Breen, Alan

Breen, Alexander C.

Carvil, P.

Green, D. A.

Russomano, T.

Bournemouth University Research Online

Effects of a proposed microgravity countermeasure, the MK VI SkinSuit, upon markers of lumbar geometry and kinematics following unloading Alexander Breen1, Philip Carvil 2,3, David Andrew Green3,4,5, Thais Russomano 6, Alan Breen 11.  Faculty of Science and Technology, Bournemouth University2.  Science and Technology Facilities Council, Daresbury Laboratory3  C entre of Human and Applied Physiological Sciences, King’s College London4. Space Medicine Team, European Astronaut Centre5  KBR Wyle6  CEMA, Faculty of Medicine University of LisbonPresenter: Dr Phil Carvil, philip.carvil@stfc.ac.uk Head of Clusters Business and Innovation DirectorateScience and Technology Facilities CouncilUK Research and Innovation ISGP Conference, Antwerp, Belgium, July 5th 2023Daily living on Earth involves a cycle of intermittent axial loading absent in space Stature increases up to 7cm reported in microgravitySevere back pain also reported in orbit On return a 4-fold increased risk of intervertebral disc (IVD) herniation has been reported, particularly in the lumbar spine  Post-mission no observable lumbar IVD swelling detected, however, a decreased range of motion and paraspinal muscle volume observedSpinal Countermeasures are needed to re-introduce axial loading in space BackgroundBackground – The Spine and IVDCervical SpineLumbar SpineThoracic SpineHeadPelvisPsoas MajorIVDAnteriorPosteriorPsoas MajorMultifidus MultifidusErector SpineaErector SpineaQuadratus LuburumQuadratus LuburumApophysealJointsVertebral canalEndplateNucleus PulposusEndplateOuter annulusVertebral bodyVertebral bodyInner annulusHydrated IVDBulged, dehydrated IVDAnterior longitudinal ligamentPosterior longitudinal ligamentInterspinousligamentLigamentum FlavumIVDEndplateNucleus PulposusEndplateOuter annulusVertebral bodyVertebral bodyInner annulusHydrated IVDBulged, dehydrated IVDExercise forms a critical part of this program providing musculoskeletal and cardiovascular support Exercise modalities can impart high axial loading on the spine >100% bodyweight (BW) for acute periods of time However, the IVD’s response are to acute loading and ’ loading over time Countermeasures which can be utilised for longer periods might offer greater spinal protectionCountermeasures©NASA©ESABi-directional elastic weaves impart low resistive tension circumferentially and high resistive tension axially Design modifications over time have been incorporated to facilitate long duration wear (>8h) Mk VI Skinsuit provides tolerable ~20% bodyweight loading (axially) at the feetCountermeasures: SkinSuitMKIIIMKIVaMKIVbMKVMKVIMKVIFlightFF FF F FB B BBBB©ESA KCL MITInvestigate the effect of 4-hour axial reloading upon markers of disc swelling in the lumbar spine, induced by the Mk VI SkinSuitDetermine if reloading acts to increase intervertebral motion, by comparing parameters of intervertebral restraint between conditions (with and without SkinSuit loading)Aims©AECC ESA KCL22 male participants (26±4y; 1.77±0.07m;76±11.1kg)Reviewed by UK NHS Ethics BoardEach participant measured for a custom Mk VI Skinsuit, that provided on average 0.19±0.03Gz axial loading at the footEach participant was screened for suitability by radiographerTwo participants withdrew, not in analysisMethod - Participants©AECC ESA KCLAn analogue was required to evaluate countermeasures and investigate this effectof unloading that is representative of spaceflight – Hyper Buoyancy FlotationMethod – Simulating microgravityREST: Restrictive environmentalstimulation therapy?6o Head down tilt(HDT)Dry immersion©ESA CNES MEDES©Navasiolava©InfinityfloatingWaterbed, partly-filled with saturated, saline water (1.7gcm3) inducing ‘horizontal buoyancy’Provides accessibility for countermeasure evaluation (stature, imaging, loading etc.)Several prior studies performed to validate HBFProtocol repeated 6 weeks apart with participants acting as own control Participants arrived at the imaging facility where a HBF was installed within transport (trolley) of the imaging suiteTwo types of imaging used: Magnetic resonance (MRI) and Quantitative fluoroscopy (QF) to look at lower spine (lumbar) Geometry [MRI] and kinematics [QF].Method – Protocol8 HOUR OVERNIGHT FLOTATION4 HOUR FLOTATIONMRI(~15 MINS)= 15 minutesSTANDING STATUREQF (~15 MINS)SUPINE TRANSPORTDON SKINSUIT(IN SKINSUIT TRIAL ONLY)STANDING STATUREMRI(~15 MINS)QF (~15 MINS)STANDINGASSESSMENTMethod – Imaging Protocol (Geometry)• Participants transferred supine to MRI from HBF by trolley• Lumbar spinal scans taken aligned through IVD:-• 11 T2 weighted Sagittal slices • 20 (four blocks of five) axial slices• Measurements of lumbar curvature, height, IVD height and cross-sectional area taken using commercial software (OsiriX Lite, Pixmeo Sarl, Switzerland). • Post all supine tests, protocol repeated upright (seated)©AECC ESA KCLMethod – Imaging Protocol (Kinematics)• Imaging performed with a Siemens Arcadis AvanticVC10A digital fluoroscope • Central ray positioned at L3-4 disc with all vertebrae from L2-S1 in the field of view• Scans taken in both supine (passive recumbent) and upright (standing) positions:• Supine: 40 ̊ of flexion, followed by 40 ̊ of extension using a computer-controlled motor operated table, which allowed passive motion of the spine• Upright: Standing active flexion 60̊ / extension 20)̊• Image acquisition at 15Hz synchronised with controller of motor table• QF image processing/analysis were performed using MATLAB©AECC ESA KCLMethod – Imaging Protocol (Kinematics)©AECC ESA KCLFollowing 4h Reloading:• Lower lumbar spine length (p=0.01) • Greater lordosis (p=0.0001)• Reduce IVD disk height (more pronounced during upright)No significant difference in IVD cross-sectional area and volume. Results  - GeometrySupineUpright051015L1/L2 L2/L3 L3/L4 L4/L5 L5/S1IVD Height (mm)UnloadedReloaded* $051015L1/L2 L2/L3 L3/L4 L4/L5 L5/S1IVD Height (mm)UnloadedReloaded* $$ *During supine imaging, it was observed:-• An increased in IV-RoM during flexion at L3-4 (p=0.01) and L4-5 (p=0.003)• Lower dynamic disc height at L5-S1 (p=0.002)• More translation at L3-4 (p=0.02)No significant differences observed during upright, active flexion/extensionResults - KinematicsIV- RotationTranslationConclusionShort term (4 hour) wear of the Mk VI SkinSuit appears to restore lumbar mobility andlordosis following a microgravity analogue exposure in a healthy control population and maybe an effective countermeasure for post space flight lumbar disc herniation.©ESA NASAAcknowledgementsProject part of the wider SkinSuit ProgrammeKing’s College London:Stephen HarridgeGeorgina EllisonLindsay MarjoramJulia AttiasSusan Halson-BrownAdrianna VillaDavid SnellGerrard RaffertyVictoria MacbeanAmelia MooreThomas GkouvinasAlexander SeghalJuan Rios KristajanssonTess Morris-PattersonIrene Di GiulioIlaria CinelliAECC:Mel JonesDebbie HorneNeil OsbourneEmilie ClaerboutJade MerifieldESA & EACGuillaume WeertsArnaud RungeJonathan ScottAndreas MogansanThomas PesquetCasey PruettAlexander FrechetteNora PetersenSimon Evetts (Past)MIT:Dava NewmanDustin KendrickRachel BellisleRMIT:James WaldieUCL: Peter TaylorCostumeworks (past)Daninese& ALL THE PARTICIPANTS!!!

Effects of a proposed microgravity countermeasure, the MK VI SkinSuit, upon markers of lumbar geometry and kinematics following unloading

https://eprints.bournemouth.ac.uk/38951/7/Presentation%20V2%20for%20ISGP.pdf

Effects of a proposed microgravity countermeasure, the MK VI SkinSuit, upon markers of lumbar geometry and kinematics following unloading

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