Terry Gerton I’m really interested in this conversation because certainly space exploration is on the mind of the public. We’ve got the Project Hail Mary movie in theaters. We just saw Artemis II astronauts on a highly successful mission. You all have been working in this science space for years. What are the biggest human performance challenges associated with long distance or long term space flight?
Michael Schubert Yeah, the greatest challenges are related to, the duration spent in space impairs our ability to walk, particularly if we need to exit the spacecraft urgently. So if you’ve followed NASA on the space program recently, and it has been exciting, you’re absolutely right, Terry. What you will notice is when the crew are taken out of the capsule, they need some assistance walking. And so NASA and the greater science community is concerned that if the vehicle were to land in a position on Mars or some future space location, that they would have difficulty getting out of out of capsule safely. So ability to walk, ability to perceive the environment. Ability to see clearly when they land, all related to, in part, integration of the balance system that we have in our heads, one in each ear. And that balance system, when it’s exposed to microgravity, conditions of reduced gravity for a long period of time, it sort of has to reorient what it does. It’s no longer needed to detect gravity. And so that leads to some problems when they are then. Reintroduced to a gravitational field.
Terry Gerton So this research that you all are doing now is trying to get after that, and it’s got a very interesting approach. It brings together Navy medicine, Air Force Research Laboratory, NASA, and academic partners like Johns Hopkins, kind of all centered at Wright-Patterson. Mr. Folga, what’s the value of having all of this integrated at that one spot?
Rich Folga Well, first of all, the combination of the human centrifuge and the Kraken device, which is our research device that we can use for any type of motion application with large fields of view, the two devices are extremely complimentary and there’s only one other location in the world that has that sort of complimentary co-located capability. And so from a U.S. Perspective, this is a really unique opportunity. Our lab here moved from Pensacola. The Air Force’s equivalent lab moved from San Antonio during base realignment and closure. And now we’ve got this combined campus of all these air medical experts here. So when a question like this comes up, our devices can be used to help answer those questions. And then in this particular case, the original plan was to use the Kraken, but we found that the centrifuges are much more, as a better application, a better system to execute the protocol. And so we’re using the Air Force’s centrifuge, but the Navy and Hopkins were teamed originally, and so we kept that teaming and moved the project over there. But that’s the wonderfulness of this location is we were able to quickly flex, use our partnerships, and move the experiment over there where it’s been being conducted successfully ever since
Terry Gerton Dr. Schubert, let me come back to you. Describe the nature of this study. It’s obviously getting after the human balance issues that you talked about, but how does the centrifuge play into that and what are you actually looking to test?
Michael Schubert Yeah, the centrifuge is the best analog on Earth that we have to replicate as close as possible what the crew members experience when they return from long-duration space travel. They are disoriented, their balance is off, and the way that we do that is we put them in a centrifuge and their position in a certain way that after one hour of being centrifuged in that position, and it’s interesting, Terry, actually … during the centrifugation, they feel okay, generally. There’s not a lot of motion sickness during it. Some of them have it. But when they egress the vehicle, when they get out of that centrifuge, that’s when they appreciate that their balance is not very good. They don’t feel as good when they move their head. And that’s the best analog we have to what the crew member experiences. What the study is designed to do is measure a self-automated rehab device and its ability to treat the effects of motion sickness once you’ve been exposed to it. So the design is to test people before and after centrifugation on various gait tasks and various perceptual tasks and various eye movement tasks that are all functions of the balance system, which we call the vestibular system. Then there’s an intervention where half of the subjects will do this rehab intervention and half of them will not perform any intervention which is sort of the current standard of care for motion sickness. On earth when we get motion sickness we find a dark room, we turn out the lights, we don’t move. And so that is kind of the standard of care. So we’re comparing a movement related rehab device that’s self-automated versus that no movement condition. And measuring the effects of that on those outcomes that have been measured, that I’ve specified.
Terry Gerton Mr. Folga, I’m imagining my time on carnival rides when I think about centrifuge. Is that kind of what we’re talking about here?
Rich Folga It is. It is. So if you’ve got a long arm and the capsule’s at the end of that arm, and like Michael said that we position them in a way to get the acceleration forces just right and then they’re spinning. So when you watch a device, it doesn’t look like it’s moving very fast but we’re actually achieving three times the force of gravity and that gravitational vector is kind of pushed kind of into them through their chest. So it’s got a front to back force and they’re sort of laying back with their knees sort of above their chest level. If you can imagine feet first. Into the turn. So it’s basically, you know, driving in this very large circle and they’re being kind of pushed into their seat. And so you feel like you weigh three times as much as you do or if somebody’s sitting on your chest essentially the whole time. And then once you kind of adapt to that, you’re basically in that position without moving for an hour. And that’s our goal is to get them to spin for a full hour. It’s not super comfortable, as Michael said. There’s going to be some discomfort with that. You have alterations of blood flow and you have different things we try to accommodate for, cradling their head and lumbar support, because all that stuff starts to get messed up when you push somebody like that for that long of a period of time. And most folks aren’t adapted to that. So it is kind of a strange carnival ride, but you can think of those rides at the, whether it’s the carnival or at an amusement park where they put you against the wall and they centrifuge you and spin it and it pins you against a wall. It’s sort of the same thing as that. Just imagine doing it feet first.
Terry Gerton For an hour.
Rich Folga It’s a long ride, so most of the time you’re in line that long, not in the ride you need to be in.
Michael Schubert That’s right.
Terry Gerton I’m speaking with Dr. Michael Schubert. He’s a professor in the ENT Department at Johns Hopkins University School of Medicine. And Mr. Rich Folga is an aerospace medical research device program manager at the Naval Aerospace Medical Research Laboratory. Dr. Schubert, let me come back to you because you’re the designer of this study. Its applications are obvious for space missions, but might it be extended as you get through it to other applications for human performance here on Earth in other conditions?
Michael Schubert Absolutely Terry, the device is also being measured in patients on Earth that have had a surgery to remove a benign growth that occurs on their balance nerve. So similar design, we’re measuring the ability of the device to improve the same outcome balance and gait, walking and eye movement control compared to the standard of care for rehab in a civilian population. The unfortunate reality is on Earth there are not a lot of experts to manage vestibular disorders and so we believe that if we can create an automated device that people can have access to in rural areas in particular or areas that just don’t have the medical expertise that this can help quite a bit. So, there’s certainly an Earth application as well for developing this technology.
Terry Gerton Mr. Folga, let me come back to you, because you all are soliciting participations for this carnival ride, if we can go back to that metaphor. What are you looking for in the participants and what risks might they incur?
Rich Folga So what we’re looking for are folks, because the centrifuge is an Air Force asset, we need to have folks that have TRICARE medical coverage. So that’s one of the requirements to participate in studies that we do on our campus here using our military apparatus. And then what we are looking for are folks that in this particular case, because of, we need make sure there’s some level screening that they can perform the duty and the tasks. And so our general kind of ticket to ride also involves an air medical clearance notice. So it’s basically similar to what an airman or a pilot, a private pilot would have for their FAA medical clearance. And so that gives us some assurance that those folks are fit enough to be able to do the tasks that we need them to do. And so if you’ve got those two things, then you’re eligible. And so, that’s usually who we’re looking for. So it tends to be military populations that are volunteering because we’re on a military base. And if they happen to be in a flight status, then they’ll have an air medical clearance notice. So that’s our target population, or somebody that can get that clearance notice as well from an aviation medical examiner or provider.
Terry Gerton Any concerns about balancing the risks to individual participants with the scientific value of the study?
Rich Folga Yes, so of course, any time you put somebody in an apparatus like this, they’ll consider it to be greater than minimal risk. And so the institutional review board will look at that and they’ll look at all our risk mitigation criteria and what the possible outcomes can be. But generally speaking, as Michael addressed, the thing we’re trying to induce is motion sickness. And for the most part, it’s really a pretty common thing. And so whether you go fishing or you’re on a bumpy airplane ride, It’s really the kind of thing that folks encounter every day or could encounter every day. And so we’re screening folks, obviously to meet the medical and the air medical kind of clearance level, but we’re also asking them about their normal susceptibility to these things. And so, we’re trying to find folks that are sort of in that mid range of they have a mild susceptibility, to motion sickness. And so they would be a good candidate because we want them to feel the effects. We don’t want somebody that’s a zealot that can ride in a rollercoaster 100 times in a row and then they get out and feel nothing. It’s like, well, we’re probably not going to have that same effect because we’re trying to use folks that are good astronaut analogs as well, because that’s your immediate transition here is back to NASA for space flight. So we’re looking for folks that kind of fit that mold, the age range, population range, and then kind of the medical makeup as well. So by doing that, we feel like we’re mitigating most of our risks and the devices and our safety procedures are very well rehearsed and the devices are generally very, very safe. And so as far as risk goes, the population is not really going to see a lot of that. But anytime you’re making somebody ill there’s a chance that maybe afterwards it would take them a while before let’s say they’re ready to drive home, so we want to accommodate for that and make sure folks are aware of that
Terry Gerton Are you getting a good response to the call for volunteers?
Rich Folga Well, as you mentioned earlier, the fact that Artemis II launched and came back and it was such a success has been a wonderful recruiting thing for us. So yes, we’ve been getting a great response. And in fact, there’s somebody in the centrifuge next door to me right now doing this exact spin. So we’ve got a Marine Corps volunteer, Marine Corps pilot who’s volunteered to come over and do that and is in the centrifuge as we speak. So that’s really exciting doing this study. And so we don’t know if they’re in the treatment condition or not. I don’t that, but I can tell you that they’re spinning for science as we speak. So it’s very exciting. And we only need a handful more folks and then we’ll be fully booked.
Terry Gerton Spinning for Science sounds like a great new program.
Rich Folga We’ll do a bit of that.
Terry Gerton Dr. Schubert, let me come back to you. Let’s assume that your study here is successful. What happens next? What’s the next stage of research in human performance that you would like to see undertaken?
Michael Schubert Well, there’s a lot related to the device. First of all, it’s just sort of the commercial development. It’s always a big leap to move science from the lab out to the public. So this is equipment. It’s fairly technically involved. It does need to be iterated upon. So that would be one step would be just to commercially develop some of this stuff to get it into the hands of other people at broader numbers to actually validate it in that way. The other next step that would be good to do is to see if we can treat folks beforehand. Remember, in this design, we are inducing the dizziness, as Rich said, and then applying the intervention. It might be nice to look at, I mean, I think it would be nice, to look an intervention during, when they’re traveling to get to their destination, really, and NASA’s really focused, as you know, on the Moon and then Mars. The distance to the moon is relatively short, so we don’t have to worry so much about motion sickness for there. But for Mars, it’s much longer. So can we intervene during the trip? So what studies could we design where we prevent or we significantly reduce the effects of the long duration space travel during the travel? Can you do rehab during the trips so that when you get there, you can get out of the vehicle and be fine and not have to do a post-trip intervention? I think those designs would be useful.
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