NOTE: End date changed to 6/30/2022 per HHC (Ed., 6/28/2022)

Specific Aims:

1. Quantify functional performance from measurements on long-duration crewmembers taken as close in time to landing as possible.

2. Develop a recovery timeline of functional performance on long-duration crewmembers.

3. Determine the efficacy of U.S. and Russian compression garments as countermeasures for alleviating orthostatic intolerance.

Dr. Reschke has retired from NASA. The new Principal Investigator is Scott Wood, Ph.D. For information on the continued investigation, see "Recovery of Functional Performance Following Long Duration Space Flight (Field Test) (PI: Wood)".

September 2021 Report:

During this reporting period, our Institute of Biomedical Problems (IBMP) colleagues received permission to resume their portion of the Field Test (FT) to achieve the originally agreed upon subject count of 30. During this reporting period, IBMP collected data on the final three Russian subjects during 62S (October 2020 landing) and 63S (April 2021 landing). As previously reported, eighteen subjects (7 Russian, 11 USOS ) had completed the reduced FT (pilot) protocol between Expeditions 36 and 43 (September 2013 - June 2015 landings). The full protocol included 19 Russian and 11 USOS subjects between Expeditions 44 and 63 (September 2015 – April 2021). Of the full FT, two (1 Russian, 1 USOS) were one-year mission crewmembers and one (USOS) was on orbit for 9 mo. It is also important to note that 9 of the Russian FT subjects had previously participated in either the pilot (n=6) or full (n=3) protocols. In summary, the NASA and Russian teams collected data on a total of 39 different United States Orbital Segment (USOS) and Russian crewmembers in both the pilot and full Field Test, with 9 Russian crewmembers being tested twice (total of 48 subject assignments).

The special issue of the Russian journal Aerospace and Environmental Medicine honoring the Co-Principal Investigator of the FT, our long-time colleague Dr. Inessa Kozlovskaya, was published in December 2020. As previously reported, Reschke et al. summarized the FT methodology in this issue, which provided the basis for the sensorimotor portion of the Standard Measures to be conducted throughout the remainder of the International Space Station (ISS) program. As an example of the functional deficits observed, Reschke et al. (Aerosp Environ Med, 2020--see Bibliography section) presented results for the seat egress and walking task that involved turning 180 degrees and stepping over obstacles. This task referred to as the Walk and Turn with Obstacle was subsequently added to the Standard Measures protocol.

Another manuscript in preparation is focused on the time course of recovery using data from both the pilot and full FT protocols. Based on this combined data set, 100% of crewmembers experienced some level of motion sickness symptoms upon landing. However, the incidence and severity of motion sickness is dramatically reduced within the first 24 hr. Both pilot and full FT included sit-to-stand, prone-to-stand (also referred to as recovery from fall), and the tandem walk with eyes open and closed. The time course of recovery varied by task difficulty; however, performance improved across all tasks within the first 24 hrs.

One of the general findings of FT is that the multiple test sessions on landing day seem to enhance readaptation. An additional manuscript is in preparation to capture this finding by comparing the results of FT participants and controls not participating in FT on the required medical test using Computerized Dynamic Posturography. This test is typically performed immediately following return to Johnson Space Center (JSC) on all crewmembers. While there is a high degree of variability in both groups, the FT participants on average performed better on the posture tests following the direct return. This provides evidence that the sensorimotor recovery may be enhanced with incrementally increasing rehabilitation tasks similar to what was used in FT.

The results from FT have been included in several briefings on deconditioned crewmembers this past year, including to the Commercial Crew Program, as well as the Orion and Human Landing System management teams. The FT data was also a critical part of the evidence base for the December 2020 Human System Risk Board (HSRB) review of the risk of altered sensorimotor/vestibular function impacting critical mission tasks (Sensorimotor Risk). During the upcoming year, the two manuscripts mentioned above will be submitted following the inclusion of the final subjects. In addition, a comprehensive manuscript including all of the FT tasks will be submitted with our Russian colleagues. This manuscript will also utilize the repeated tests (n=9) to examine the effect of previous flight experience.

NOTE: End date changed to 6/30/2022 per HHC (Ed., 6/28/2022)

Specific Aims:

1. Quantify functional performance from measurements on long-duration crewmembers taken as close in time to landing as possible.

2. Develop a recovery timeline of functional performance on long-duration crewmembers.

3. Determine the efficacy of U.S. and Russian compression garments as countermeasures for alleviating orthostatic intolerance.

Lee et al. (Front Physiol, 2020--see Bibliography section) published the results of the portion of FT designed 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. In this manuscript, they presented the results of the eleven USOS astronauts (9 M, 2 F) that completed the full FT protocol. The stand test protocol consisted of 2 min of prone rest followed by 3.5 min of standing. Subjects completed one familiarization session and two preflight data collection sessions in standard clothing. Three tests on landing day while wearing GCG were conducted 1-4 h (R+0A), ~12 h (R+0B), and ~28 h after landing (R+0C). 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). A 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. Therefore, wearing the GCG after space flight prevented the tachycardia that normally occurs while standing after space flight without compression garments and protected against a decrease in blood pressure during a short stand test.

A special issue of the Russian journal Aerospace and Environmental Medicine (Aviakosmicheskaia i ekologicheskaia meditsina) is pending publication to honor the Co-PI of the FT, our long-time colleague Dr. Inessa Kozlovskaya, who passed away in February 2020. In this issue, Reschke et al. (see Bibliography section) summarize the FT methodology, which has provided the basis for the sensorimotor portion of the Standard Measures which will be conducted through the remainder of the International Space Station (ISS) program. As an example of the functional deficits observed, Reschke et al. (Aersop Environ Med, 2020) presented results for 38 FT subjects on the seat egress and walking task that involved turning 180 degrees and stepping over obstacles. Significant increases in the time-to-complete this task on landing day were observed. The differences were greatest for the first trial using the 5 cm obstacle (t(37)= 10.5, p<0.01) but were also highly significant for the 10 cm (t(37)= 8.0, p<0.01) and 15 cm obstacles (t(37)= 7.6, p<0.01). The greater difference for the 5 cm obstacle was likely due to the fact that this was the first trial. This task referred to as the Walk and Turn with Obstacle has recently been added to the Standard Measures protocol.

The completion of the data analysis and publications has been impacted by COVID-19 related delays in receiving the final set of Russian data. This transfer is expected during the upcoming fall (2020). A major focus of the analysis this past year has been on characterizing the time course of recovery of three measures that were included in both pilot and full FT protocols. We anticipate the draft manuscript describing these results to be submitted in the early portion of FY21.

Specific Aims:

1. Quantify functional performance from measurements on long duration crewmembers taken as close in time to landing as possible.

2. Develop a recovery timeline of functional performance on long duration crewmembers.

3. Determine the efficacy of U.S. and Russian compression garments as countermeasures for alleviating orthostatic intolerance.

To ensure that data could be collected on both astronauts and cosmonauts immediately after landing the research has been divided into two investigative efforts: (1) a Pilot Field Test and (2) the full Field Test. The full Field Test will begin with the first U.S. International Space Station one year mission (42S).

Pilot Studies: A total of 18 crewmembers (11 United States Orbital Segment [USOS] and 7 cosmonauts) from eight Expeditions completed the dataset for the Pilot Field Test (PFT) study, which consisted of performing three simple tasks as soon after landing as possible: Sit-to-Stand, Recovery from Fall, and Tandem Heel-to-Toe Walk. Tests were conducted either in the medical tent at the Soyuz landing site or at the Karaganda/Kustanai airport in Kazakhstan (KZ). After demonstrating successful data collections at the landing site, two additional PFT sessions were added to the R+0 postflight schedule: one at the refueling airport in Scotland and the other at the Johnson Space Center Astronaut Crew Quarters. Eight of the 11 USOS astronauts were tested at all three locations on landing day. Additionally, data were collected in the medical tent on all three returning crewmembers for two separate Expeditions, demonstrating that multiple crewmembers can be tested on the same mission at the Soyuz landing site.

Field Test:

The Field Test (FT), being a joint US/Russian study, has faced many logistical challenges. Therefore, a second US FT operator was dispatched to KZ and introduced to all of the stakeholders involved in crew return activities in KZ (in the medical tent) and Norway/Scotland (at the refueling airport), and was trained as a back-up operator to conduct these high profile tasks. Also, the US FT team continued to conduct demonstrations and training sessions for the assigned flight surgeons before each landing so they could assist in the field and other remote locations as needed. Single operator data collection for two USOS crewmembers was completed successfully for the first time in the field and at Prestwick, Scotland, UK.

To date, a total of 17 six-month crewmembers (7 USOS and 10 cosmonauts) have completed the FT. In addition, two One-Year mission crewmembers (one USOS and one cosmonaut) and one 9.5-month crewmember (USOS) have also completed the FT. The FT team continued to consistently demonstrate that it is possible to conduct the entire test (9 tasks) in the tent/airport in KZ and at the refueling station where time is greatly constrained, including: 1) Gaze Nystagmus, 2) Sit-to-Stand, 3) Recovery from Fall, 4) Dysmetria, 5) Eye/Hand Coordination, 6) Force Discrimination, 7) Seat Egress Obstacle, 8) Tandem Heel to Toe Walk, 9) Push Test, and 10) Dynamic Visual Acuity (DVA is not collected in KZ).

Specific Aims:

1. Quantify functional performance from measurements on long duration crewmembers taken as close in time to landing as possible.

2. Develop a recovery timeline of functional performance on long duration crewmembers.

3. Determine the efficacy of U.S. and Russian compression garments as countermeasures for alleviating orthostatic intolerance.

To ensure that data could be collected on both astronauts and cosmonauts immediately after landing the research has been divided into two investigative efforts: (1) a Pilot Field Test and (2) the full Field Test. The full Field Test will begin with the first U.S. International Space Station one year mission (42S).

Pilot Studies: A total of 18 crewmembers (11 United States Orbital Segment [USOS] and 7 cosmonauts) from eight Expeditions completed the dataset for the Pilot Field Test (PFT) study, which consisted of performing three simple tasks as soon after landing as possible: Sit-to-Stand, Recovery from Fall, and Tandem Heel-to-Toe Walk. Tests were conducted in either the medical tent at the Soyuz landing site, or at the Karaganda/Kustanai airport in Kazakhstan (KZ). After demonstrating successful data collections at the landing site, two additional PFT sessions were added to the R+0 postflight schedule: one at the refueling airport in Scotland and the other at the Johnson Space Center Astronaut Crew Quarters. Eight of the 11 USOS astronauts were tested at all three locations on landing day. Additionally, data were collected in the medical tent on all three returning crewmembers for two separate Expeditions, demonstrating that multiple crewmembers can be tested on the same mission at the Soyuz landing site.

Field Test: The Field Test (FT), being a joint US/Russian study, has been faced with many logistical challenges. Therefore, a second US FT operator was dispatched to KZ and introduced to all of the stakeholders involved in crew return activities in KZ (in the medical tent) and Norway (at the airport), and was trained as a back-up operator to conduct these high profile tasks. Also, the US FT team continued to conduct demonstrations and training sessions for the assigned flight surgeons before each landing so they could assist in the field and other remote locations as needed. Finally, single operator training and certification was completed for several laboratory members in preparation for supporting parallel data collections on 2 USOS crewmembers in the field and remote locations.

The team began investigating new motion capture methods so that “skeleton” videos of crew performance can be created for use in presentations and reports without compromising subject identity, including Microsoft Kinect and machine learning post-video analysis. The Kinect method can also serve as a backup when traditional video is occluded.

To date, a total of eleven 6-month crewmembers (four USOS and seven cosmonauts) have completed the FT. In addition, two One-Year mission crewmembers (one USOS and one cosmonaut) and one 9.5-month crewmember (USOS) have also completed the FT. The FT team has consistently demonstrated that it is possible to conduct the entire test (9 tasks) in the tent/airport in KZ and at the refueling station where time is greatly constrained, including: 1) Gaze Nystagmus, 2) Sit-to-Stand, 3) Recovery from Fall, 4) Dysmetria, 5) Eye/Hand Coordination, 6) Force Discrimination, 7) Seat Egress Obstacle, 8) Tandem Heel to Toe Walk, 9) Push Test, and 10) Dynamic Visual Acuity (DVA is not collected in KZ).

Specific Aims:

1. Quantify functional performance from measurements on long duration crewmembers taken as close in time to landing as possible.

2. Develop a recovery timeline of functional performance on long duration crewmembers.

3. Determine the efficacy of U.S. and Russian compression garments as countermeasures for alleviating orthostatic intolerance.

To ensure that data could be collected on both astronauts and cosmonauts immediately after landing the research has been divided into two investigative efforts: (1) a Pilot Field Test and (2) the full Field Test. The full Field Test will begin with the first U.S. International Space Station one year mission (42S).

Pilot Studies: A total of 18 crewmembers (11 United States Orbital Segment [USOS] and 7 cosmonauts) from eight Expeditions completed the dataset for the Pilot Field Test (PFT) study, which consisted of performing three simple tasks as soon after landing as possible: Sit-to-Stand, Recovery from Fall, and Tandem Heel-to-Toe Walk. Tests were conducted in either the medical tent at the Soyuz landing site, or at the Karaganda/Kustanai airport in Kazakhstan (KZ). After demonstrating successful data collections at the landing site, two additional PFT sessions were added to the R+0 postflight schedule: one at the refueling airport in Scotland and the other at the Johnson Space Center (JSC) Astronaut Crew Quarters. Eight of the 11 USOS astronauts were tested at all three locations on landing day. Additionally, data were collected in the medical tent on all three returning crewmembers for two separate Expeditions, demonstrating that multiple crewmembers can be tested on the same mission at the Soyuz landing site.

Field Test: The Field Test (FT), being a joint US/Russian study, has been faced with many challenges. Newly implemented NASA Information Technology (IT) security regulations caused significant delays in the shipment of the FT hardware to the Gagarin Cosmonaut Training Center (GCTC) in Star City, Russia. To prevent loss of data, preflight data were collected on two cosmonauts during their trips to JSC. After considerable effort to comply with IT regulations, the decision was made to obtain temporary IT waivers that would permit the use of NASA computers to collect the postflight data for one cosmonaut only, then bring the NASA computers back and have the Russians purchase the needed computers. All postflight testing was successfully completed on the first cosmonaut, after which, JSC FT personnel helped the Russian FT team purchase compatible computers and set them up at the GCTC in time to support the preflight data collections for the next cosmonaut.

Because the crewmembers are wearing either the gradient compression garment (GCG) or the Kentavr on landing day, there was a concern that these garments might affect crewmember performance on tasks requiring locomotion and balance control. Therefore, a case study was conducted and concluded that neither garment impacts crewmember performance.

To date, a total of three crewmembers (one United States Orbital Segment [USOS] and two cosmonauts) have completed the FT. In addition, two One-Year mission crewmembers (one USOS and one cosmonaut) have also completed the FT. The FT team demonstrated that it was possible to conduct the entire test (9 tasks) in the tent/airport in KZ and at the refueling station where time is greatly constrained, including: 1) Gaze Nystagmus, 2) Sit-to-Stand, 3) Recovery from Fall, 4) Dysmetria, 5) Eye/Hand Coordination, 6) Force Discrimination, 7) Seat Egress Obstacle, 8) Tandem Heel to Toe Walk, 9) Push Test, and 10) Dynamic Visual Acuity.

Specific Aims:

1. Quantify functional performance from measurements on long duration crewmembers taken as close in time to landing as possible.

2. Develop a recovery timeline of functional performance on long duration crewmembers.

3. Determine the efficacy of U.S. and Russian compression garments as countermeasures for alleviating orthostatic intolerance.

To ensure that data could be collected on both astronauts and cosmonauts immediately after landing the research has been divided into two investigative efforts: (1) a Pilot Field Test and (2) the full Field Test. The full Field Test will begin with the first U.S. International Space Station (ISS) one year mission (42S).

Four USOS crewmembers and three cosmonauts have consented to participate in the PFT for future Expeditions.

Field Test: The JSC Institutional Review Board (IRB) approved the Field Test protocol on December 5, 2013. Shortly after JSC IRB approval, the Field Test obtained international approvals from the Human Research Multilateral Review Board, JAXA (Japanese Exploration Space Agency), and ESA (European Space Agency). A Test Readiness Review was conducted and approved without actions on July 31, 2014.

The first Field Test data collection/familiarization session was completed in August. Because this crewmember is participating in both the FT and Functional Task Test (FTT) experiments, which have many overlapping tasks, great effort was put into developing an integrated FTT/FT protocol to save crew time. This integrated protocol was tested end-to-end with multiple dry runs conducted to improve efficiency and optimize test flow. The integrated FTT/FT protocol will be implemented for each test session that the FTT and FT experiments have in common: L-180, L-90, L-60, R+1, R+6, and R+30.

The Field Test (FT), being a joint US/Russian study, has been faced with many challenges. While developing hardware, software, and protocols, FT operators were also required to travel to support the PFT, to support multiple trips to Russia to attend Multilateral Human Research Panel for Exploration meetings, and to meet with our Russian investigators to finalize the hardware, protocol, and testing schedule for the FT. Once the hardware was finalized, multiple sets of hardware were purchased to support testing at the three locations on landing day and to support the testing in Russia.

Because the crewmembers will be wearing either the gradient compression garment (GCG) or the Kentavr on landing day, a case study was initiated to investigate whether or not the GCG and Kentavr affect crewmember performance on tasks requiring locomotion and balance control.

Specific Aims:

1. Quantify functional performance from measurements on long duration crewmembers taken as close in time to landing as possible.

2. Develop a recovery timeline of functional performance on long duration crewmembers.

3. Determine the efficacy of U.S. and Russian compression garments as countermeasures for alleviating orthostatic intolerance.