UK Research For Health in Space
The human exploration of space and its associated research are pushing the boundaries of what is technically feasible. The recently established space biomedicine and space environments communities in the UK are preparing for the New Space era, the momentum for which will emanate from the commercial human spaceflight sector. With many distinctive technical challenges to be overcome, the spaceflight paradigm allows numerous psychological and behavioural aspects, as well as biological and physical systems to be examined under unique and unusual circumstances which in turn drive a significant amount of terrestrial research and, in particular, healthcare innovation.
The number of viable commercial human spaceflight companies with significant hardware either undergoing testing or involved in space trials is in double figures. Akin to the aviation industry’s early years after the Wright Brothers demonstrated powered flight, the near future will see an explosion of human traffic in low earth orbit which is expected to result in a world as different to the present as today is to the pre-flight era.
Research and development (R&D) in this field requires us to examine questions in the physical and life sciences that cannot be investigated within the normal terrestrial environment including aspects of the space environment such as reduced gravity, radiation and isolation. Furthermore, the constraints imposed by operating in space often lead to innovation in terms of size, power and volume reduction. For example, recent NASA space environments research has led to new applications of medical ultrasound practices in hospitals across the United States. Other examples include innovation in closed loop water supply technologies that have better enabled long duration space missions and which also benefit isolated and impoverished communities suffering from water supply and quality issues on Earth.
While the UK has
traditionally taken a
‘back seat’ in
research is undertaken
While the UK has traditionally taken a ‘back seat’ inhuman spaceflight, world-class space biomedicine research is undertaken domestically, under the broad umbrella of space environments R&D. Currently, British biomedical research provides a return on investment second only to the United States. Given that the progression from terrestrial biomedical research to space biomedical activities is a relatively small step due to common approaches and questions, the potential exists for the UK to excel at this field as well. It is broadly accepted that a coordinated biomedical science approach is fundamental to fully understand and prevent most of the adverse and still unresolved physiological problems faced by humans during spaceflight, examples of which are muscle wasting, bone loss, cardiovascular deconditioning and loss of neuromuscular control. Increased knowledge of these conditions will not only improve the health of humans in space but also on Earth, as most of them are characteristics of ageing.
Human Health in Space
Upon return from International Space Station (ISS) long-duration missions (usually six months) astronauts must undergo at least a month of intensive rehabilitation. This rehabilitation is required to counteract the deconditioning of multiple physiological systems resulting from time spent in space. To date approximately 530 people have flown in space, with this number expected to expand many times during the course of the next decade as commercial human space flight becomes economically viable. These future ‘space flight participants’ will be exposed to the rigors of space, and many will do so despite possessing pathologies that have yet to be exposed to the stresses of space. This latter point is particularly note-worthy as, due the expense involved, the typical commercial space-goer in the near future is likely to be middle-aged with an associated health profile.
The absence of gravity causes the human circulatory system to equalize i.e., blood normally pulled to the lower body on earth, rises to the upper body in space. This equilibration increases stimulation of receptors in the upper body and decreases stimulation of certain lower body receptors. Over time the normal responses of these receptors to the stimulation experienced on earth is altered, albeit temporarily. This, coupled with reductions in blood volume, deconditioning and atrophy of muscle tissue and alterations in hormonal responses to stress, leads to several days of poor blood pressure control upon return to Earth. This condition, termed orthostatic intolerance, causes astronauts to faint if left standing unaided for more than a few minutes during their first few days back on Earth. The effects of space travel on orthostatic tolerance remain one of the space industries’ intractable problems. Fluid loading regimes to try to increase blood volume prior to re-entry, lower body negative pressure routines in flight and lower body positive pressure garments worn on landing, are used to try to minimise the occurrence and severity of this condition. However, it has not been resolved yet.
One commonly cited effect of time in space is the leaching of calcium from bones and a general reduction in their density and strength over time. For some astronauts the density of some bones does not recover even years after their space mission. When the stimulus for bone formation is reduced, for example by taking away impact forces felt during locomotion, it weakens, adopting a structure relevant to the new environment. In certain ways this condition is like accelerated ageing. Space R&D teams are investigating the aetiology and treatment of this condition. The use of drugs, such as bisphosphonates, and activities such as impact and vibration exercise are all under evaluation as countermeasures. In-flight countermeasure programmes, in particular since the advent of NASA’s Advance Resistive Exercise Devise, do reduce the degree of bone deconditioning seen on ISS, but a fully effective remedy has yet to be found.
The most recently noted adverse effect of spending time in space is a condition termed ‘Visual Impairment with raised Intracranial Pressure’ (VIIP). The head-ward shift of body fluids in space is likely to be associated with increased fluid pressure in the cranium. This in turn may be linked with changes in eye morphology and vision as noted in many astronauts on their return from space. This effect was revealed so recently that the research community is only able to look into its aetiology now in sufficient detail to attempt elucidating the mechanisms of VIIP.
Most of the adverse effects of spaceflights that we are familiar with are associated with long spells in space. Only a few relatively benign conditions, such as space motion sickness, occur in the first few hours or days. However, our ‘subjects’ to date have been individuals selected for their almost faultless health profiles. With the advent of commercial human spaceflight, many spaceflight participants will enter the extreme environment of space with conditions which, although benign or manageable on earth, could be worsened or lead to unforeseen effects in space. For example, the off-loading of the spine in microgravity leads to an increase in height in the first few hours, something that appears to be related to the low back pain experienced by most astronauts in the first days of their mission. Subsequent changes in spine morphology and associated stabilizer muscles over time are likely to be related to the increased risk and incidence of post mission Herniated Nucleus Pulposus (slipped disc). Low back pain is a common condition across developed societies and as such can be expected to be prevalent amongst commercial human spaceflight customers. This condition may not be affected by only a few minutes of microgravity, but once orbital flight and low earth orbit holidays are available it will become important that these potential effects are understood.
R&D Solutions in Space and on Earth
Although the UK has some catching up to do in terms of spaceflight research, the Centre of Human Aerospace & Physiological Sciences at King’s College London is currently evaluating an intravehicular garment, the ‘skinsuit’, which acts to constrict the body by placing an axial load along the spine. The skinsuit appears to be able to passively replace much of the Gz (a measure of gravity) stimulus lost in microgravity and may prevent spinal lengthening when worn. The skinsuit may also reduce the headward movement of body fluids that occurs in space, which could have a bearing on post flight orthostatic tolerance. At University Hospital Southampton, researchers have developed a non-invasive means to measure changes in intracranial pressure. This system is to be evaluated on the ISS in 2015 and could provide an important improvement in our ability to monitor the development of VIIP leading to treatment or prevention of the condition. Finally, improved means of rehabilitation from the effects of spaceflight are being researched by Northumbria University. A novel device, the Functional Readaptive Exercise Device (FRED), has been developed which appears to preferentially target and train spine stabiliser muscles. This simple exercise device may lead to much more efficient and effective recovery post mission, with a decrease in the risk of back injuries such as slipped discs.
Directing limited R&D funds towards resolving space-related biomedical conditions offers humanity a means to improve its ability to live and work in space in the future. It is clear, however, that Earth-based healthcare gains must also result from these efforts. In particular, biological and physical systems examined under unique and unusual circumstances drive a significant amount of terrestrial research, something that is clearly seen on the continent in countries such as Germany, the Netherlands and France. For example, it is recognised that the skinsuit technology might be suitable for support clothing for cerebral palsy sufferers; FRED technology may provide an effective treatment for low back pain sufferers, and it is hoped that a non-invasive intracranial pressure measuring system will provide a valuable new tool to hospital A&E departments for the treatment of patients with head injuries.
Psychological Support for Long-duration Missions
Human travel and residence on other planets and moons will be extremely challenging – so much so that there is a need to revise attitudes toward the crew on these missions, and the nature of the psychological support that can be provided for them. Scientists at the Centre for Space Medicine at the University College London have conducted extensive research on these issues.
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Currently the nature of psychological support relies on a live communication link with Earth where the majority of the responsibility remains with specialists on the ground. However, the nature of the psychological support during long-duration missions, extending beyond Earth’s orbit, will primarily rely on the resources available on board the spacecraft mainly due to delays of up to 20mins or potential loss of communication with Earth. Consequently, the responsibility for the optimal functioning of the crew throughout the mission will need to reside with the crew on the spacecraft. Hence, it is recommended that the crew be equipped with the knowledge, skills and responsibility to monitor their own psychological well-being. Crew members will need to monitor each other, to promote positive group interaction and continuous self-development, and to alert and request assistance from the ground crew if needed.
Technological assistance in this field is also under development. The psychological support toolset has been developed to consist of three main parts: Preventive measures, monitoring/detecting and resolution tools. Preventive measures will focus on providing the means to support the digestion and sharing of the crew’s mission experiences with ground crew, family and friends. Monitoring and detection measures are envisaged, for example, to be based on pattern recognition techniques that will record behavioural patterns, facial and voice expressions of individual crewmembers and analyse these in relation to surrounding conditions and actions of other crewmembers. Resolution technology will focus on providing the crew with assistance, when preventive measures, training and warning measures could not prevent the development of a situation or an issue.
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The Embedded Psychological Support Integrated for LONg-duration missions (EPSILON) is designed to be embedded throughout the spaceship and integrated with the equipment and tools the crew will use in order to provide comprehensive psychological support. The technology will have two interlinked databases: one will contain all the information collected during prevention and monitoring phase and the second database will allow the crew to systematically search and identify applicable resolution tools.
Space Biomedicine in the UK
In recent years it has become increasingly clear that a national body was needed in the UK to facilitate intra-and international liaison and collaboration in the field of space biomedicine. Five students formed the UK Space Biomedicine Association in 2000 (then called the Space Medicine Group) as a product of the 1999 ‘Futures in UK Space Biomedical Research’ conference established by Kevin Fong at University College London. Then, in 2011, the UK Space Biomedicine Consortium was established with the support of the UK Space Agency, University College London and King’s College London. The Consortium has since grown to a membership of over 30 organisations, including Imperial College, and has embarked upon a process of drawing up a national space biomedicine strategy underpinned by four research programmes which will benefit Earth-based healthcare and the UK’s preparation for the era of commercial human spaceflight. A parallel and complementary activity is the establishment of a Microgravity Working Group by the UK Space Agency also in 2011, which evolved into the Space Environments Working Group, a UK Space Agency sub-committee.
In November 2012 the UK subscribed to the European Space Agency’s Life and Physical Sciences Programme (ELIPS) and will participate in the International Space Station (ISS) Utilisation Programme. The UK Space Environments community will bring together the various groups involved or interested in ELIPS related research from space biomedicine and astrobiology to materials science and microgravity physics.
A strong and vocal space environments research community will support the government in its deliberations concerning future UK contributions to optional ESA programmes such as ELIPS and ISS Utilisation and other bilateral space flight opportunities. A strong UK participation in the international human spaceflight effort is necessary to prevent the nation from falling further behind the rest of the world in a technological field that will increasingly become integral to the economic foundations of any developed society. The new movement spearheaded by the UK Space Biomedicine and Space Environments communities is offering a means to prepare and, when appropriate, to participate in the exploration of our solar system and to enable British men and women to live and work routinely in low Earth orbit alongside the citizens of other nations.
Dr. Simon Evetts is contracted by the company Wyle, to manage the Medical Projects and Technology Unit of the European Astronaut Centre, Cologne, Germany. He is the Coordinator of the UK Space Biomedicine Consortium. Dr. Iya Whiteley is a Human Computer Interaction and Cognitive System Engineer and a Deputy Director of the Centre for Space Medicine at Mullard Space Science Laboratory, UCL. The authors thank Major Tim Peake, European Astronaut Centre, European Space Agency and Prof Charles Cockell, University of Edinburgh for their contributions. The UK Space Environments Conference will be on 9-10 November 2013: www.uksbaconference.co.uk