The role of physiotherapy in the European Space Agency strategy for preparation and reconditioning of astronauts before and after long duration space flight

Abstract

Spaceflight and exposure to microgravity have wide-ranging effects on many systems of the human body. At the European Space Agency (ESA), a physiotherapist plays a key role in the multidisciplinary ESA team responsible for astronaut health, with a focus on the neuromusculoskeletal system. In conjunction with a sports scientist, the physiotherapist prepares the astronaut for spaceflight, monitors their exercise performance whilst on the International Space Station (ISS), and reconditions the astronaut when they return to Earth. This clinical commentary outlines the physiotherapy programme, which was developed over nine longduration missions. Principles of physiotherapy assessment, clinical reasoning, treatment programme design (tailored to the individual) and progression of the programme are outlined.Implications for rehabilitation of terrestrial populations are discussed. Evaluation of the reconditioning programme has begun and challenges anticipated after longer missions, e.g. to Mars, are considered. Key WordsPhysiotherapy; microgravity; spaceflight; astronaut reconditioning; exercise; low back pain 4 IntroductionThe requirements of the human body, in particular the neuro-musculoskeletal system, are very different in space than on Earth. Interestingly, physiological spaceflight data suggest that it is more difficult to return to gravity than to adapt to microgravity conditions (Payne et al 2007). On Earth, the line of gravity normally passes through the ventral part of the L3 vertebral body (Richter & Hebgen, 2006), ensuring optimal load transfer). In microgravity, musculoskeletal adaptations are appropriate to that environment but this has major effects on muscle function and posture. Astronauts move in a predominantly flexed position and the centre of mass shifts posteriorly (Baroni et al, 2001), with increased recruitment of flexor muscles and a loss of extensors (Fitts et al 2001; Fitts et al 2000). A shift of muscle fibres types from tonic (type 1) to phasic (type 2) occurs (Fitts 2001). Graviceptors, which are sensory receptors that contribute to providing a neural representation of the direction of gravity, with respect to the gravity vector (Binder 2009), no longer function in microgravity.The astronaut therefore receives less information about his/her posture and has to rely on vision and feedback from dynamic receptors.Prolonged microgravity has negative effects on muscle strength and endurance, motor control, coordination and balance (Layne et al, 2001), which may place the astronaut at higher risk of injury. In the spine, primarily lumbar, intervertebral discs absorb more water (hyperhydration) than on Earth (Belavy et al 2016), which can be associated with low back pain (LBP) inflight but is short-lived and has been reported in 70% of astronauts without a history of LBP and 100% of those with a history of LBP (Pool-Goodzwaard et al 2015). The effects of microgravity on the intervertebral disc must be considered to allow safe re-loading of the spine postflight, as the astronaut must readapt...

Postflight reconditioning for European Astronauts – A case report of recovery after six months in space

“…The present case report focuses of the physical activity and sport component of the ESA reconditioning programme, which is complementary to the physiotherapy concept reported by Lambrecht et al in this special issue of Musculoskeletal Science and Practice [17].…”

“…The ESA postflight reconditioning programme is based on the best evidence available from terrestrial rehabilitation [17]. Future exploration missions of up to three years, such as to Mars, will be even more challenging to recover from and require research to develop optimal reconditioning programmes.…”

Surgical Aspects of Space Medicine

“…Immediately post-landing astronauts may compliant of a general weakness, orthostatic intolerance and neurosensory troubles, including pitch sensitivity [which could affect an individual's capabilities to walk]. Once able, astronauts experience a prolonged period of physical reconditioning to recover both musculoskeletal and cardiovascular systems [27] .…”

Parallels between astronauts and terrestrial patients – Taking physiotherapy rehabilitation “To infinity and beyond”

“…In the BBR-2, two physiotherapists were provided with a unique opportunity. The European Space Agency (ESA) physiotherapist (Lambrecht et al 2017) and a physiotherapist experienced in motor control training designed and delivered a reconditioning program. Magnetic resonance imaging (MRI) of the lumbo-pelvic region was conducted at the start and end of bed rest and during the recovery period.…”

“…The ESA approach to post space mission lumbo-pelvic reconditioning has been published (Evetts et al, 2014;Lambrecht et al 2017;Petersen et al 2017). Whilst the physiotherapy programme encompassed much more than rehabilitation of the lumbo-pelvic region, a recent case history documented changes in lumbo-pelvic muscles associated with spaceflight .…”