Dry immersion induced acute low back pain and its relationship with trunk myofascial viscoelastic changes.

Microgravity induces spinal elongation and Low Back Pain (LBP) but the pathophysiology is unknown. Changes in paraspinal muscle viscoelastic properties may play a role. Dry Immersion (DI) is a ground-based microgravity analogue that induces changes in m. erector spinae superficial myofascial tissue tone within 2 h. This study sought to determine whether bilateral m. erector spinae tone, creep, and stiffness persist beyond 2 h; and if such changes correlate with DI-induced spinal elongation and/or LBP. Ten healthy males lay in the DI bath at the Institute of Biomedical Problems (Moscow, Russia) for 6 h. Bilateral lumbar (L1, L4) and thoracic (T11, T9) trunk myofascial tone, stiffness and creep (MyotonPRO), and subjective LBP (0-10 NRS) were recorded before DI, after 1h, 6 h of DI, and 30min post. The non-standing spinal length was evaluated on the bath lifting platform using a bespoke stadiometer before and following DI. DI significantly modulated m. erector spinae viscoelastic properties at L4, L1, T11, and T9 with no effect of laterality. Bilateral tissue tone was significantly reduced after 1 and 6 h DI at L4, L1, T11, and T9 to a similar extent. Stiffness was also reduced by DI at 1 h but partially recovered at 6 h for L4, L1, and T11. Creep was increased by DI at 1 h, with partial recovery at 6 h, although only T11 was significant. All properties returned to baseline 30 min following DI. Significant spinal elongation (1.17 ± 0.20 cm) with mild (at 1 h) to moderate (at 6 h) LBP was induced, mainly in the upper lumbar and lower thoracic regions. Spinal length increases positively correlated (Rho = 0.847, p = 0.024) with middle thoracic (T9) tone reduction, but with no other stiffness or creep changes. Spinal length positively correlated (Rho = 0.557, p = 0.039) with Max LBP; LBP failed to correlate with any m. erector spinae measured parameters. The DI-induced bilateral m. erector spinae tone, creep, and stiffness changes persist beyond 2 h. Evidence of spinal elongation and LBP allows suggesting that the trunk myofascial tissue changes could play a role in LBP pathogenesis observed in real and simulated microgravity. Further study is warranted with longer duration DI, assessment of IVD geometry, and vertebral column stability.

Macro- and microstructural changes in cosmonauts' brains after long-duration spaceflight.

Long-duration spaceflight causes widespread physiological changes, although its effect on brain structure remains poorly understood. In this work, we acquired diffusion magnetic resonance imaging to investigate alterations of white matter (WM), gray matter (GM), and cerebrospinal fluid (CSF) compositions in each voxel, before, shortly after, and 7 months after long-duration spaceflight. We found increased WM in the cerebellum after spaceflight, providing the first clear evidence of sensorimotor neuroplasticity. At the region of interest level, this increase persisted 7 months after return to Earth. We also observe a widespread redistribution of CSF, with concomitant changes in the voxel fractions of adjacent GM. We show that these GM changes are the result of morphological changes rather than net tissue loss, which remained unclear from previous studies. Our study provides evidence of spaceflight-induced neuroplasticity to adapt motor strategies in space and evidence of fluid shift-induced mechanical changes in the brain.

Efficacy of Gradient Compression Garments in the Hours After Long-Duration Spaceflight.

The incidence of presyncopal events is high soon after a long-duration spaceflight;>60% of returning astronauts could not complete a 10-min 80° head-up tilt test on landing day (R+0) after ~6 months of spaceflight. The objective of this study was to demonstrate the ability of a lower body gradient compression garment (GCG) to protect against an excessive increase in heart rate and a decrease in blood pressure during standing after long-duration spaceflight. Methods: Eleven astronauts (9 M, 2 F) volunteered to participate. The stand test protocol consisted of 2 min of prone rest followed by 3.5 min of standing. Subjects completed one familiarization session, two preflight data collection sessions in standard clothing, and three tests on landing day while wearing GCG. Postflight tests were conducted 1-4 h (R+0A), ~12 h (R+0B), and ~28 h after landing (R+0C). Results: All astronauts completed the stand test preflight. Three astronauts were unable to attempt the stand test at R+0A, and one of these was unable to start the test at R+0B. One astronaut was unable to complete 3.5 min of standing at R+0B (test ended at 3.3 min). Review of the individual's blood pressure data revealed no hypotension but the astronaut reported significant motion sickness. Of the astronauts who participated in testing on landing day, the heart rate and mean arterial pressure responses to standing (stand-prone) were not different than preflight at any of the postflight sessions. Conclusion: Wearing the GCG after spaceflight prevented the tachycardia that normally occurs while standing after spaceflight without compression garments and protected against a decrease in blood pressure during a short stand test.

Brain ventricular volume changes induced by long-duration spaceflight.

Long-duration spaceflight induces detrimental changes in human physiology. Its residual effects and mechanisms remain unclear. We prospectively investigated the changes in cerebrospinal fluid (CSF) volume of the brain ventricular regions in space crew by means of a region of interest analysis on structural brain scans. Cosmonaut MRI data were investigated preflight (n = 11), postflight (n = 11), and at long-term follow-up 7 mo after landing (n = 7). Post hoc analyses revealed a significant difference between preflight and postflight values for all supratentorial ventricular structures, i.e., lateral ventricle (mean % change ± SE = 13.3 ± 1.9), third ventricle (mean % change ± SE = 10.4 ± 1.1), and the total ventricular volume (mean % change ± SE = 11.6 ± 1.5) (all P < 0.0001), with higher volumes at postflight. At follow-up, these structures did not quite reach baseline levels, with still residual increases in volume for the lateral ventricle (mean % change ± SE = 7.7 ± 1.6; P = 0.0009), the third ventricle (mean % change ± SE = 4.7 ± 1.3; P = 0.0063), and the total ventricular volume (mean % change ± SE = 6.4 ± 1.3; P = 0.0008). This spatiotemporal pattern of CSF compartment enlargement and recovery points to a reduced CSF resorption in microgravity as the underlying cause. Our results warrant more detailed and longer longitudinal follow-up. The clinical impact of our findings on the long-term cosmonauts' health and their relation to ocular changes reported in space travelers requires further prospective studies.

Cellular Responses of Human Postural Muscle to Dry Immersion.

Support withdrawal has been currently considered as one of the main factors involved in regulation of the human locomotor system. For last decades, several authors, including the authors of the present paper, have revealed afferent mechanisms of support perception and introduced the concept of the support afferentation system. The so-called "dry immersion" model which was developed in Russia allows for suspension of subjects in water providing the simulation of the mechanical support withdrawal. The present review is a summary of data allowing to appreciate the value of the "dry" immersion model for the purposes of studying cellular responses of human postural muscle to gravitational unloading. These studies corroborated our hypothesis that the removal of support afferentation inactivates the slow motor unit pool which leads to selective inactivation, and subsequent atony and atrophy, of muscle fibers expressing the slow isoform of myosin heavy chain (which constitutes the majority of soleus muscle fibers). Fibers that have lost a significant part of cytoskeletal molecules are incapable of effective actomyosin motor mobilization which leads to lower calcium sensitivity and lower range of maximal tension in permeabilized fibers. Support withdrawal also leads to lower efficiency of protective mechanisms (nitric oxide synthase) and decreased activity of AMP-activated protein kinase. Thus, "dry" immersion studies have already contributed considerably to the gravitational physiology of skeletal muscle.

The effect of spaceflight and microgravity on the human brain.

Microgravity, confinement, isolation, and immobilization are just some of the features astronauts have to cope with during space missions. Consequently, long-duration space travel can have detrimental effects on human physiology. Although research has focused on the cardiovascular and musculoskeletal system in particular, the exact impact of spaceflight on the human central nervous system remains to be determined. Previous studies have reported psychological problems, cephalic fluid shifts, neurovestibular problems, and cognitive alterations, but there is paucity in the knowledge of the underlying neural substrates. Previous space analogue studies and preliminary spaceflight studies have shown an involvement of the cerebellum, cortical sensorimotor, and somatosensory areas and the vestibular pathways. Extending this knowledge is crucial, especially in view of long-duration interplanetary missions (e.g., Mars missions) and space tourism. In addition, the acquired insight could be relevant for vestibular patients, patients with neurodegenerative disorders, as well as the elderly population, coping with multisensory deficit syndromes, immobilization, and inactivity.

Cortical reorganization in an astronaut's brain after long-duration spaceflight.

To date, hampered physiological function after exposure to microgravity has been primarily attributed to deprived peripheral neuro-sensory systems. For the first time, this study elucidates alterations in human brain function after long-duration spaceflight. More specifically, we found significant differences in resting-state functional connectivity between motor cortex and cerebellum, as well as changes within the default mode network. In addition, the cosmonaut showed changes in the supplementary motor areas during a motor imagery task. These results highlight the underlying neural basis for the observed physiological deconditioning due to spaceflight and are relevant for future interplanetary missions and vestibular patients.

Russian Countermeasure Systems for Adverse Effects of Microgravity on Long-Duration ISS Flights.

INTRODUCTION: The system of countermeasures for the adverse effects of microgravity developed in the USSR supported the successful implementation of long-duration spaceflight (LDS) programs on the Salyut and Mir orbital stations and was subsequently adapted for flights on the International Space Station (ISS). From 2000 through 2010, crews completed 26 ISS flight increments ranging in duration from 140 to 216 d, with the participation of 27 Russian cosmonauts. These flights have made it possible to more precisely determine a crew-member's level of conditioning, better assess the advantages and disadvantages of training processes, and determine prospects for future developments.

Evolution of Russian Microgravity Countermeasures.

INTRODUCTION: Countermeasures to prevent or partially offset the negative physiologic changes that are caused by the effects of microgravity play an important role in supporting the performance of crewmembers in flight and their safe return to Earth. Research conducted in Russia on the orbital stations Salyut and Mir, as well as simulation experiments on the ground, have demonstrated that changes that occur during extended spaceflight in various physiologic systems can be prevented or significantly decreased by using countermeasures. Hardware and techniques used on the ISS have been substantially improved to reflect the experience of previous extended missions on Russian orbital stations. Countermeasures used during early ISS missions consisted of the U.S. treadmill (TVIS), cycle ergometer (ВБ-3), a set of resistance bands, a postural muscle loading suit (Penguin-3), electrical stimulator (Tonus-3), compression thigh cuffs (Braslet-М), a lower body negative pressure (LBNP) suit (Chibis), a lower body g-loading suit (Kentavr), and water/salt supplements. These countermeasures are described in this article.

Russian system of countermeasures on board of the International Space Station (ISS): the first results.

The system of countermeasures used by Russian cosmonauts in space flights on board of International Space Station (ISS) was based on the developed and tested in flights on board of Russian space stations. It included as primary components: physical methods aimed to maintain the distribution of fluids at levels close to those experienced on Earth; physical exercises and loading suits aimed to load the musculoskeletal and the cardiovascular systems; measures that prevent the loss of fluids, mainly, water-salt additives which aid to maintain orthostatic tolerance and endurance to gravitational overloads during the return to Earth; well-balanced diet and medications directed to correct possible negative reactions of the body to weightlessness. Fulfillment of countermeasure's protocols inflight was thoroughly controlled. Efficacy of countermeasures used were assessed both in- and postflight. The results of studies showed that degrees of alterations recorded in different physiological systems after ISS space flights in Russian cosmonauts were significantly higher than those recorded after flights on the Russian space stations. This phenomenon was caused by the failure of the ISS crews to execute fully the prescribed countermeasures' protocols which was as a rule excused by technical imperfectness of exercise facilities, treadmill TVIS particularly.

Some approaches to medical support for Martian expedition.

Medical support in a Martian expedition will be within the scope of crew responsibilities and maximally autonomous. Requirements to the system of diagnostics in this mission include considerable use of means and methods of visualization of the main physiological parameters, telemedicine, broad usage of biochemical analyses (including "dry" chemistry), computerized collection, measurement, analysis and storage of medical information. The countermeasure system will be based on objective methods of crew fitness and working ability evaluation, individual selection of training regimens, and intensive use of computer controlled training. Implementation of the above principles implies modernization and refinement of the countermeasures currently used by space crews of long-term missions (LTM), and increases of the assortment of active and passive training devices, among them a short-arm centrifuge. The system of medical care with the functions of prevention, clinical diagnostics and timely treatment will be autonomous, too. The general requirements to medical care during the future mission are the following: availability of conditions and means for autonomous urgent and special medical aid and treatment of the most possible states and diseases, "a hospital", and assignment to the crew of one or two doctors. To ensure independence of medical support and medical care in an expedition to Mars an automated expert system needs to be designed and constructed to control the medical situation as a whole.

Electromyographic activity in the Rhesus monkey forelimb muscles during a goal directed movement and locomotion before, during and after spaceflight.

The aim of the present study was to analyse the effects of microgravity on i) the achievement of goal-directed arm movements and ii) the quadrupedal non-human primate locomotion. A reaching movement in weightlessness would require less muscle contraction since there is no need to oppose gravity. Consequently the electromyographic (EMG) activity of the monkey forelimb muscles should be changed during or after spaceflight. EMG activity of the biceps and triceps muscles during goal-directed arm movements were studied in Rhesus monkeys before, during and after 14 days of spaceflight and flight simulation at normal gravity. The EMG activity was also recorded during treadmill locomotion before and after spaceflight. When performing arm motor tasks, the delay values of the EMG bursts were unchanged during the flight. On the contrary, mean EMG was significantly decreased during the flight comparatively to the pre- and post-flight values, which were very similar. Compared with flight animals, the control ground monkey showed no change in the burst durations and mean EMG. After spaceflight, quadrupedal locomotion was modified. The animals had some difficulty in moving, and abnormal steps were numerous. The integrated area of triceps bursts was increased for the stance phase during locomotion. Taken together these data showed that spaceflight induces a dual adaptative process: first, the discharge of the motor pools of the forelimb musculature was modified during exposure to microgravity, and then upon return to Earth, monkeys changed their new motor strategy and re-adapt to normal gravity.

The correlation between aerobic fitness and motion sickness susceptibility.

Susceptibility to motion sickness has been linked to aerobic fitness in several studies, however, these studies have not elucidated the underlying physiological mechanism by which increased aerobic fitness is related to a decreased ability to tolerate motion sickness stimuli. This pilot study provides further evidence of a relationship between aerobic fitness and motion sickness susceptibility. It also suggests that aerobic capacity is more specifically linked to signs and symptoms of vasomotor origin including stomach discomfort, nausea and/or vomiting, headache, and diaphoresis. By independently correlating vasomotor susceptibility and neurogenic susceptibility to maximum oxygen uptake, we find that vasomotor symptoms in particular are significantly increased in aerobically fit individuals. Larger studies should be conducted to confirm this relationship.

Smooth pursuit deficits in space flights of variable length.

The maintenance of stable vision is a primary function of the neurovestibular and sensory-motor systems. There is, however, strong evidence suggesting that space flight results in a modification of the central nervous system and subsequent control of ocular-motor responses. These changes effect those neural mechanisms which are responsible for holding images steady on the retina during brief, self-initiated, head rotations or during the voluntary pursuit of moving targets. Recent studies have shown significant saccadic intrusions in both of these experimental paradigms, including an inability to null the vestibulo-ocular reflex (VOR) during the head/eye pursuit task. The maintenance of vision, while not entirely stable, both inflight and immediately postflight is now believed to be due to neural strategies that evolve for the purpose of assisting in directing the moving target onto the retina.

Countermeasures for long-term space flights, lessons learned from the Russian space program.

Physical exercises (PE) constitute the most important part of the Russian countermeasure system which is proved to be highly successful in fighting negative effects of weightlessness on the physiological systems of the body. To control the intensity and volume of the workload and also specific features of the regimens used by cosmonauts during SF there were provided monthly 3-days recordings of cosmonaut training sessions with the subsequent downlinking of the obtained information to the ground control center. Additionally once a month cosmonauts performed a fitness test that was composed of 11 minutes of locomotion on the passive treadmill including slow, middle range and maximal running. The results of 3-days recordings and fitness test allowed to evaluate correctly effectiveness of PE protocols used by cosmonauts and to form recommendations for their corrections. The effectiveness of the onboard exercise program after SF was evaluated based on results of detailed studies of alterations that were recorded in different parts of sensory-motor system.