143 - Parastronautics: Physiatry for Spaceflight

Objectives:

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  To understand the clinical requirements inherent to providing medical support to space crews where one or more members is a person with a disability
  
  


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  To record the effect of physiatric medical decision making on the personal health and mission success of astronaut-like crews
  
  


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  To document the principles of physiatry being integrated into operational aerospace medicine
  
  


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  To develop and test novel methods of screening, risk-stratification, and risk mitigation potentially relevant to parastronaut initiatives
  
  

Design: This ongoing, observational, cross-sectional study spanning two full flights or “missions” and one upcoming flight all take place in chartered parabolic aircraft and have to date involved screening and risk-stratifying more than 100 potential flyers; providing medical support for 26 flyers with disabilities affecting vision, hearing, or mobility; and supporting crews of up to 36 persons per parabolic flight. Methods included history taking, medical records review, 2-3 in-person and virtual medical screenings per flier with disabilities. Interventions included individual anti-nausea preflight medication plan consistent with pre-existing medical and pharmacological regimen; personalized bowel and bladder regimens where applicable; flight suits customized for flier function and physiology; and personalized aircraft ingress and egress procedures based on flyer method of propulsion.


Results: Flyer screenings for three parabolic flights resulted in crews with the following adaptations/disabilities: 12 flyers with mobility adaptations, one BLE-amputee, two single-LE amputees, two flyers with congenital quad-limb deficiency, 1 flyer utilizing crutches/scooter for mobility, 7 WC users. 8 legally blind flyer. 6 deaf flyers. For Flyers with disabilities affecting mobility, accessible aircraft ingress/egress methods were designed. For crew with visual and auditory-based disabilities, navigation systems were implemented. All crew members experienced variable gravity environments with a high degree of safety, including Lunar(1/6thg) Martian(~1/3rdg) and microgravity. In between each 20-30 second reduced-gravity time-span the crew experiences an equal length 1.8g segment as the plane pulled out of the dive to prepare for the next parabolic drop. Using the agile, evolving, novel screening approaches, adapting existing risk stratification tools, individualizing flyer health and safety plans, and preflight practice runs, illnesses and injuries were effectively prevented from impacting the crew.

Conclusions: Clinically speaking, these parabolic flight exposures definitively demonstrated that not only are persons with disabilities able to safely traverse variable gravity fields, but in some ways do so more effectively than their non-disabled counterparts. They also proved that multidisciplinary teams of physiatrists, aerospace-medicine trained physicians, neuroscientists, and therapists can provide effective medical support to full crews of flyers with disabilities and their research support teams. Using agile, evolving, novel screening approaches, adapting existing risk stratification tools, individualizing flyer health and safety plans, and preflight practice runs, significant illnesses and injuries can be effectively prevented from negatively impacting the entire space crew.

Scientific Paper Best Paper Award Abstract: Introduction

Parabolic flight has been used by space agencies as a research tool and a means to train astronauts and test equipment. It involves the use of an airplane outfitted with a section of the fuselage without seats or other equipment where microgravity movement and testing take place. The parabolic flight path of the plane produces variable gravity fields ranging from 1.8 g to microgravity (sometimes called “weightlessness”) which researchers use to test equipment and operations. In this way, the parabolic environment affords an excellent analog for testing how persons with disabilities might adapt to the spaceflight environment.

Design

This ongoing, observational, cross-sectional study spanning two full flights or “missions” and one upcoming flight involving a chartered parabolic aircraft; screening and risk-stratifying more than 100 potential flyers; providing medical support for 26 flyers with disabilities affecting vision, hearing, or mobility; and supporting crews of up to 36 persons per parabolic flight.

Results

Potential flyer screenings for three parabolic flights resulted in crew members with the following adaptations/disabilities: 12 flyers with mobility adaptations, including 1 bilateral lower extremity-amputee, 2 single-lower extremity amputees, 2 flyers with congenital quad-limb deficiency, 1 flyer who used crutches and a scooter for mobilization, and 7 wheelchair users. 8 crew members were legally blind. 6 crew members were deaf.

For those flyers with disabilities affecting mobility, the screening and planning process included identifying and implementing accessible aircraft ingress and egress methods and safe, dignified transfers from the seats in the rear of the aircraft to the open section of the fuselage after the parabolic flight corridor altitude had been reached. In that corridor, which was 100 miles long and 10 miles wide, crew members experienced variable gravity environments with a high degree of safety, including Lunar (1/6th g) Martian (~1/3rd g) and microgravity. In between each 20-30 second reduced-gravity time-span the crew experiences an equal length 1.8 g segment as the plane pulled out of the dive and returned to altitude to prepare for the next parabolic drop.

Crew who were blind were paired with a sighted support crew member during ingress and egress of the aircraft and when the microgravity interval ended. During microgravity intervals, flyers conducted their own experiments in non-verbal communication, including light signaling, tactile guidance, sign language call-outs, accurate translation across the cabin, and more. With limited-to-no assistance, during variable gravity exposures, the blind crew rapidly adapted their strategies for traversing “normal” space on one plane to the three-dimensional microgravity environment filled with dozens of individuals, each of whom were moving in six degrees of freedom, some of whom were wearing prosthetic limbs and/or research equipment .

While the parabolic flight environment was adapted to some degree to accommodate for the crew with disabilities, the crew’s own strategies for surviving and thriving the challenges of the built environment on Earth were leveraged to the advantage of the entire crew. The system signally changes between gravitational intervals, micro to hypergravity, is one example. The standard communication method on these parabolic flights - auditory callouts - is prone to failure in the noisy cabin environment. On these flights, the light-based alert system designed by the deaf crew signaled shifts in gravity with a series of flashes. This system proved so effective in the context of an uninsulated 727 with 40 souls aboard that the Medical team and others rapidly came to rely upon it. This use of ASL has been similarly transformative. Both flights to date had an ASL interpreter aboard to provide critical communication with the deaf crew in the event of an emergency. However, sign language quickly proved to be the most effective means of rapid communication between team members posted in different areas of the cabin moving in different orientations and directions relative to each other. Communications in ASL could be carried on from one end of the aircraft to the other without distracting other crew members or requiring a headset system.

Most space travelers struggle to integrate the fact that lower extremities are of limited assistance while in microgravity. Crew members who mobilize with the aid of prosthetics doffed them or replaced them with tool-holding devices. Crew with spinal cord injuries immediately mobilized using only their arms, instantly adapted to an environment that takes flyers without spinal cord injuries several tries to begin to master.

Conclusions

These discoveries, many of which took place during the flights themselves, demonstrate how disability inclusion in spaceflight not only functions adequately but actively supports more effective and safe space exploration. Clinically speaking, these parabolic flight exposures definitively demonstrated that not only are persons with disabilities able to safely traverse variable gravity fields, but in some ways do so more effectively than their non-disabled counterparts. They also proved that multidisciplinary teams of physiatrists, aerospace-medicine trained physicians, neuroscientists, and therapists can provide effective medical support to full crews of flyers with disabilities and their research support teams. Using agile, evolving, novel screening approaches, adapting existing risk stratification tools, individualizing flyer health and safety plans, and preflight practice runs, significant illnesses and injuries can be effectively prevented from negatively impacting the entire crew.