Millard F. Reschke

Recovery of postural equilibrium control following spaceflight

Decreased postural stability is observed in most astronauts immediately following spaceflight. Because ataxia may present postflight operational hazards, it is important to determine the incidence of postural instability immediately following landing and the dynamics of recovery of normal postural equilibrium control. It is postulated that postflight postural instability results from in-flight adaptive changes in central nervous system (CNS) processing of sensory information from the visual, vestibular, and proprioceptive systems. The purpose of the present investigation was to determine the magnitude and time course of postflight recovery of postural equilibrium control and, hence, readaptation of CNS processing of sensory information. Thirteen crew members from six spaceflight missions were studied pre- and postflight using a modified commercial posturography system. Postural equilibrium control was found to be seriously disrupted immediately following spaceflight in all subjects. Readaptation to the terrestrial environment began immediately upon landing, proceeded rapidly for the first 10-12 hours, and then proceeded much more slowly for the subsequent 2-4 days until preflight stability levels were reachieved. It is concluded that the overall postflight recovery of postural stability follows a predictable time course.

Vestibular plasticity following orbital spaceflight: recovery from postflight postural instability

Results of previous studies suggested that the vestibular mediated postural instability observed in astronauts upon return to earth from orbital spaceflight may be exacerbated by an increased weighting of visual inputs for spatial orientation and control of movement. This study was performed to better understand the roles of visual and somatosensory contributions to recovery of normal sensori-motor postural control in returning astronauts. Preflight and postflight, 23 astronaut volunteers were presented randomly with three trials of six sensory organization test (SOT) conditions in the EquiTest system test battery. Sagittal plane center-of-gravity (COG) excursions computed from ground reaction forces were significantly higher on landing day than preflight for those test conditions presenting sway-referenced visual and/or somatosensory orientation cues. The ratio of summed peak-to-peak COG sway amplitudes on the two sway-referenced vision tests (SOTs 3 + 6) compared to the two eyes closed tests (SOTs 2 + 5) was increased on landing day, indicating an increased reliance on visual orientation cues for postural control. The ratio of peak-to-peak COG excursions on sway-referenced surfaces (SOTs 4, 5 & 6) to an earth fixed support surfaces (SOTs 1, 2 & 3) increased even more after landing suggesting primary reliance on somatosensory orientation cues for recovery of postflight postural stability. Readaptation to sway-referenced support surfaces took longer than readaptation to sway-referenced vision. The increased reliance on visual and somatosensory inputs disappeared in all astronauts 4-8 days following return to earth.

The Effects of Target Distance on Eye and Head Movement during Locomotion

The vestibuloocular reflex (VOR) serves to maintain a stable retinal image by generating eye movements that compensate for head perturbations. It has been demonstrated that during natural behaviors such as walking and running, the VOR stabilizcs gaze against angular head movement. Indeed, individuals with loss of vestibular function experience impaired visual acuity and oscillopsia during locomotion, thus undcrscoring the importance of the VOR in maintaining gaze stability during locomotion.* However, during locomotion the head also experiences linear displacement-7-s and must therefore generate a linear VOR (LVOR) if visual acuity is to be maintained. The response characteristics of the LVOR are dependent on the amount of ocular translation relative to the visual target position produced during lincar head motion.k8 A target viewed at a relatively large distance requires only small compensatory eye movements. However, as the target of interest is brought closer to the eyes, larger compensatory eye movements are required to maintain ocular fixation. The LVOR is thought to be driven predominantly by otolith input and modulated by the state of ocular vergence; this provides larger compensatory eye movements during fixation of near Interestingly, angular head movements are also compensatory for linear head displacement experienced during locomotion. However, i t is not known how such head movements respond to changes in target distance from the eyes. The aim of the present experiment was to characterize how the eyes and head compensate for vertical linear head displacement produced during locomotion and to determine how changes in target distance affect these compensatory responses. These studies represent ground-based investigations that were conducted prior to similar preand postflight testing of NASA astronaut subjects.

Space flight and neurovestibular adaptation

Space flight represents a form of sensory stimulus rearrangement requiring modification of established terrestrial response patterns through central reinterpretation. Evidence of sensory reinterpretation is manifested as postflight modifications of eye/head coordination, locomotor patterns, postural control strategies, and illusory perceptions of self or surround motion in conjunction with head movements. Under normal preflight conditions, the head is stabilized during locomotion, but immediately postflight reduced head stability, coupled with inappropriate eye/head coordination, results in modifications of gait. Postflight postural control exhibits increased dependence on vision which compensates for inappropriate interpretation of otolith and proprioceptive inputs. Eye movements compensatory for perceived self motion, rather than actual head movements have been observed postflight. Overall, the in‐flight adaptive modification of head stabilization strategies, changes in head/eye coordination, illusionary motion, and postural control are maladaptive for a return to the terrestrial environment.

Ground-based training for the stimulus rearrangement encountered during spaceflight

Approximately 65-70% of the crew members now experience motion sickness of some degree during the first 72 h of orbital flight on the Space Shuttle. Lack of congruence among signals from spatial orientation systems leads to sensory conflict, which appears to be the basic cause of space motion sickness. A project to develop training devices and procedures to preadapt astronauts to the stimulus rearrangements of microgravity is currently being pursued. The preflight adaptation trainers (PATs) are intended to: demonstrate sensory phenomena likely to be experienced in flight, allow astronauts to train preflight in an altered sensory environment, alter sensory-motor reflexes, and alleviate or shorten the duration of space motion sickness. Four part-task PATs are anticipated. The trainers are designed to evoke two adaptation processes, sensory compensation and sensory reinterpretation, which are necessary to maintain spatial orientation in a weightless environment. Recent investigations using one of the trainers indicate that self-motion perception of linear translation is enhanced when body tilt is combined with visual surround translation, and that a 270 degrees phase angle relationship between tilt and surround motion produces maximum translation perception.

Smooth Pursuit Tracking

Russian investigators have reported changes in pursuit tracking of a vertically moving point stimulus during space flight.1 Early in microgravity, changes were manifested by decreased eye movement amplitude (undershooting) and the appearance of correction saccades. As the flight progressed, pursuit of the moving point stimulus deteriorated while associated saccadic movements were unchanged. Immediately postflight there was an improved execution of active head movements, indicating that the deficiencies in pursuit function noted in microgravity may be of central origin.1 In contrast, tests of two cosmonauts showed that horizontal and vertical smooth pursuit were unchanged inflight.2 However, results of corresponding saccadic tasks showed a tendency toward the overshooting of a horizontal target early inflight, with high accuracy developing later inflight, accompanied by an increased saccade velocity and a trend toward decreased saccade latency. On the basis of these equivocal results, we have further investigated the effects of space flight (modified vestibular and sensory-motor function) on the smooth pursuit mechanism.

Salivary Total Protein and Experimental Coriolis Sickness

Symptomatic reporting has been used in quantifying the severity of motion sickness including Coriolis sickness. This study was designed to objectively examine if the dynamic changes of salivary protein concentration relate to the severity of Coriolis sickness. Healthy adults with normal vestibular function underwent a modified Coriolis Sickness Susceptibility Index (CSSI) test, utilizing a staircase profile. Salivary samples were obtained prior to stimulation, 15, 30, and 45 min following stimulus onset, and/or upon reaching nausea-II endpoint. Total protein concentration tended to rise over the initial 30 min of stimulation, and then level off or decline. A statistically significant difference was found between the pre-stimulation and 30 min samples. Although some variability existed among the subjects, the general pattern of changes along the time course was similar. An inverse correlation approaching statistical significance was found between control (non-stimulus) total protein levels, and minutes of Coriolis stimulation required to reach the nausea-II endpoint. Thus, baseline salivary total protein levels can be of use in predicting susceptibility of Coriolis sickness and other forms of motion sickness.

Effects of eccentric rotation on the human pitch vestibulo-ocular reflex.

Conclusion. The pitch plane vestibulo-ocular reflex (VOR) gain and symmetry at low frequencies (≤0.3 Hz) are enhanced by otoliths and/or somatosensory sensory cues during combined angular and linear stimuli. We conclude that neural processing of these linear motion cues is used to improve the VOR when stimulus frequencies are below the optimal range for the canals. Objective. The purpose of this study was to examine the effects of eccentric rotation on the passive pitch VOR responses in humans. Subjects and methods. Eleven subjects were placed on their left sides (90° roll position) and rotated in the pitch plane about an earth-vertical axis at 0.13, 0.3, and 0.56 Hz. The inter-aural axis was either aligned with the axis of rotation (no modulation of linear acceleration) or offset from it by 50 cm (centripetal linear acceleration directed feet-ward). The modulation of pitch VOR responses was measured in the dark with a binocular videography system. Results. The pitch VOR gain was significantly increased and the VOR asymmetry was significantly reduced at the lowest stimulus frequencies during eccentric rotation. There was no effect of eccentric rotation on the pitch gain or asymmetry at the highest frequency tested.

Facilitation of Adaptation and Acute Tolerance to Stressful Sensory Input by Doxepin and Scopolamine Plus Amphetamine

This work characterizes a new methodologic and pharmacologic approach to control terrestrial and space motion sickness (SMS). The experimental design allowed separate evaluation of drug action on susceptibility and adaptability, and used repeated measures to approximate the chronic stressful motion of microgravity. Daily exposure to cross‐coupled angular acceleration for 5 consecutive days demonstrated that the efficacy of doxepin and scopolamine plus amphetamine in the prevention of autonomic system dysfunction was not only apparent on the first test day (P < .01), but was also evident in the substantially enhanced resistance developed over the 5‐day test period (P < .01) as compared with placebo. This indicates that daily use of these medications does not diminish therapeutic efficacy (tolerance). The efficacy of doxepin was anticipated because it possesses pharmacologic properties similar to those of established anti‐motion sickness drugs. Comparable efficacy after doxepin loading for 4 hours, 3 days, or 21 days suggests a mechanism distinct from its antidepressant effects, possibly related to its potent antihistaminergic actions. Use of doxepin has operational significance to the National Aeronautics and Space Administration, in comparison with current preparations of scopolamine plus amphetamine, because of doxepins minimal impact on cognitive performance, and most importantly, its favorable pharmacokinetic profile, particularly its long half‐life.

Neurovestibular Symptoms in Astronauts Immediately after Space Shuttle and International Space Station Missions

Objectives (1) To assess vestibular changes and related sensorimotor difficulties, especially instability of posture and gait, among astronauts immediately after they return from space and to compare the effects experienced after short- and long-duration space missions. (2) To determine whether any difficulties experienced were severe enough to impair the astronauts’ ability to leave the spacecraft in the event of an emergency. Study Design Prospective cohort study. Setting National Aeronautics and Space Administration’s Kennedy Space Center and Johnson Space Center. Subjects and Methods Fourteen crewmembers of 3 Space Shuttle missions that lasted about 1 week and 18 crewmembers of 8 International Space Station missions that lasted about 6 months were given brief vestibular examinations 1 to 5 hours after landing. These examinations focused on the presence of vestibular and motor coordination difficulties, as well as motion sickness and motion sensations. Standardized tests included the observation of abnormal eye movements, finger-to-nose pointing, standing up from a seated position, postural stability, and tandem gait. Results Unsteady walking and postural instabilities were observed after short- and long-duration missions. Motion sickness symptoms were observed after long-duration missions but not after short-duration missions. The symptom most frequently reported by the astronauts was an exaggerated perceived motion associated with sudden head movements during reentry and after landing. Conclusion The severity of the observed abnormalities would limit the ability of crewmembers during the first 5 hours after landing and increase the time required to leave the spacecraft during this period.