Published: July 9, 2015

Vestibular Experiments in Space

Early in space exploration, research on the vestibular system was of great interest due to astronaut reports of spatial disorientation, nausea, and post-flight balance issues during the Apollo Program (1961-1972).1 This constellation of symptoms became known as Space Adaptation Syndrome (SAS).

by Ryan Camilon, MD, Shaun A. Nguyen, MD, Ted A. Meyer, MD, PhD, and Paul R. Lambert, MD

Images provided by nasa.gov and history.nasa.govImages provided by nasa.gov and history.nasa.gov

Early in space exploration, research on the vestibular system was of great interest due to astronaut reports of spatial disorientation, nausea, and post-flight balance issues during the Apollo Program (1961-1972).1 This constellation of symptoms became known as Space Adaptation Syndrome (SAS).

The shuttle-based Spacelab missions (1983-1998) utilized this unique environment to perform vestibular research with many studies focusing on SAS. In weightlessness, Spacelab crewmembers experienced sudden visual reorientation when recognizing static objects in their surroundings. The brain expected otolith organ signals to be in parallel with visual cues. However, when otolith organ information conflicted with visual signals (such as seeing the position of a chair) SAS symptoms were felt.2

Thus, investigators proposed the theory of sensory conflict as the cause. The brain would then learn to ignore the information provided by the otolith organs and focus more on visual, tactile, and proprioceptive clues in order to adapt to space.

Images provided by nasa.gov and history.nasa.govImages provided by nasa.gov and history.nasa.gov

Experiments on Mir and the International Space Station (ISS) were of longer duration and sought to develop countermeasures to SAS and post-flight postural deconditioning.3 Reflexes that involve otolith organ information such as the vestibular-ocular reflex (VOR) were studied. Torsional VOR, mediated by both the semicircular canals and otolith organs, was found to be inhibited in space.4 Ocular counter-rolling (OCR) was also found to be significantly reduced.5

It was concluded that the postural and gaze problems experienced by astronauts post-flight are related to the deconditioning of otolith organ signal interpretation. Several ongoing experiments on the ISS are investigating the use of in-flight centrifugation to prevent such deconditioning.

With space tourism on the horizon, these experiments have grown in importance. Though SAS will become more prevalent, commercial space flight brings several research benefits including larger sample sizes and more generalizable conclusions. It is evident that the exploration of the issues involving the vestibular system has had a healthy head start.

References

  1. Homick JL. Apollo flight crew vestibular assessment. Biomedical Results of Apollo. United States; 1975:323-340.
  2. Neal V, McMahan T, Dooling D. Living and working in space: life sciences. In: Garber S, ed. NP-119 Science in Orbit: The Shuttle & Spacelab Experience, 1981-1986. NASA; 2004.
  3. Clement G, Ngo-Anh JT. Space physiology II: adaptation of the central nervous system to space flight—past, current, and future studies. Eur J Appl Physiol. Jul 2013;113(7):1655-1672.
  4. Lackner JR, DiZio P. Vestibular, proprioceptive, and haptic contributions to spatial orientation. Ann Rev Psychol. 2005;56:115-147.
  5. Moore ST, Clement G, Raphan T, Cohen B. Ocular counterrolling induced by centrifugation during orbital space flight. Exp Brain Res. 2001;137(3-4):323-335.
NASA astronaut Rusty Schweickart performs the first extravehicular activity in space during Apollo 9. He had the first documented case of SAS. A Spacelab astronaut uses a physiological tape recorder to monitor eye and head movements.
More from July 2015 - Vol. 34 No. 06
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Supporting the future
The Centralized Otolaryngology Research Efforts (CORE) grants program plays a critical role in advancing the field of otolaryngology by providing support to research projects, research training, and career development.
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Working together on performance measures
Measurement aligns with registry, payment models Quality metrics and performance measures have assumed center stage as payment progresses forward to alignment with quality of care and efficiency in care. To address Member needs for clinical quality measures, the AAO-HNSF launched the Performance Measures Task Force (PMTF) comprised of Richard M. Rosenfeld, MD, MPH, Chair, and Lisa E. Ishii, MD, MHS, James C. Denneny, MD, Richard V. Smith, MD, Jane T. Dillon, MD, MBA, Julie L. Goldman, MD, and David R. Nielsen, MD, in 2014. The Task Force held its first meeting in February 2015. Specific outcomes included a commitment to develop two prioritized sets of measures based on clinical practice guidelines (CPG), a continued collaboration with the AMA-convened Physician Consortium for Performance Improvement® (AMA-PCPI®) for measures testing, and exploration of tools that will facilitate faster development of measures from CPGs. Over the past year, the Foundation has produced a measures development strategy aligned with its registry initiative and new payment models to meet critical Member needs in the realm of quality reporting and support of Medicare and commercial reimbursement with an overarching goal of reinforcing the value of care provided by Members. The AAO-HNSF is moving forward for Members on three fronts in the realm of clinical quality measures. First, the Foundation took over ownership and stewardship of the AMA-PCPI® measures most applicable to our Members, which include acute otitis externa (AOE), adult sinusitis, and otitis media with effusion (OME) in December 2014. Each of the measures had time-limited endorsement from the government contractor for measure endorsement, the National Quality Forum (NQF). One of the key roles of measure owners and stewards is ensuring the continued validity and endorsement, as well as dissemination and use of the clinical quality measures in its portfolio. 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You will report for at least 50 percent of your group’s Medicare Part B patient population. For more information on group reporting, visit www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Registry-Reporting.html. The good news is the Academy has made the process of measure selection easier by having identified all the measures that could be used by Academy Members and sorted them by quality domain for ease of use. The measures highlighted in red were developed and stewarded by the Academy. To secure information on all of the individual measures contained in the table at right, visit www.entnet.org/content/individual-quality-measures. It is clear with the passage of H.R. 2 Medicare Access and CHIP Reauthorization Act of 2015, the need for quality measures will continue well into the future. The Academy recognizes the complexity and difficulty of the CMS quality reporting and hence, the decision to invest resources into quality measurement development specific to our specialty. 2015 National Quality Strategy Domains (Individual/Claims Measures)   Patient Safety Person and Caregiver- Centered Experiences and Outcomes [Patient and Family Engagement]   Communication and Care Coordination   Effective Clinical Care [Clinical Processes/Effectiveness]   Community/ Population Health [Population/Public Health]   Efficiency and Cost Reduction [Efficient Use of Healthcare Resources] Perioperative Care: Selection of Prophylactic Antibiotic – First OR Second Generation Cephalosporin PQRS #21 Patient Centered Surgical Risk Assessment and Communication PQRS #358 Medication Reconciliation PQRS #46 Controlling High Blood Pressure PQRS #236 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention PQRS #226 Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy – Avoidance of Inappropriate Use PQRS #93 Perioperative Care: Discontinuation of Prophylactic Parenteral Antibiotics (Non- Cardiac Procedures) PQRS #22 Optimal Asthma Control PQRS #398 Care Plan PQRS# 47 Acute Otitis Externa (AOE): Topical Therapy PQRS #91 Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented PQRS #317 Adult Sinusitis: Antibiotic Prescribed for Acute Sinusitis (Appropriate Use) PQRS #331 Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in All Patients) PQRS #23 Functional Outcome Assessment PQRS #182 Diabetes: Hemoglobin A1c Poor Control PQRS #1 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan PQRS #128 Adult Sinusitis: Appropriate Choice of Antibiotic: Amoxicillin Prescribed for Patients w/ Acute Bacterial Sinusitis PQRS #332 Perioperative Temperature Management PQRS #193 Falls: Plan of Care PQRS #155 Asthma: Pharmacologic Therapy for Persistent Asthma Ambulatory Care Setting PQRS #53 Preventive Care and Screening: Influenza Immunization PQRS #110 Adult Sinusitis: CT for Acute Sinusitis (Overuse) PQRS #333 Falls: Risk Assessment PQRS #154 Functional Deficit: Change in Risk-Adjusted Functional Status for Patients with Neck, Cranium, Mandible, Thoracic, Spine, Ribs, or Other General Orthopedic Impairments PQRS #223 Immunizations for Adolescents PQRS #394 Adult Sinusitis: More than One CT Scan Within 90 Days for Chronic Sinusitis (Overuse) PQRS #334 Documentation of Current Medications in the Medical Record PQRS #130 Biopsy Follow-Up PQRS #265 Tobacco Use and Help with Quitting Among Adolescents PQRS #402 Appropriate Treatment for Children w/Upper Respiratory Infection PQRS #65 Radiology Exposure Time Reported for Procedures Using Fluoroscopy PQRS #145 Pain Assessment and Follow-Up PQRS #131 Appropriate Testing for Children with Pharyngitis PQRS #66 Pneumonia Vaccination Status for Older Adults PQRS #111 Reporting as individuals For physicians reporting as individuals, you may use these clinical quality measures groups or the other measures groups listed on our web site at www.entnet.org/content/quality-measures-groups. Sinusitis Measures Group Measure #130 Documentation of Current Medications in the Medical Record Measure #131 Pain Assessment and Follow-Up Measure #226 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention Measure #331 Adult Sinusitis: Antibiotic Prescribed for Acute Sinusitis (Appropriate Use) Measure #332 Adult Sinusitis: Appropriate Choice of Antibiotic: Amoxicillin Prescribed for Patients with Acute Bacterial Sinusitis (Appropriate Use) Measure #333 Adult Sinusitis: Computerized Tomography (CT) for Acute Sinusitis (Overuse) Acute Otitis Externa Measures Group Measure #91 Acute Otitis Externa (AOE): Topical Therapy Measure #93 Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy – Avoidance of Inappropriate Use Measure #130 Documentation of Current Medications in the Medical Record Measure #131 Pain Assessment and Follow-Up Measure #154 Falls: Risk Assessment Measure #155 Falls: Plan of Care Measure #226 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention Measure #317 Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented
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