This proposal responds to NASA Research Announcement (NRA) NNJ09ZSA002N and teams world experts in musculoskeletal (MSK) ultrasound at Henry Ford Health System (HFHS) and space medical experts at Wyle Integrated Science and Engineering to evaluate the ability of ultrasound to characterize acute microgravity associated changes in lumbar and cervical spine to provide operationally relevant data to optimize crew health and guide countermeasure development.
An increased height of astronauts is seen during microgravity; the exact mechanism is unclear. Relaxation of the postural muscles, combined with elongation of inter-vertebral disc spaces may be involved. Back pain is frequent during adaption to spaceflight; however, this has not resulted in changes to mission requirements or objectives. Neurologic sequelae have been seen with terrestrial spinal elongation; fortunately this has not occurred in astronaut crews.
This proposal will determine the accuracy of MSK ultrasound in characterizing the anatomy of the vertebral unit (disc, musculature, facets, ligaments) and develop just-in-time training methodologies to provide essential information to answer operationally relevant mandates with a team of experts to conduct ground, simulated microgravity, and in-flight experiments to answer the aims:
1. Determine the accuracy of MSK ultrasound in characterizing the normal and microgravity associated changes in the vertebral unit.
2. Investigate the human factors, level of experience, and training necessary to perform focused cervical and lumbar vertebral MSK ultrasound in microgravity with inexperienced ultrasound operators in parallel with expert operators.
3. Determine the anatomic changes in the vertebral unit during long duration spaceflight with astronaut performed vertebral ultrasound.
Design and Methods
I. GROUND BASED INVESTIGATIONS
Baseline evaluation of vertebral unit with MSK ultrasound: Expert sonologists at HFHS will perform magnetic resonance imaging (MRI) and vertebral unit MSK examinations on normal volunteers to assess anatomic accuracy, develop normalization tables, and optimize methodology.
Just in time training methodologies for non-expert users
A multi-media, just in time training program with reference cue cards will be developed for non-expert operators. The ability of non-expert operators to perform vertebral MSK examinations autonomously or with remote-expert guidance will be evaluated.
II. SIMULATED MICROGRAVITY INVESTIGATIONS
Human factors analysis of vertebral MSK ultrasound in a microgravity environment will be completed during parabolic flight to optimize subject and operator positioning and restraint.
III. FLIGHT INVESTIGATIONS
Pre-flight and Post-flight: The flight procedures will consist of a comprehensive vertebral MSK ultrasound and MRI evaluation of long duration crew-members. In-flight procedures will be conducted on the International Space Station (ISS) using the Human Research Facility (HRF) ultrasound at early, mid, and late mission time periods: a post-flight MSK ultrasound and MRI will also be done to assess microgravity anatomic effects and gravitational return to baseline.
Significance to NASA: This proposal will provide longitudinal, real time data regarding adaptation of the vertebral unit during long duration spaceflight to enhance mission completion, countermeasure development, and astronaut health. The ability to assess the crewmember musculoskeletal system is critical to guide countermeasures, provide functional data for high risk or impact activities, and assess acute injuries which may occur during exploration class spaceflight. Astronaut performed ultrasound examinations on the ISS have demonstrated that diagnostic quality images can be obtained with targeted training: the procedures developed and verified during this proposal will provide novel data and capabilities to enhance crew health for long duration space missions. |