Norsk, Peter

NASA Technical Reports Server

National Aeronautics and Space Administration
Physiological Health Protection in Space
Peter Norsk, M.D., dr. med.
Element Scientist
USRA/NASA‐JSC
https://ntrs.nasa.gov/search.jsp?R=20140005015 2019-08-29T14:34:00+00:00Z
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National Aeronautics and Space Administration
Weightlessness
 Radiation
 Isolation
Distance
 PO2‐changes
 Circadian rhythms
National Aeronautics and Space Administration
Weightlessness
 Radiation
 Isolation
Distance
 PO2‐changes
 Circadian rhythms
Synergistic effects?
HHC Intra-Element/P. Norsk 5
Example
Zhou Y, Ni H, Li M, Sanzari JK, et al. (2012) PLoS ONE 7(9):
e44329. doi:10.1371/journal.pone.0044329
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0044329
An example of synergistic 
effects of 0 G‐simulation 
and radiation (2 Gy)
Present platform in LEO
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Muscle Function
Exp 1-32 (IRED n=22 ARED+T2 n=25)
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iRED
ARED
Mean
Knee ext strength     Knee flex strength    Knee ext endurance    Knee flex endurance  Ankle PF strength     Trunk extensor strength
+T2
* Updated data since 2010 Bone Summit
Areal BMD 
g/cm2
%/Month 
Change + SD
Lumbar Spine -1.06+0.63*
Femoral Neck -1.15+0.84*
Trochanter -1.56+0.99*
Total Body -0.35+0.25*
Pelvis -1.35+0.54*
Arm -0.04+0.88
Leg -0.34+0.33*
*p<0.01, n=16-18
DXA:  BMD losses are regional and rapid
Hip
1.5% / month
Whole Body
0.3% / month
Lumbar Spine
1% / month
LeBlanc et al, J Musculoskeletal 2000
Bisphosphonates as a Countermeasure to 
Spaceflight Effects - mitigates of urinary 
calcium excretion
Slide courtesy of Dr. A. LeBlanc
‘Integrated Cardiovascular’
Functional Mobility Test Data: Evaluates Loco-motor control
Time to Complete Course
Recovery of functional mobility to 95% of preflight level took 15 days.  
N = 18 Mulavara AP, Feiveson A, Feidler J, Cohen HS, Peters BT, Miller CA, Brady R, Bloomberg JJ. Experimental Brain Research. 202(3): 649-59. 2010.
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L-60 L-30 R+0 R+1 R+6 R+30
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Incorrect Steps: 
sidestepped, opened eyes, 
or paused for more than 
three seconds between steps 
Shuttle ISS
Pre                      Postflight Pre                      Postflight
Tandem Walk Test
020
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100 ** P < 0.01
short duration  stand  n=6
short duration tilt  n=20
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long duration tilt  n=6
**
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Meck et al., 
Psychosomatic 
Medicine, 63:865‐873, 
2001
Orthostatic Intolerance
• Mitigated by:
o Oral salt and fluid loading
o Antigravity garment
o Additional clinical i.v fluid treatment
HHC Intra-Element/P. Norsk 18
VIIP Syndrome
HHC Intra-Element/P. Norsk 19
Fluid shift induced vision and
intracranial pressure changes!
FD‐2Preflight press briefing
Example of cephalad fluid shift
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Integrated Visual Impairment/Intracranial Pressure Project 
Risk Background ‐ Symptoms
Background:
•8 known “clinical cases” (of 34 long duration crew) members
•Each with different degrees of symptoms 
•Elevated measures of Intracranial Pressure (ICP) post flight
MRI Orbital 
Image 
showing 
globe 
flattening 
Normal Globe Flatten Globe
•Choroidal Folds ‐
parallel grooves in the 
posterior pole
•Globe Flattening 
•Optic Disc Edema (swelling) 
•Altered Blood flow
•“cotton wool” spots 
•Hyperopic Shifts
‐Up to +1.75 diopters 
•Increased Optic Nerve 
Sheath Diameter
0 1 2 3 4 5
-10
-5
0
5
Mean Fish Servings (#/wk)
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Immunity is Altered During Long‐duration Spaceflight onboard ISS
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L‐180 L‐45 Early Mid Late R+0 R+30
P
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M
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IL‐10
***
Cytokine Production Profiles Latent Herpesvirus Reactivation
HHC Intra-Element/P. Norsk 24
Future approach
HHC Intra-Element/P. Norsk 25
IPCS:
HHC Intra-Element/P. Norsk 26
IPCS:
HHC Intra-Element/P. Norsk 27
IPCS:
Integrated
Physiological
Countermeasure
Suite
HHC Intra-Element/P. Norsk 28
Based on ISS Research
Integrated Physiological Countermeasure Suite
• Develop individualized CM‐protection programs: Computer modeling, G‐transition training 
Pre‐flight
• Establish healthy life style: Exercise, food intake
Integrated Physiological Countermeasure Suite
• Exercise prescriptions: Aerobic and resistive
• Sensory‐motor adaptation: Computer programs , vestibular (galvanic) stimulation
• Anti‐VIIP bracelets (+/‐ dynamic exercise) and/or medication
• Anti‐motion sickness & anti‐inflammatory medications (medication stability monitoring)
• Immune/OSaD‐biomarkers (Lab analysis of urine, blood, saliva)
• Cardiovascular, VIIP, muscle/bone (ultrasound, ECG, BP, OCT, CCFP/TCD, vision, cognition)
In‐flight
Monitoring
Training & Prevention
Treatment and prevention
• Functional food items: Omega‐3, anti‐oxidants, low salt and iron
• Anti‐orthostatic pre‐landing fluid and salt ingestion
• Anti‐osteoporotic medications: Bisphosphonates, anabolics, ACE‐inhibitors
• EVA pre‐breathing
Integrated Physiological Countermeasure Suite
• Anti‐orthostatic garment and fluid/salt treatment
• G‐transition medication, vestibular (galvanic) stimulation
Planetary landing
Integrated Physiological Countermeasure Suite
• Exercise prescriptions: Aerobic and resistive
• Sensory‐motor adaptation: Computer programs , vestibular (galvanic) stimulation
• Anti‐VIIP bracelets (+/‐ dynamic exercise) and/or medication
• Anti‐motion sickness & anti‐inflammatory medications (medication stability monitoring)
• Anti‐orthostatic garment and fluid/salt treatment
• Immune/OSaD‐biomarkers (Lab analysis of urine, blood, saliva)
• Cardiovascular, VIIP, muscle/bone (ultrasound, ECG, BP, OCT, CCFP/TCD, vision, cognition)
• Develop individualized CM‐protection programs: Computer modeling, G‐transition training 
Pre‐flight
• Establish healthy life style: Exercise, food intake
In‐flight
• G‐transition medication, vestibular (galvanic) stimulation
Planetary landing:
Monitoring
Training & Prevention
Treatment and prevention
• Functional food items: Omega‐3, anti‐oxidants, low salt and iron
• Anti‐orthostatic pre‐landing fluid and salt ingestion
• Anti‐osteoporotic medications: Bisphosphonates, anabolics, ACE‐inhibitors
• EVA pre‐breathing
HHC Intra-Element/P. Norsk 33
But ‐
HHC Intra-Element/P. Norsk 34
But – why not bring gravity?
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Artificial Gravity
Spinning:
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Artificial Gravity
Inside
Spinning:
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Artificial Gravity
Inside
Part ofSpinning:
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Artificial Gravity
Inside
Part of
Whole vehicle
Spinning:
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• The minimum artificial gravity level?
• The protection of Martian gravity?
We don’t know:
Thank 
you!


Physiological Health Protection in Space

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