic disc edema, choroidal folds, cotton wool spots, globe flattening, and distended optic nerve sheaths). In some cases, elevated cerebrospinal fluid pressure has been documented postflight reflecting increased intracranial pressure (ICP). While the eye appears to be the main affected end organ of this syndrome, the ocular affects are thought to be related to the effect of cephalad fluid shift on the vascular system and the central nervous system. The leading hypotheses for the development of VIIP involve microgravity induced head-ward fluid shifts along with a loss of gravity-assisted drainage of venous blood from the brain, both leading to cephalic congestion and increased ICP. Although not all crewmembers have manifested clinical signs or symptoms of the VIIP syndrome, it is assumed that all astronauts exposed to microgravity have some degree of ICP elevation in-flight. Prolonged elevations of ICP can cause long-term reduced visual acuity and loss of peripheral visual fields, and has been reported to cause mild cognitive impairment in the analog terrestrial population of Idiopathic Intracranial Hypertension (IIH). These potentially irreversible health consequences underscore the importance of identifying the factors that lead to this syndrome and mitigating them

The Visual Impairment Intracranial Pressure Syndrome in Long Duration NASA Astronauts: An Integrated Approach

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