Parallels between astronauts and terrestrial patients - Taking physiotherapy rehabilitation "To infinity and beyond"

3D cell culture model: From ground experiment to microgravity study

Microgravity has been shown to induce many changes in cell growth and differentiation due to offloading the gravitational strain normally exerted on cells. Although many studies have used two-dimensional (2D) cell culture systems to investigate the effects of microgravity on cell growth, three-dimensional (3D) culture scaffolds can offer more direct indications of the modified cell response to microgravity-related dysregulations compared to 2D culture methods. Thus, knowledge of 3D cell culture is essential for better understanding the in vivo tissue function and physiological response under microgravity conditions. This review discusses the advances in 2D and 3D cell culture studies, particularly emphasizing the role of hydrogels, which can provide cells with a mimic in vivo environment to collect a more natural response. We also summarized recent studies about cell growth and differentiation under real microgravity or simulated microgravity conditions using ground-based equipment. Finally, we anticipate that hydrogel-based 3D culture models will play an essential role in constructing organoids, discovering the causes of microgravity-dependent molecular and cellular changes, improving space tissue regeneration, and developing innovative therapeutic strategies. Future research into the 3D culture in microgravity conditions could lead to valuable therapeutic applications in health and pharmaceuticals.

Cytoskeleton Markers in the Spinal Cord and Mechanoreceptors of Thick-Toed Geckos after Prolonged Space Flights

Spaceflight may cause hypogravitational motor syndrome (HMS). However, the role of the nervous system in the formation of HMS remains poorly understood. The aim of this study was to estimate the effects of space flights on the cytoskeleton of the neuronal and glial cells in the spinal cord and mechanoreceptors in the toes of thick-toed geckos (Chondrodactylus turneri GRAY, 1864). Thick-toed geckos are able to maintain attachment and natural locomotion in weightlessness. Different types of mechanoreceptors have been described in the toes of geckos. After flight, neurofilament 200 immunoreactivity in mechanoreceptors was lower than in control. In some motor neurons of flight geckos, nonspecific pathomorphological changes were observed, but they were also detected in the control. No signs of gliosis were detected after spaceflight. Cytoskeleton markers adequately reflect changes in the cells of the nervous system. We suggest that geckos’ adhesion is controlled by the nervous system. Our study revealed no significant disturbances in the morphology of the spinal cord after the prolonged space flight, supporting the hypothesis that geckos compensate the alterations, characteristic for other mammals in weightlessness, by tactile stimulation.

Bioinformatic Study of Transcriptome Changes in the Mice Lumbar Spinal Cord After the 30-Day Spaceflight and Subsequent 7-Day Readaptation on Earth: New Insights Into Molecular Mechanisms of the Hypogravity Motor Syndrome

The hypogravity motor syndrome (HMS) is one of the deleterious impacts of weightlessness on the human body in orbital space missions. There is a hypothesis that disorders of musculoskeletal system as part of HMS arise in consequence of changes in spinal motor neurons. The study was aimed at bioinformatic analysis of transcriptome changes in lumbar spinal cords of mice after a 30-day spaceflight aboard biosatellite Bion-M1 (space group, S) and subsequent 7-day readaptation to the Earth’s gravity (recovery group, R) when compared with control mice (C group) housed in simulated biosatellite conditions on the Earth. Gene ontology and human phenotype ontology databases were used to detect biological processes, molecular functions, cellular components, and human phenotypes associated with HMS. Our results suggest resemblance of molecular changes developing in space orbit and during the postflight recovery to terrestrial neuromuscular disorders. Remarkably, more prominent transcriptome changes were revealed in R vs. S and R vs. C comparisons that are possibly related to the 7-day recovery period in the Earth’s gravity condition. These data may assist with establishment of HMS pathogenesis and proposing effective preventive and therapeutic options.

State-of-the-Art Exercise Concepts for Lumbopelvic and Spinal Muscles - Transferability to Microgravity

Low back pain (LBP) is the leading cause of disability worldwide. Over the last three decades, changes to key recommendations in clinical practice guidelines for management of LBP have placed greater emphasis on self-management and utilization of exercise programs targeting improvements in function. Recommendations have also suggested that physical treatments for persistent LBP should be tailored to the individual. This mini review will draw parallels between changes, which occur to the neuromuscular system in microgravity and conditions such as LBP which occur on Earth. Prolonged exposure to microgravity is associated with both LBP and muscle atrophy of the intrinsic muscles of the spine, including the lumbar multifidus. The finding of atrophy of spinal muscles has also commonly been reported in terrestrial LBP sufferers. Studying astronauts provides a unique perspective and valuable model for testing the effectiveness of exercise interventions, which have been developed on Earth. One such approach is motor control training, which is a broad term that can include all the sensory and motor aspects of spinal motor function. There is evidence to support the use of this exercise approach, but unlike changes seen in muscles of LBP sufferers on Earth, the changes induced by exposure to microgravity are rapid, and are relatively consistent in nature. Drawing parallels between changes which occur to the neuromuscular system in the absence of gravity and which exercises best restore size and function could help health professionals tailor improved interventions for terrestrial populations.

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

BACKGROUND

Postflight reconditioning of astronauts is understudied. Despite a rigorous, daily inflight exercise countermeasures programme during six months in microgravity (μG) on-board the International Space Station (ISS), physiological impairments occur and postflight reconditioning is still required on return to Earth. Such postflight programmes are implemented by space agency reconditioning specialists. Case Description and Assessments: A 38 year old male European Space Agency (ESA) crewmember's pre- and postflight (at six and 21 days after landing) physical performance from a six-month mission to ISS are described.

ASSESSMENTS

muscle strength (squat and bench press 1 Repetition Maximum) and power (vertical jump), core muscle endurance and hip flexibility (Sit and Reach, Thomas Test).

INTERVENTIONS

In-flight, the astronaut undertook a rigorous daily (2-h) exercise programme. The 21 day postflight reconditioning exercise concept focused on motor control and functional training, and was delivered in close co-ordination by the ESA physiotherapist and exercise specialist to provide the crewmember with comprehensive reconditioning support.

OUTCOMES

Despite an intensive inflight exercise programme for this highly motivated crewmember, postflight performance showed impairments at R+6 for most parameters, all of which recovered by R+21 except muscular power (jump tests).

CONCLUSIONS

Regardless of intense inflight exercise countermeasures and excellent compliance to postflight reconditioning, postflight performance showed impairments at R+6 for most parameters. Complex powerful performance tasks took longer to return to preflight values. Research is needed to develop optimal inflight and postflight exercise programmes to overcome the negative effects of microgravity and return the astronaut to preflight status as rapidly as possible.

Methodology for astronaut reconditioning research

Space medicine offers some unique challenges, especially in terms of research methodology. A specific challenge for astronaut reconditioning involves identification of what aspects of terrestrial research methodology hold and which require modification. This paper reviews this area and presents appropriate solutions where possible. It is concluded that spaceflight rehabilitation research should remain question/problem driven and is broadly similar to the terrestrial equivalent on small populations, such as rare diseases and various sports. Astronauts and Medical Operations personnel should be involved at all levels to ensure feasibility of research protocols. There is room for creative and hybrid methodology but careful systematic observation is likely to be more achievable and fruitful than complex trial based comparisons. Multi-space agency collaboration will be critical to pool data from small groups of astronauts with the accepted use of standardised outcome measures across all agencies. Systematic reviews will be an essential component. Most limitations relate to the inherent small sample size available for human spaceflight research. Early adoption of a co-operative model for spaceflight rehabilitation research is therefore advised.

The immediate effects of exercise using the Functional Re-adaptive Exercise Device on lumbopelvic kinematics in people with and without low back pain

BACKGROUND

Dysfunction of the lumbar multifidus (LM) and transversus abdominis (TrA) muscles is associated with low back pain (LBP). The Functional Re-adaptive Exercise Device (FRED) has shown potential as a non-specific LBP intervention by automatically recruiting LM and TrA. Loss or lordosis and altered lumbopelvic positioning has also been linked to LBP and is often trained within LM and TrA interventions. The effect that FRED exercise has on lumbopelvic positioning and lumbar lordosis is unknown.

OBJECTIVES

To assess the effect of FRED exercise on lumbopelvic kinematics and alignment to establish whether FRED exercise promotes a favourable lumbopelvic posture for training LM and TrA.

DESIGN

Within and between-group comparison study.

METHOD

One hundred and thirty participants, 74 experiencing LBP, had lumbopelvic kinematic data measured during over-ground walking and FRED exercise. Magnitude-based inferences were used to compare walking with FRED exercise within participants and between the asymptomatic and LBP groups, to establish the effects of FRED exercise on lumbopelvic kinematics, compared to walking, in each group.

RESULTS

FRED exercise promotes an immediate change in anterior pelvic tilt by 8.7° compared to walking in the no-LBP and LBP groups. Sagittal-plane spinal extension increased during FRED exercise at all spinal levels by 0.9° in the no-LBP group, and by 1.2° in the LBP group.

CONCLUSIONS

FRED exercise promotes a lumbopelvic position more conducive to LM and TrA training than walking in both asymptomatic people and those with LBP.

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

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 neuro-musculoskeletal 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 long-duration 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.