Preparing for Long Duration Space Missions Dr. Marc Shepanek - - PowerPoint PPT Presentation

▶
preparing for long duration space missions
SMART_READER_LITE
LIVE PREVIEW

Preparing for Long Duration Space Missions Dr. Marc Shepanek - - PowerPoint PPT Presentation

Mar 03, 2023 22 likes •595 views

https://ntrs.nasa.gov/search.jsp?R=20150009015 2018-05-12T09:03:19+00:00Z Preparing for Long Duration Space Missions Dr. Marc Shepanek Plymouth Medical School Presentation, May 18, 2015 Disclaimer This presentation represents the opinions of

slide-1
SLIDE 1

Preparing for Long Duration Space Missions

  • Dr. Marc Shepanek

Plymouth Medical School Presentation, May 18, 2015

https://ntrs.nasa.gov/search.jsp?R=20150009015 2018-05-12T09:03:19+00:00Z

slide-2
SLIDE 2

Shepanek Plymouth Presentation May 18, 2015

Disclaimer

This presentation represents the opinions of the author and not the policy or perspective of any portion of the federal government.

slide-3
SLIDE 3

Qualifications

  • Lead Aerospace and Behavioral Health NASA HQ
  • Assistant Professor of Psychiatry Uniformed Services University of

the Health Sciences

  • US Representative in Human Biology and Medicine to the

Scientific Committee on Antarctic Research (SCAR)

  • NSF Grantee and Investigator on physiological and psychological

adaptation to Antarctic Environment

  • Cancer survivor with experience in severe weight and muscle loss,

exposure to radiation

  • Clinical practice at Washington Hospital Center.
slide-4
SLIDE 4

Shepanek/NASA GW Apri l23, 2012

slide-5
SLIDE 5

Plymouth England

slide-6
SLIDE 6

Aerospace Medicine

 Aerospace Medicine is that specialty

area of medicine concerned with the determination and maintenance of the health, safety, and performance of those who fly in the air or in space

slide-7
SLIDE 7

Challenges of Space Missions

Muscle atrophy Bone loss Endocrine/Immune/Hematology Neurosensory & Neuromotor Cardiovascular/ Pulmonary Psychological Fluid Shifting Cancer risk Cataract risk Psychosocial/cultural

slide-8
SLIDE 8

Pathological Adaptive

Musculoskeletal Endocrine Neurosensory & Neuromotor Cardiovascular/ Pulmonary

Adaptation

Psychological

slide-9
SLIDE 9

Conditions Managed in Extreme Environments

Infections

Chicken Pox

Herpes

Hepatitis

Polio - like illness

Malaria

Amoebiasis

Giardia

PUO Mental and Behavioral

  • Acute anxiety
  • Depression
  • Paranoid schizophrenia
  • Gestures of suicide
  • Anorexia nervosa (male)

Neoplasms

Ca breast

Ca testis

SCC (branchial cyst)

BCC

Melanoma Eye

Retinal detachment

Foreign object injury Endocrine, nutritional, metabolic

Gout Respiratory

Staph

Pneumonia Circulatory

Cardiac arrhythmias

Myocardial infarction

Intracranial bleeding

Brain

Intracranial Pressure

Strokes

Unconscious Digestive

  • Appendicitis
  • Peptic ulcer
  • Cholelithiasis
  • Proctitis
  • Leiomyoma eroding gastric

vessel

  • Dental

Genito - Urinary

Renal Calculus

Prostatitis

Hydronephrosis

STD Poisoning

Nutmeg toxicity

CO poisoning

Sick Building syndrome

slide-10
SLIDE 10

 Space sickness  Illness of family member  Injury of family member  Loss of income  Loss of relationship  Death of family member  Dissolution of sponsoring institution  Exhaustion  Problems sleeping  Eye injury  Weight loss (muscle and bone)  Fire  Declining work schedule  Gastrointestinal stress  Vision problems  Severe headache  Loss of motivation

Some stresses experienced in space flight

slide-11
SLIDE 11

Evolution of Space Related Knowledge

Is There A Problem? ISS and beyond Countermeasures employed Defining the Problem 1960 Integrating International E ffort Long Duration E xtended flight International Intercultural 1970 1980 1990 2000 New vehicle New Mission configurations F acing the unknown

slide-12
SLIDE 12
slide-13
SLIDE 13

 The physiologic environment changes the

moment you leave the surface of the earth

14.69 lbs/in2 at Sea Level

slide-14
SLIDE 14

Lots of Changes

 What are the human implications of altitude?

Pressure decreases

Gravity decreases

Oxygen availability decreases

Temperature decreases, then increases, then decreases, then increases again

slide-15
SLIDE 15

Potential Physiologic Effects

  • f Space Travel

 Hypoxia  Decompression Sickness  Trapped Gas  Acceleration  Spatial Disorientation  Visual Illusions  Somato-sensory Illusions  Human Factors  Many others…

slide-16
SLIDE 16

Aerospace Medical Association

Highest Human Habitation...18,000 ft

Environmental Requirements Oxygen

OXYGEN UNDER PRESSURE NEEDED PRESSURE SUIT NEEDED ARMSTRONG’S LINE

TROPOPAUSE

Mt Everest 29,028 ft Andes Mt Whitney

TROPOSPHERE STRATOSPHERE

SEA LEVEL

OXYGEN NEEDED

10 20 30 40 50 60 70 760 523 349 226 141 87 54 34

As altitude increases, available oxygen decreases

10 20 30 40 50 60 70 760 523 349 226 141 87 54 34

Press Alt in mm Hg Thou. Ft

slide-17
SLIDE 17

Hypoxia

 Subjective symptoms  Breathlessness, apprehension, headache, dizziness,

fatigue, nausea, blurred vision, tunnel vision, numbness, tingling

 Objective signs  Increased respiratory depth and rate, cyanosis,

confusion, poor judgment, behavioral changes, loss of coordination, somnolence, unconsciousness

 Effective Performance Time  18000 ft – 20 to 30 minutes  25000 ft – 3 to 5 minutes  30000 ft – 1 to 2 minutes  35000 ft – 0.5 to 1 minute  40000 ft – 15 to 20 seconds  43000 ft – 9 to 12 seconds

slide-18
SLIDE 18

Decompression Sickness

 Bends

 Pain only, 60 – 70% of cases  Skin bends

 Chokes

 Multiple pulmonary gas emboli  < 2% of DCS cases  Dyspnea, substernal chest pain,

dry cough

 Neurologic DCS

 Spinal cord DCS  Brain DCS

slide-19
SLIDE 19

MAXILLARY FRONTAL ETHMOIDS SPHENOIDS

There are several places in the human body where air can get

  • trapped. The ear, the sinuses, and the stomach and

intestines are a few examples.

Trapped Air

slide-20
SLIDE 20

Aerospace Medical Association

Sustained Positive (+) Gz

POOLING BEGINS 1-3 “G” GREYOUT 3-4 “G” BLACKOUT 4-5 “G” UNCONSCIOUSNESS 5-6 “G”

slide-21
SLIDE 21

What’s the big deal

 Huge consequences, in flight  There isn’t always a curb to pull over too

slide-22
SLIDE 22

Challenges to Humans

  • f Space Travel

No Air, different mixes of gases

Different Gravity, variable gravity

Really High Speeds and deceleration

Really Long Distances, really long time

Too much Radiation, small and large

Isolation and confinement as Individuals, pairs and groups….

slide-23
SLIDE 23

Weightlessness

slide-24
SLIDE 24

Long Distances = Long Duration

The average distance from the Earth to the Moon is 238,854 miles

The average distance from Mars to the Earth is about 142 million miles, with a range of 56 to 401 million miles Voyager 1, 1977 35,000 miles/hour 119 AU/ 11+ Billion miles away

slide-25
SLIDE 25

Radiation Protection We Take For Granted…

Galactic Cosmic Rays Solar Energetic Particles

(Solar Particle Events or Coronal Mass Ejections)

slide-26
SLIDE 26

Isolation and Confinement with the same people…

slide-27
SLIDE 27

Eating and Drinking in Space

slide-28
SLIDE 28

Space Physiology

slide-29
SLIDE 29

Current Top 3 Human Health Risks in Space Flight

 Increased Intracranial Pressure  Bone Loss  Radiation Exposure Risk vs Cost of Mitigation

slide-30
SLIDE 30

Intracranial Pressure (ICP)

  • This risk was “recently” found

– First case noted in 2008

  • Visual degradation and increased

cerebral spinal fluid pressure found after “long duration” space flight

  • Symptoms include visual

disturbances after long duration space flight

  • Postulated causes: microgravity

fluid shift or physiologic response to increased CO2 levels

  • New assessments and research

initiated

slide-31
SLIDE 31

Visual Impairment/Intracranial Pressure

MRI Orbital Image showing globe flattening Normal Globe Flatten Globe

  • Choroidal

Folds - parallel

grooves in the posterior pole

  • Globe Flattening
  • Optic Disc Edema (sw
  • Altered Blood flow
  • “cotton wool” spots
  • Hyperopic Shifts
  • Up to +1.75 diopters
  • Increased Optic Nerve

Sheath Diameter

slide-32
SLIDE 32

Bone Loss

slide-33
SLIDE 33

Bone Loss

 Loss of horizontal trabecular struts

slide-34
SLIDE 34

QCT Extension Study (n= 8) Postflight Trabecular BMD in

  • hip. Carpenter, D et al. Acta Astronautica, 2010.

QCT: Trabecular BMD at hip does not appear to show a recovery 2-4 years postflight.

0.1 0.11 0.12 0.13 0.14 0.15 0.16 PRE POST 1YEAR EXT

PRE: n= 16 POST: n= 16 1 YEAR: n= 16 EXT: n= 8

slide-35
SLIDE 35

Radiation Risk

 Risk Statement

Given that crewmembers are exposed to radiation from the space environment, there is a possibility for increased cancer morbidity or mortality

slide-36
SLIDE 36

Radiation

Space radiation is a major challenge to

exploration:

 Risks are high…potentially limiting mission length or crew selection  Large mission cost and uncertainties to protect against risks  New findings may change current assumptions

slide-37
SLIDE 37

Categories of Radiation Risk

 Cancer  Acute and Late Central Nervous System

(CNS) risks

Immediate or late functional changes

 Chronic & Degenerative Tissue Risks 

Cataracts, heart-disease, etc.

 Acute Radiation Sickness 

Prodromal risks Differences in biological damage of heavy nuclei in space with x-rays, limits Earth- based data on health effects of heavy ions

slide-38
SLIDE 38

Doctors versus Engineers

 Are humans the reason for the

space program, or an inconvenience to the program or both?

slide-39
SLIDE 39

Human Systems Integration: The Health Care Professional’s Perspective

 Language Gap  The importance of Human

Systems Integration is a lesson that gets relearned over and over again

 Health professionals and

engineers speak different technical languages

 Consistent HSI success occurs

when health professionals understand and correctly communicate with engineers using “requirements”

slide-40
SLIDE 40

Human Factors

 Results:

Tough lessons relearned

 Frequently noted in mishap reports 

Human factors being considered after the hardware was developed

 Past aircraft and today’s spacecraft have similar HSI short comings  Gender issue - average height of women less than average height of men

slide-41
SLIDE 41

More than the individual can cope with. Fight or flight response degrades physical health.

  • Endocrine
  • Cardio-vascular
  • Digestive
  • Neurological
  • Cognitive
  • Emotional

The longer the degradation, the greater the damage

When does Chronic Stress equal pathology?

slide-42
SLIDE 42

Ancient Rome Cold War Soviet Union United States at Guantanamo Bay

Humans Stress Humans

slide-43
SLIDE 43

Case I: Daily immersion in ice water, forced marches to the point of physical collapse, sleep deprivation, food deprivation, constant yelling and physical intimidation by groups of individuals with weapons. Case II: Forced to live for 240 continuous hours with constant exposure to 80 decibels. Radiation exposure, muscle wasting, bone damage. Case III: Restricted primarily to indoor activity, sleep reduction and circadian shifting, indoctrinations and training 12-14 hours a day. Constant daily, weekly, monthly critical feedback to redirect cognitive, social and emotional processes.

Case Studies in Stress

slide-44
SLIDE 44

Training to be a Navy Seal Being an Astronaut aboard the International Space Station Going to Medical School or getting a Ph.D.

Humans Stress Humans

slide-45
SLIDE 45

When the individual can cope. Physical and mental health improves with challenge.

  • Cognitive
  • Emotional
  • Cardio-vascular
  • Digestive
  • Endocrine
  • Neurological

The longer the challenge, the more likely to reach

  • ptimum performance

When does Chronic Stress not equal pathology?

slide-46
SLIDE 46

Energy channeled for improvement.

  • 1. Eliminate the 4 F club: Flight, Fight, Freeze or Forget

a) Educate the individual about possible stressors to reduce the element of surprise b) Develop coping skills to deal with surprise

  • 2. Work with individuals to develop goals
  • 3. Inform and if possible include the individual in planning

exposure(s) to stress(ors)

  • 4. Develop a system of support for the individual to cope

with stress(ors)

  • 5. Allow stress at a rate that is healthy for the individual
  • 6. Develop a feedback mechanism for individual about

stress(ors)

Chronic Stress as an Asset

slide-47
SLIDE 47

Fully supported systems approach

  • 1. Educate the individual about challenges (Intellectual)
  • 2. Train individuals to meet those challenges (Work)
  • 3. Have a network to support individuals (Social)
  • 4. Engage in physical activity (Physical Health)
  • 5. Appreciate life (Emotional or Spiritual Health)

Chronic Stress as an Asset

slide-48
SLIDE 48

Shepanek Academy of Behavioral Medicine June 28, 2014

Framing/perspective is key. Isolation and confinement as a hero or in support of a good or noble cause has different results than isolation and confinement as a pariah or in support of a bad or evil cause. Astronaut, Chilean Miner, Licensed Therapist Psychotic Mass Murder, Terrorist, Sex Trade Worker

Chronic Stress as an Asset

slide-49
SLIDE 49

Space Technologies

 Wireless Devices

 Hospital Telemetry Systems

 Infrared Thermometers  Cordless Tools  Dehydrated food…and ice cream too.

slide-50
SLIDE 50

 Medical Challenges to Human Space

flight

 Planning for human space missions, a

three pronged approach

 Human  System  Environment

 Short Term Missions versus Long

Term

slide-51
SLIDE 51

Human performance is dependent on a… ...System that responds effectively to… …Environmental challenges

Elements of Human Space Flight

slide-52
SLIDE 52

Long Duration Mission Health Care Criteria

 Prevent problems  Treat crew members

and return them to duty

 Minimize impact on

remainder of crew

 Provide for crew safety  Provide for remote

consultation when possible

 Provide on board

resources when possible

slide-53
SLIDE 53

Ultimate Health Objective

 Maintain health and

well-being before, during, and after mission

slide-54
SLIDE 54

Acknowledgements:

  • Dr. Richard Williams
  • Dr. Arnauld Nicogossian
  • Dr Vince Michaud
  • Dr. Al Holland
  • Dr. Desmond Lugg
  • Dr. David Williams
  • Dr. William Sipes
  • Dr. Albert Harrison
  • Dr. Larry Palinkas
  • Dr. Jeff Ayton
  • Dr. Iain Grant
slide-55
SLIDE 55

Thank You! Questions?

slide-56
SLIDE 56
slide-57
SLIDE 57

Shepanek/NASA GW Apri l23, 2012