Factors associated with neck pain in fighter aircrew: a systematic review and meta-analysis.

Neck pain is a common complaint among fighter aircrew, impacting workforce health and operational capability. This systematic review aimed to identify, evaluate and synthesise the current evidence for factors associated with the occurrence of neck pain among fighter aircrew. Six electronic databases were searched in June 2019 and updated in June 2020 utilising the maximum date ranges. Included studies were appraised for methodological quality, ranked according to level of evidence and relevant data extracted. Where methods were homogeneous and data availability allowed, meta-analyses were performed. A total of 20 studies (16 cross sectional, one case-control, one retrospective cohort and two prospective cohort) were eligible for inclusion. Of the 44 factors investigated, consistent evidence was reported for greater occurrence of neck pain among aircrew operating more advanced aircraft and those exposed to more desk/computer work, while another 12 factors reported consistent evidence for no association. Of the 20 factors where meta-analyses could be performed, greater occurrence of neck pain was indicated for aircrew: flying more advanced aircraft, undertaking warm-up stretching and not placing their head against the seat under greater +Gz. Despite many studies investigating factors associated with neck pain among fighter aircrew, methodological limitations limited the ability to identify those factors that are most important to future preventive programmes. High-quality prospective studies with consistent use of definitions are required before we can implement efficient and effective programmes to reduce the prevalence and impact of neck pain in fighter aircrew. PROSPERO registration number: CRD42019128952.Neck pain is a common complaint among fighter aircrew, impacting workforce health and operational capability. This systematic review aimed to identify, evaluate and synthesise the current evidence for factors associated with the occurrence of neck pain among fighter aircrew.

COVID-19 lockdown and fatal motor vehicle collisions due to speed-related traffic violations in Japan: a time-series study.

Between March and May 2020, Japan experienced a lockdown due to the COVID-19 crisis. Empty roads possibly triggered speed-related traffic violations that caused fatal motor vehicle collisions (MVCs). Using police data on the monthly number of fatal MVCs between January 2010 and February 2020 in which motor vehicle drivers were at fault, we forecasted the numbers of fatal MVCs due to the speed-related violations during the lockdown and compared these with those observed. We also compared the observed to forecasted using the ratio of the number of speed-related fatal MVCs to that of non-speed related fatal MVCs. The observed numbers of speed-related fatal MVCs were within the 95% CIs of the forecasted numbers. The observed ratio was higher than the forecasted ratio in April (p=0.016). In the second month of the lockdown, drivers were more likely to commit speed-related violations that caused fatal MVCs than before the lockdown.

Acceleration-induced acute type A aortic dissection in the sky: 10-year follow-up.

Acute aortic dissection is uncommon, but can turn into a fatal disease if not managed quickly. A 49-year-old male fighter pilot presented to us after sudden excruciating chest pain during a flight at the moment of an acute spiral down action. A contrast-enhanced computed tomography angiography showed Stanford type A aortic dissection that required surgical ascending aorta and hemiarch replacement with uneventful postoperative recovery and 10-year follow-up. Here, we presented the first report of a previously healthy pilot developed acute aortic dissection in the sky. Physicians should be aware of such a case that might happen more common with rapid aviation progress.

Effect of acceleration on the rate of power development and neural activity of the leg extensors across the adult life span.

PURPOSE: The rate of power development (RPD) represents the capacity to rapidly generate power during a dynamic muscle contraction. As RPD is highly susceptible to aging, its decline can have important functional consequences. However, the effect of age on RPD in response to rapid changes in movement velocity (cfr. fall incidence) is not yet clear. Therefore, the present study aimed to examine the effect of age on RPD and neural drive in response to different accelerations. METHODS: Three maximal isokinetic leg extensor tests at 540°/s with different initial acceleration phases at 3200, 5700 and 7200°/s2 were performed. RPD, which is the slope of the power-time curve during the acceleration phase, was calculated for 83 subjects aged between 20 and 69 years. Mean electromyography signal amplitude was determined for rectus femoris (RF), vastus lateralis (VL) and biceps femoris muscles. RESULTS: The average annual age-related decline rate of RPD at highest acceleration was - 2.93% and was - 1.52% and - 1.82% higher compared to lower acceleration rates (p < 0.001). This deficit can probably be explained by an age-related impairment in neural drive during the first 75 ms of the acceleration phase, as evidenced by a reduced RF and VL neuromuscular activity of - 0.30% and - 0.36% at highest versus lowest acceleration (p < 0.05). CONCLUSION: These findings highlight the inability of aged individuals to quickly respond to abrupt changes in movement velocity, which requires more focus in training and prevention programs.

The effect of impact location on brain strain.

OBJECTIVE: To determine the effect of impact direction on strains within the brain. RESEARCH DESIGN: Laboratory drop tests of hybrid III head-form and finite element simulation of impacts. METHODS AND PROCEDURES: A head-form instrumented with accelerometers and gyroscopes was dropped from 10 different heights in four orientations: front, rear, left and right-hand side. Twelve impacts with constant impact energy were chosen to simulate, to determine the effect of the impact location. A finite element head model was used to simulate these impacts, using 6 degrees of freedom. Following this, a further set of simulations were performed, where the same acceleration profiles were applied to different head locations. MAIN OUTCOME AND RESULTS: The angular accelerations recorded were up to 30% higher in lateral and rear impacts when compared to frontal impacts. High strains in the midbrain (41%) were recorded from severe frontal impacts where as high strains in the corpus callosum (44%) resulted from lateral impacts with the same energy. CONCLUSION: Impact direction is very significant in determining the subsequent strains developed in the brain. Lateral impacts result in the highest strains in the corpus callosum and frontal impacts result in high strains in the mid-brain.

Deceleration, Acceleration, and Impacts Are Strong Contributors to Muscle Damage in Professional Australian Football.

Gastin, PB, Hunkin, SL, Fahrner, B, and Robertson, S. Deceleration, acceleration, and impacts are strong contributors to muscle damage in professional Australian football. J Strength Cond Res 33(12): 3374-3383, 2019-The purpose of this study was to investigate the relationships between serum creatine kinase [CK], an indirect marker of muscle damage, and specific indices of match load in elite Australian football. Twenty-six professional players were assessed during a competitive Australian Football League (AFL) season. [CK] was collected 24-36 hours before match and 34-40 hours after match during 8 in-season rounds. An athlete-tracking technology was used to quantify match load. Generalized estimating equations and random forest models were constructed to determine the extent to which match-load indices and pre-match [CK] explained post-match [CK]. There was a 129 ± 152% increase in [CK] in response to AFL competition. Generalized estimating equations found that number of impacts >3g (p = 0.004) and game time (p = 0.016) were most strongly associated with post-match [CK]. Random forest, with considerably lower errors (130 vs. 316 U·L), found deceleration, acceleration, impacts >3g, and sprint distance to be the strongest predictors. Pre-match [CK] accounted for 11% of post-match [CK], and considerable interindividual and intraindividual variability existed in the data. Creatine kinase, an indicator of muscle damage, was considerably elevated as a result of AFL competition. Parametric and machine-learning analysis techniques found several indices of physical load associated with muscle damage during competition, with impacts >3g and high-intensity running variables as the strongest predictors. [CK] may be used as a global measure of muscle damage in field team sports such as AF, yet with some caution given cost, invasiveness, and inherent variability. Quantifying physical load and the responses to that load can guide athlete management decision-making and is best undertaken within a suite of practical, sport-specific measures, where data are interpreted individually and with an understanding of the limitations.

Frequency-dependence of discomfort caused by vibration and mechanical shocks.

The frequency content of a mechanical shock is not confined to its fundamental frequency, so it was hypothesised that the frequency-dependence of discomfort caused by shocks with defined fundamental frequencies will differ from the frequency-dependence of sinusoidal vibration. Subjects experienced vertical vibration and vertical shocks with fundamental frequencies from 0.5 to 16 Hz and magnitudes from ±0.7 to ±9.5 ms-2. The rate of growth of discomfort with increasing magnitude of motion decreased with increasing frequency of both motions, so the frequency-dependence of discomfort varied with the magnitudes of both motions and no single frequency weighting will be ideal for all magnitudes. At the frequencies of sinusoidal vibration producing greatest discomfort (4-16 Hz), shocks produced less discomfort than vibration with same peak acceleration or unweighted vibration dose value. Frequency-weighted vibration dose values provided the best predictions of the discomfort caused by different frequencies and magnitudes of vibration and shock. Practitioner Summary: Human responses to vibration and shock vary according to the frequency content of the motion. The ideal frequency weighting depends on the magnitude of the motion. Standardised frequency-weighted vibration dose values estimate discomfort caused by vibration and shock but for motions containing very low frequencies the filtering is not optimum.

Helicopter Transportation Increases Intracranial Pressure: a Proof-of-Principle Study.

OBJECTIVE: After severe (primary) brain injury, Dutch physician-based helicopter emergency medical services start therapy to lower the intracranial pressure (ICP) on scene to stop or delay secondary brain injury. In some cases, helicopter transportation to the nearest level 1 trauma center is indicated. During transportation, the head-down position may counteract the ICP-lowering strategies because of venous blood pooling in the head. To examine this theory, we measured the optic nerve sheath diameter (ONSD) during helicopter transport in healthy volunteers. METHODS: The ONSD was measured by ultrasound in healthy volunteers during helicopter liftoff and acceleration in the supine position or with a raised headrest. RESULTS: In this proof-of-principle study, the ONSD increased during helicopter acceleration (-9° Trendelenburg, mean = 5.6 ± .3 mm) from baseline (0° supine position, mean = 5.0 ± .4 mm). After headrest elevation (20°-25°), the ONSD did not increase during helicopter acceleration (mean ONSD = 5.0 ± .5 mm). CONCLUSION: ONSD and ICP seem to increase during helicopter transportation in -9° head-down (Trendelenburg) position. By raising the headrest of the gurney before liftoff, these effects can be prevented.

Intraocular pressure and cerebral oxygenation during prolonged headward acceleration.

PURPOSE: Supra-tolerance head-to-foot directed gravitoinertial load (+Gz) typically induces a sequence of symptoms/signs, including loss of: peripheral vision-central vision-consciousness. The risk of unconsciousness is greater when anti-G-garment failure occurs after prolonged rather than brief exposures, presumably because, in the former condition, mental signs are not consistently preceded by impaired vision. The aims were to investigate if prolonged exposure to moderately elevated +Gz reduces intraocular pressure (IOP; i.e., improves provisions for retinal perfusion), or the cerebral anoxia reserve. METHODS: Subjects were exposed to 4-min +Gz plateaux either at 2 and 3 G (n = 10), or at 4 and 5 G (n = 12). Measurements included eye-level mean arterial pressure (MAP), oxygenation of the cerebral frontal cortex, and at 2 and 3 G, IOP. RESULTS: IOP was similar at 1 (14.1 ± 1.6 mmHg), 2 (14.0 ± 1.6 mmHg), and 3 G (14.0 ± 1.6 mmHg). During the G exposures, MAP exhibited an initial prompt drop followed by a partial recovery, end-exposure values being reduced by ≤30 mmHg. Cerebral oxygenation showed a similar initial drop, but without recovery, and was followed by either a plateau or a further slight decrement to a minimum of about -14 µM. CONCLUSION: Gz loading did not affect IOP. That cerebral oxygenation remained suppressed throughout these G exposures, despite a concomitant partial recovery of MAP, suggests that the increased risk of unconsciousness upon G-garment failure after prolonged +Gz exposure is due to reduced cerebral anoxia reserve.

A Drosophila model of closed head traumatic brain injury.

Traumatic brain injury (TBI) is a substantial health issue worldwide, yet the mechanisms responsible for its complex spectrum of pathologies remains largely unknown. To investigate the mechanisms underlying TBI pathologies, we developed a model of TBI in Drosophila melanogaster. The model allows us to take advantage of the wealth of experimental tools available in flies. Closed head TBI was inflicted with a mechanical device that subjects flies to rapid acceleration and deceleration. Similar to humans with TBI, flies with TBI exhibited temporary incapacitation, ataxia, activation of the innate immune response, neurodegeneration, and death. Our data indicate that TBI results in death shortly after a primary injury only if the injury exceeds a certain threshold and that age and genetic background, but not sex, substantially affect this threshold. Furthermore, this threshold also appears to be dependent on the same cellular and molecular mechanisms that control normal longevity. This study demonstrates the potential of flies for providing key insights into human TBI that may ultimately provide unique opportunities for therapeutic intervention.

Cerebral Oxygenation and Acceleration in Pediatric and Neonatal Interfacility Transport.

OBJECTIVE: The purpose of this study is to measure peak acceleration forces during interfacility transport; examine whether drops in cerebral oxygenation occurred; and test the associations between cerebral oxygenation, acceleration, and patient positioning. METHODS: A cerebral oximeter (INVOS-5100C; Somanetics, Minneapolis, MN) monitored regional saturation of oxygen (rSO2 [cerebral oxygenation]) in pediatric and neonatal patients (N = 24) transported between facilities by ground ambulance, helicopter, or fixed wing aircraft. An accelerometer (GP1; SENSR, Georgetown, TX) bolted to the isolette or gurney recorded z-axis (aligned with the spine) accelerations. RESULTS: The z-axis peak accelerations (absolute values of g) by transport type were as follows: ground ambulance takeoff mean = 0.16 and landing mean = 0.08, helicopter takeoff mean = 0.16 and landing mean = 0.05, fixed wing aircraft takeoff mean = 0.14 and landing mean = 0.20. During takeoff, 2 of 7 patients in the head-to-front of vehicle position experienced rSO2 drop. During landing, 4 of 13 patients in the head-to-back of vehicle position experienced rSO2 drop. There were no significant associations of rSO2 drop during takeoff and landing with patient positioning or with z-axis peak acceleration. CONCLUSION: Acceleration forces of pediatric and neonatal interfacility transport are small and comparable in magnitude. The relationship between rSO2 drop and patient positioning was not significant in this pilot study.

Neurocognitive responses to a single session of static squats with whole body vibration.

The purpose of this study was to determine if the head accelerations using a common whole body vibration (WBV) exercise protocol acutely reduced neurocognition in healthy subjects. Second, we investigated differential responses to WBV plates with 2 different delivery mechanisms: vertical and rotational vibrations. Twelve healthy subjects (N = 12) volunteered and completed a baseline (BASE) neurocognitive assessment: the Immediate Postconcussion Assessment and Cognitive Test (ImPACT). Subjects then participated in 3 randomized exercise sessions separated by no more than 2 weeks. The exercise sessions consisted of five 2-minute sets of static hip-width stance squats, with the knees positioned at a 45° angle of flexion. The squats were performed with no vibration (control [CON]), with a vertically vibrating plate (vertical vibration [VV]), and with a rotational vibrating plate (rotational vibration [RV]) set to 30 Hz with 4 mm of peak-to-peak displacement. The ImPACT assessments were completed immediately after each exercise session and the composite score for 5 cognitive domains was analyzed: verbal memory, visual memory, visual motor speed, reaction time, and impulse control. Verbal memory scores were unaffected by exercise with or without vibration (p = 0.40). Likewise, visual memory was not different (p = 0.14) after CON, VV, or RV. Significant differences were detected for visual motor speed (p = 0.006); VV was elevated compared with BASE (p = 0.01). There were no significant differences (p = 0.26) in reaction time or impulse control (p = 0.16) after exercise with or without vibration. In healthy individuals, 10 minutes of 30 Hz, 4-mm peak-to-peak displacement vibration exposure with a 45° angle of knee flexion did not negatively affect neurocognition.

Predicting the health risks related to whole-body vibration and shock: a comparison of alternative assessment methods for high-acceleration events in vehicles.

In this paper, alternative assessment methods for whole-body vibration and shocks are compared by means of 70 vibration samples measured from 13 work vehicles, deliberately selected to represent periods containing shocks. Five methodologies (ISO 2631-1:1997, BS 6841:1987, ISO 2631-5:2004, DIN SPEC 45697:2012 and one specified by Gunston [2011], 'G-method') were applied to the vibration samples. In order to compare different evaluation metrics, limiting exposures were determined by calculating times to reach the upper limit thresholds given in the methods. Over 10-fold shorter times to exposure thresholds were obtained for the tri-axial VDV (BS 6841) than for the dominant r.m.s. (ISO 2631-1) when exposures were of high magnitude or contained substantial shocks. Under these exposure conditions, the sixth power approaches (ISO 2631-5, DIN SPEC, G-method) are more stringent than a fourth power VDV method. The r.m.s. method may lead to misleading outcomes especially if a lengthy measurement includes a small number of severe impacts. In conclusion, methodologies produce different evaluations of the vibration severity depending on the exposure characteristics, and the correct method must be selected. PRACTITIONER SUMMARY: Health risks related to whole-body vibration and high acceleration events may be predicted by means of several different methods. This study compares five such methods giving emphasis on their applicability in the presence of shocks. The results showed significant discrepancies between the risk assessments, especially for the most extreme exposures.

Effect of reclining a seat on the discomfort from vibration and shock on fast boats.

Passengers and crew on fast boats can experience high magnitudes of whole-body vibration and mechanical shocks that may present risks to health and cause discomfort. This study investigated the influence of reclining a seat on the discomfort caused by fast-boat motion and whether discomfort can be predicted by overall ride values according to current standards. Subjects judged the discomfort of simulations of a recorded fast boat motion in a seat reclined by 0°, 15°, 30°, 45°, or 60°. Reclining the seat caused no significant change in overall discomfort, suggesting that if a reclined seat can be shown to reduce risks of injury it may be acceptable in respect of comfort. The findings are inconsistent with the predictions of standards and show that revised frequency weightings are required to account for seat pan or seat back inclination. PRACTITIONER SUMMARY: Contrary to predictions of current standards, reclining a seat may not increase discomfort during fast-boat motion. Revised frequency weightings for evaluating the severity of whole-body vibration are required to account for seat pan or seat back inclination.

Measures of internal lumbar load in professional drivers - the use of a whole-body finite-element model for the evaluation of adverse health effects of multi-axis vibration.

The present study aimed to (1) employ the method for evaluation of vibration containing multiple shocks according to ISO/CD 2631-5:2014 (Model 1) and DIN SPEC 45697:2012 in a cohort of 537 professional drivers, (2) deliver the results for a re-analysis of epidemiological data obtained in the VIBRISKS study, (3) clarify the extent to which vibration acceleration and individual variables influence risk values, such as the daily compressive dose S(ed) and the risk factor R, and (4) compare the results with in vivo measurements and those obtained in previous studies with similar models. The risk factor R was influenced by the acceleration, lifetime exposure duration, sitting posture, age at the start of exposure and body mass/body mass index in order of decreasing effect. Age and annual and daily exposure duration had only a marginal effect. The daily compressive dose S(ed) and the risk factor R showed weak linear association with the daily vibration exposure A(8) and the vibration dose value VDV. The study revealed high shear forces in the lumbar spine. PRACTITIONER SUMMARY: In a re-analysis of an epidemiological study of professional drivers, a software tool available with standards DIN SPEC 45697:2012 and ISO/CD 2631­5:2014 Model 1 was used to calculate the risk to the lumbar spine in terms of daily compressive dose S(ed) and risk factor R. The tool was found to be suitable for risk assessment in a large cohort.

The Use of Release-Active Antibody-Based Preparations for Vertigo Prevention in Adults.

The effectiveness of antibody-based release-active preparations Impaza (antibodies to eNOS), Tenoten (antibodies to brain-specific protein S-100), Dietressa (antibodies to type 1 cannabinoid receptor), Brizantin (combined preparation, antibodies to brain-specific protein S-100 and type 1 cannabinoid receptor), and Divaza (combined preparation, antibodies to brain-specific protein S-100 and eNOS) in the prevention of vertigo was studied on the model of intermittent accumulation of Coriolis accelerations (ICCA). Modification of activity of vestibular receptors and signal systems by release-active preparations contributed to an increase in ICCA tolerance time. Combined preparation Impaza possessed the most significant antinaupathic properties. Brizantin was less potent in this respect.

Biomechanics of subdural hemorrhage in American football: review of the literature in response to rise in incidence.

The number of catastrophic head injuries recorded during the 2011 football season was the highest since data collection began in 1984--the vast majority of these cases were secondary to subdural hemorrhage (SDH). The incidence of catastrophic head injury continues to rise: the average yearly incidence from 2008 to 2012 was 238% that of the average yearly incidence from 1998 to 2002. Greater than 95% of the football players who suffered catastrophic head injury during this period were age 18 or younger. Currently, the helmet industry utilizes a standard based on data obtained at Wayne State University approximately 50 years ago that seeks to limit severity index--a surrogate marker of translational acceleration. In this manuscript, we utilize a focused review of the literature to better characterize the biomechanical factors associated with SDH following collisions in American football and discuss these data in the context of current helmet standard. Review of the literature indicates the rotational acceleration (RA) threshold above which the risk of SDH becomes appreciable is approximately 5,000 rad/s(2). This value is not infrequently surmounted in typical high school football games. In contrast, translational accelerations (TAs) experienced during even elite-level impacts in football are not of sufficient magnitude to result in SDH. This information raises important questions about the current helmet standard--in which the sole objective is limitation of TA. Further studies will be necessary to better define whether helmet constructs and quality assurance standards designed to limit RA will also help to decrease the risk of catastrophic head injury in American football.

Significant head accelerations can influence immediate neurological impairments in a murine model of blast-induced traumatic brain injury.

Although blast-induced traumatic brain injury (bTBI) is well recognized for its significance in the military population, the unique mechanisms of primary bTBI remain undefined. Animate models of primary bTBI are critical for determining these potentially unique mechanisms, but the biomechanical characteristics of many bTBI models are poorly understood. In this study, we examine some common shock tube configurations used to study blast-induced brain injury in the laboratory and define the optimal configuration to minimize the effect of torso overpressure and blast-induced head accelerations. Pressure transducers indicated that a customized animal holder successfully reduced peak torso overpressures to safe levels across all tested configurations. However, high speed video imaging acquired during the blast showed significant head accelerations occurred when animals were oriented perpendicular to the shock tube axis. These findings of complex head motions during blast are similar to previous reports [Goldstein et al., 2012, "Chronic Traumatic Encephalopathy in Blast-Exposed Military Veterans and a Blast Neurotrauma Mouse Model," Sci. Transl. Med., 4(134), 134ra160; Sundaramurthy et al., 2012, "Blast-Induced Biomechanical Loading of the Rat: An Experimental and Anatomically Accurate Computational Blast Injury Model," J. Neurotrauma, 29(13), pp. 2352-2364; Svetlov et al., 2010, "Morphologic and Biochemical Characterization of Brain Injury in a Model of Controlled Blast Overpressure Exposure," J. Trauma, 69(4), pp. 795-804]. Under the same blast input conditions, minimizing head acceleration led to a corresponding elimination of righting time deficits. However, we could still achieve righting time deficits under minimal acceleration conditions by significantly increasing the peak blast overpressure. Together, these data show the importance of characterizing the effect of blast overpressure on head kinematics, with the goal of producing models focused on understanding the effects of blast overpressure on the brain without the complicating factor of superimposed head accelerations.

Kinematic and dynamic biomechanical values in relation to muscle activity during contact head impact.

OBJECTIVE: For the evaluation of neck injury the relative distance was observed between a marker placed on the forehead and a marker placed on the shoulder and also by change of the angle. To compare the severity of head injury a value of maximum head acceleration was used, HIC and a 3 ms criterion. All criteria were related to the activity of musculus sternocleidomastoideus and musculus trapezius in a situation of expected or unexpected contact impact. MATERIALS AND METHODS: The situation was recorded using a Qualisys system, head acceleration of probands in three axes was recorded using the accelerometer, activity of neck muscles was monitored by a mobile EMG. RESULTS: Maximum head acceleration was 5.61 g for non-visual and 5.03 g for visual. HIC36 was 6.65 non visual and 5.97 for visual. 3-ms criterion was 5.37 g for non-visual and 4.89 g for visual and max. force was 291 N for non-visual and 314 N for visual. The average time of muscle activation of the observed group without visual perception is 0.355 s after hitting an obstacle, with visual perception 0.085 s before the crash. CONCLUSIONS: Kinematic values indicate more favourable parameters for neck injuries for visual. Head injury criteria show an average decrease of about 10% for visual. We can conclude that the visual perception means a significant increase in pre-activation of the observed muscle group of almost 745% and lower activation in following phase of approximately 90%.

Onset of positional vertigo during exposure to combined G loading and chest-to-spine vibration.

BACKGROUND: Aerospace environments commonly expose pilots to vibration and sustained acceleration, alone and in combination. CASE REPORTS: Of 16 experimental research participants, 3 reported symptoms of vertigo and signs of torsional nystagmus during or shortly following exposure to sustained chest-to-spine (+3.8 Gx) acceleration (G loading) and chest-to-spine (0.5 g(x)) vibration in the 8-16 Hz band. Two of the participants reported intermittent vertigo for up to 2 wk, were diagnosed with benign paroxysmal positional vertigo (BPPV), and were treated successfully with the Epley Maneuver. On a follow-up survey, a third participant reported transient BPPV-like vertigo, which resolved spontaneously. The follow-up survey also prompted participants to self-report other effects following research protocol exposure to vibration and G loading, revealing details about other minor and transient, but more common, effects that resolved within 3 h. DISCUSSION: Our studies indicated a significantly elevated incidence of BPPV following exposure to vibration plus G loading compared to vibration alone that was positively correlated with participant age. One mechanism for the rolling sensation in BPPV involves broken or dislodged otoconia floating within one of the posterior semicircular canals, making the canal gravity-sensitive. Our observations highlight a heretofore unforeseen risk of otolith damage sustained during launch, undetectable in space, potentially contributing to vertigo and perceived tumbling upon re-entry from microgravity.