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Biomedical Results from Skylab
NASA SP-377

Biomedical
Results from
Skylab
Edited by
Richard S. Johnston and
Lawrence F. Dietlein
NASA Lyndon B. Johnson Space Center

Scientific and Technical In[ormation O0_ce


NATIONAL AERONAUTICS AND SPACE ADMINISTRATION
Washington, D.C.
1977
Library of Congress Cataloging in Publication Data
Main entry under title:
Biomedical results from Skylab.
(NASA SP ; 377)
Includes index.
1. Space Medicine. 2. Space flight--Physiological effect. 3. Skylab Program. I.
Johnston, Richard S. II. Dietlein, Lawrence F. III. Title. IV. Series: United States.
National Aeronautics and Space Administration. NASA SP ; 377.
RCl135.B56 616.9'80214 76-54287

For sale by the Superintendent of Documents, U.S. Government Printing Office

Washington, D.C. 20402 Stock Number 033-000-00648-9


Class No. NAS 1.21:377

iv

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Foreword

The successful conclusion of the Skylab Program following the Apollo


series marks the end of an era in which the United States proved that men
could not only explore the Moon, but could also live and work effectively in
space for prolonged periods of time. The conclusions of these initial efforts
in space exploration also heralds the beginning of a new era during which
the use of space will be developed and expanded for the benefit of all man-
kind.
Progress in development of manned space flight and exciting new scien-
tific discoveries in space over the past two decades have produced, in addi-
tion to pride in achievement and moments of exaltation, a new feeling of
closeness to our neighbors across the oceans and a rededication to preserv-
ing and improving the quality of life on our planet.
Through the years, the quest for more knowledge about space and its
impact on man sparked the technological advances in related scientific and
engineering disciplines. Happily, at this present point in human history,
sufficiently advanced technology and man's will to explore the unknown
joined forces to make space flight possible. Following this breakthrough, the
further understanding of the nature and extent of man's capabilities in
space became an urgent issue. Inquiries about how man might behave,
prosper, or be adversely affected in the unique environment accompanying
space exploration have influenced the course of the space flight program.
This book chronicles the work of scientists attempting to understand the
responses of man and his life processes in an environment previously totally
unknown to living systems.
During the Mercury, Gemini, and Apollo Programs, only limited meas-
urements of astronaut physiological responses were possible. Restricted
internal volumes of the spacecraft and the operational complexities of those
missions essentially precluded the conduct of in-depth measurements to
gather in-flight data on physiological changes. From those early observa-
tions, however, it became apparent that there were three environmental or
operational factors of paramount concern: namely, space radiation, altera-
tions in circadian rhythm, and null gravity. Of these, the physiological
responses attributable to absence of accelerative forces were notably
unique. In the earlier programs, the decisions to proceed with longer, more
complex missions were based, to a large extent, on the postflight biomedical
evaluation of flight crews. An extensive program of biomedical measure-
ments performed during flight had to await the advent of larger space-
craft with longer stay-time capabilities. Skylab presented this opportunity.
The Life Sciences Program encompassed inquiries into the effects of space
flight on basic biological systems, the physiological responses of man, as
well as the health, well-being, and safety of the crewmen.
This program was developed and executed under the auspices of the
Life Sciences Directorate at the Lyndon B. Johnson Space Center. The data
vi BIOMEDICAL RESULTS FROM SKYLAB

resulting from such a program, it was felt, could effectively establish new
goals for more sophisticated scientific research into the basic mechanisms
involved in the various observed responses of man.
The success of the Skylab Life Sciences Program was made possible, in
large measure, by the dedication and professional excellence of its re-
search and management teams, and the outstanding cooperation and per-
formance of the astronauts who expertly executed the in-flight phases of
the experiments.
Exhaustive research and development activities over the past two
decades produced the engineering and medical criteria used for assuring the
health and safety of the crewmen, maintaining hygiene and relative com-
fort, and providing the basic needs for living and operating in a strange
and artificial environment. The essential task remaining was to determine
through scientific observations the extent, nature, rate of onset, and pro-
gression of any delerious event(s) which might threaten crewmen. These
scientific inquiries have been documented, and great confidence has been
gained that man can perform effectively for long periods of time in space if
his health is properly maintained and his bodily needs satisfied.
Space flight provides the opportunity to look at living systems from an
entirely new vantage point. Perhaps, at some time in the future, such in-
vestigative efforts will provide new theories about the origin of life and
the organization of life systems on Earth. The biomedical reports in this
book indicate that the few deleterious effects on physiological functions
are moderate in degree and completely reversible. These findings under-
score the enormously resilient capacity of the body and its organ systems to
perform their functions in an orderly fashion. The research conducted
during these successful Skylab missions represents only the beginning of an
inquiry that will add new dimensions to our understanding of living sys-
tems and may provide additional insight into the origin, evolution, and
miracle of life itself.

CHRISTOPHER C. KRAFT, JR., Director


Lyndon B. Johnson Space Center
Specialacknowledgment is madeof the el_ortsof WaylandE. Hull of the
Life SciencesDirectorate,LyndonB. JohnsonSpaceCenter,for preparing
this researchfor publicationin bookform, and of the many contributing
authors for their unstinting cooperation in the preparation of their manu-
scripts. Particular recognition is due Mrs. Sylvia A. Rose of The Boeing
Company for her superb technical editing e1_ort and to contributing per-
sonnel at NASA Headquarters, Washington, D.C.

RSJ
LFD

vii
Contents

SECTION I

Introduction

Chapter Page
1 SKYLAB MEDICAL PROGRAM OVERVIEW .................... 3
Richard S. Johnston
2 FLIGHT CONTROL EXPERIENCES ......................... 20
F. Story Musgrave
3 SKYLAB 4 CREW OBSERVATIONS .......................... 22
Edward G. Gibson
4 SKYLAB 2 CREW OBSERVATIONS AND SUMMARY ............ 27
Joseph P. Kerwin
5 SKYLAB CREW HEALTH--CREW SURGEONS' REPORTS ........ 30
Jerry R. Hordinsky
6 SKYLAB ORAL HEALTH STUDIES ........................ 35
Lee R. Brown, William J. Frome, Sandra Handler, Merrill G.
Wheatcroft, Linda J. Rider
7 ANALYSIS OF THE SKYLAB FLIGHT CREW HEALTH
STABILIZATION PROGRAM ............................ 45
J. Kelton Ferguson, Gary W. McCoUum, Benjamin L. Portnoy
8 SKYLAB ENVIRONMENTAL AND CREW MICROBIOLOGY STUDIES . 53
Gerald R. Taylor, Richard C. Graves, J. Kelton Ferguson,
Royce M. Brockett, Ben J. Mieszkuc
9 RADIOLOGICAL PROTECTION AND MEDICAL DOSIMETRY
FOR THE SKYLAB CREWMEN ........................... 64
J. Vernon Bailey, Rudolf A. Hoffman, Robert A. English
10 TOXICOLOGICAL ASPECTS OF THE SKYLAB PROGRAM .......... 70
Wayland J. Rippstein, Jr., Howard J. Schneider

SECTION II

Neurophysiology
11 EXPERIMENT M131. HUMAN VESTIBULAR FUNCTION
1. Susceptibility to Motion Sickness .................. 74
2. Thresholds for Perception of Angular Acceleration as
revealed by the Oculogyral Illusion .............. 91
3. The Perceived Direction of Internal and External
Space ........................................ 100
Ashton Graybiel, Earl F. Miller, H, Jerry L. Homick
12 EFFECTS OF PROLONGED EXPOSURE TO WEIGHTLESSNESS
ON POSTURAL EQUILIBRIUM ........................... 104
Jerry L. Homick, Millard F. Reschke, Earl F. Miller, II

ix

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BIOMEDICAL RESULTS FROM SKYLAB

Chapter Page
13 EXPERIMENT M133. SLEEP MONITORING ON SKYLAB ....... 113
James D. Frost, Jr., William H. Shumate, Joseph G. Salamy,
Cletis R. Booher
14 VISUAL LIGHT FLASH OBSERVATIONS ON SKYLAB 4 ........ 127

Rudolf A. Hoffman, Lawrence S. Pinsky, W. Zach Ashborne,


J. Vernon Bailey
15 CHANGES IN THE ACHILLES TENDON REFLEXES FOLLOWING
SKYLAB MISSIONS ................................... 131

Joseph T. Baker, Arr_uld E. Nicogossian, G. Wyck!iffe Hof-


tier, Robert L. Johnson, Jerry Hordinsky
16 TASK AND WORK PERFORMANCE ON SKYLAB MISSIONS 2, 3,
AND 4. TIME AND MOTION STUDY--EXPERIMENT M151 ... 136
Joseph F. Kubis, Edward J. McLaughlin, Janice M. Jackson,
Rudolph Rusnak, Gary H. McBride, Susan V. Saxon
17 CREW EFFICIENCY ON FIRST EXPOSURE TO ZERO-GRAVITY ... 155
Owen K. Garriott, Gary L. Doerre

SECTION III

Musculoskeletal Function

18 MINERAL AND NITROGEN METABOLIC STUDIES,


EXPERIMENT M071 .................................. 164
G. Donald Whedon, Leo Lutwak, Paul C. Rambaut, Michael
W. Whittle, Malcolm C. Smith, Jeanne Reid, Carolyn S. Leach,
Connie Rae Stadler, Deanna D. Sanford
19 PHYSIOLOGICAL MASS MEASUREMENTS IN SKYLAB .......... 175
William E. Thornton, John Ord
20 BONE MINERAL MEASUREMENT--EXPERIMENT M078 ....... 183
John M. Vogel, Michael W. Whittle, Malcolm C. Smith, Jr.,
and Paul C. Rambaut
21 MUSCULAR DECONDITIONING AND ITS PREVENTION
IN SPACE FLIGHT .................................... 191

William E. Thornton, John A. Rummel


22 BIOSTEREOMETRIC ANALYSIS OF BODY FORM .............. 198

Michael W. Whittle, Robin Herron, Jaime Cuzzi

SECTION IV

Biochemistry, Hematology, and Cytology


23 BIOCHEMICAL RESPONSES OF THE SKYLAB CREWMEN:
AN OVERVIEW ....................................... 204
Carolyn S. Leach, Paul C. Rambaut
24 CYTOGENIC STUDIES OF BLOOD (EXPERIMENT Mlll) ........ 217
Lillian H. Lockhart
25 THE RESPONSE OF SINGLE HUMAN CELLS TO ZERO-GRAVITY... 221
P. O'B. Montgomery, Jr., J. E. Cook, R. C. Reynolds, J. S.
Paul, L. Hayflick, D. Stock, W. W. Schulz, S. Kimzey, R. G.
Therolf, T. Rogers, D. Campbell, J. Murrell
CONTENTS xi

Chapter Page
26 BLOOD VOLUME CHANGES .............................. 235
Philip C. Johnson, Theda B. DriscoU, Adrian D. LeBIane
27 RED CELL METABOLISM STUDIES ON SKYLAB .............. 242
Charles E. Mengel
28 HEMATOLOGY AND IMMUNOLOGY STUDIES ................. 249
Stephen L. Kimzey

SECTION V
Cardiovascular and Metabolic Function
29 LOWERBODY NEGATIVE PRESSURE : THIRD MANNED
SKYLAB MISSION .................................... 284
Robert L. Johnson, G. Wyekliffe Hol_er, Arnauld E. Nieogos-
sian, Stuart A. Bergman, Jr., Margaret M. Jackson
3O VECTORCARDIOGRAPHIC RESULTS FROM SKYLAB MEDICAL
EXPERIMENT M092: LOWER BODY NEGATIVE PRESSURE .... 313
G. Wyckliffe Hoffler, Robert L. Johnson, Arnauld E. Nivogos-
sian, Stuart A. Bergman, Jr., Margaret M. Jackson
31 HEMODYNAMIC STUDIES OF THE LEGS UNDER WEIGHTLESSNESS 324
William E. Thornton, G. Wyekliffe Hol_er
32 ANTHROPOMETRIC CHANGES AND FLUID SHIFTS ............ 330
William E. Thornton, G. Wyckliffe Hol_er, John A. Rummel
33 VECTORCARDIOGRAPHIC CHANGES DURING EXTENDED
SPACE FLIGHT (M093). OBSERVATIONSAT REST AND
DURING EXERCISE ................................... 339
Raphael F. Smith, Kevin Stanton, David Stoop, Donald
Brown, Walter Janusz, Paul King
34 EVALUATION OF THE ELECTROMECHANICAL PROPERTIES OF
THE CARDIOVASCULAR SYSTEM AFTER PROLONGED
WEIGHTLESSNESS ................................... 351

Stuart A. Bergman, Jr., Robert L. Johnson


35 EFFECT OF PROLONGED SPACE FLIGHT ON CARDIAC
FUNCTION AND DIMENSIONS .......................... 366
Walter L. Henry, Stephen E. Epstein, James M. Gri_th,
Robert E. Goldstein, David R. Redwood
36 RESULTS OF SKYLAB MEDICAL EXPERIMENT M171--
METABOLIC ACTIVITY ................................ 372
Edward L. Michel, John A. Rummel, Charles F. SaTin, Mel-
vin C. Buderer, John D. Lem
37 PULMONARY FUNCTION EVALUATION DURING AND
FOLLOWING SKYLAB SPACE FLIGHTS ................... 388
Charles F. SaTin, Arnauld E. Nieogossian, A. Paul Sehachter,
John A. Rummel, Edward L. Michel
38 METABOLIC COST OF EXTRAVEHICULAR ACTIVITIES .......... 395
James M. Waligora, David J. Horrigan, Jr.
39 DETERMINATION OF CARDIAC SIZE FROM CHEST
ROENTGENOGRAMS FOLLOWING SKYLAB MISSIONS ........ 400
Arnauld E. Nicogossian, G. Wyckliffe Hoffter, Robert L. John-
son, Richard J. Gowen
xii BIOMEDICAL RESULTS FROM SKYLAB

SECTION VI

Summary
Chapter Page
40 SKYLAB: A BEGINNING ................................ 4O8
Lawrence F. Dietlein

APPENDIXES

A ppendi_
A I. EXPERIMENTAL SUPPORT HARDWARE
a. Lower Body Negative Pressure Device (M092) .... 421
Robert W. Nolte
b. Leg Volume Measuring System (M092) .......... 424
Robert W. Nolte
c. Automatic Blood Pressure Measuring
System (M092) .............................. 428
Robert W. Nolte
d. Vectorcardiograph .............................. 433
John Lintott, Martin J. Costello
e. In-flight Blood Cnllection System ................ 436
John M. Hawk
f. Ergometer ..................................... 441
John D. Lem
g. Metabolic Analyzer .............................. 445
John D. Lem
h. Body Temperature Measuring System (M171) ...... 448
John D. Lem
i. Hardware Report for Experiment M133,
Sleep Monitoring on Skylab .................... 450
Cletis R. Booher, E. Fontaine LaRue
j. Skylab Experiment M131---Rotating Litter Chair .... 455
James S. Evans, Dennis L. Zitterkopf, Robert L. Ko-
nigsberg, Charles M. Blackburn
k. Experiment Support System ..................... 459
Albert V. Shannon
II. OPERATIONAL LIFE SCIENCES SUPPORT HARDWARE
a. In-flight Medical Support ........................ 463
Charles Chassay, Sylvia A. Rose
b. Carbon Dioxide, Dewpoint Monitor ............... 474
Stanley Luczkowski
c. Atmospheric Analyzer, Carbon Monoxide
Monitor and Toluene Diisocyanate Monitor ...... 478
Albert V. Shannon
d. Skylab Hardware Report Operational
Bioinstrumentation System .................... 481
Stanley Luczkowski
e. Exerciser ...................................... 485
John D. Lem
B Subject Index ......................................... 487
SECTION I

Introduction
-/3/

N77 o
-o3781
CHAPTER 1

Skylab Medical Program Overview

RICHARD S. JOHNSTON "+

ISTORYIS FILLED with examples of man's de- its first long-term space station and has acquired
sire to explore new frontiers. Having sensed giant advancements in knowledge concerning the
the thrill of discovery, man has pressed on to scale physiological effects of increasingly extended pe-
new heights, not weighing the cost or personal riods of exposure to the space flight environment
risk, but mindful only of his destiny to conquer and in determining how well man can function
the unknown. Under adverse conditions, he has while performing tasks in space.
crossed the seas and the wastes of the arctics until Space medicine studies using experimental ani-
there were no longer any new seas to cross, moun- mals were initiated prior to 1959. Limited medical
tains to climb, or arctic poles to visit. Thus has studies and observations on men in space were
he explored his Earth. initiated in the United States with the Project
Exploration has always been a risky under- Mercury Program. This project (ref. 1) served
taking and opportunity for it is largely dependent to dispel many basic concerns regarding the frail-
upon the advancement of technologies in trans- ties of the human space explorer. It was shown
portation and life support. With the development that man could operate effectively during the
of chemical propellants and the application of acceleration periods of launch and entry, and that
some fundamental laws of physics, high velocity he could adapt to the weightless environment and
rocket propulsion became a reality; this is all perform useful tasks. Medical measurements made
man needs to kindle his imagination to reach be- during these early flights showed that normal
yond his Earth and to start the exploration of his body functions were not adversely altered. The
universe. Although preservation of life and health few changes which occurred were moderate but
is esser_tial to the successful conquest of the un- reversible. For example, postural hypotension was
known, few explorers have conducted studies on observed when the astronauts returned to the
themselves or documented their responses to new Earth's gravity field.
environments. A notable exception was the work The first series of medical studies during
conducted during the 1935 International High weightless flights was provided by the Gemini
Altitude Expedition to the Chilean Andes when Program (refs. 2, 3). One objective of these flights
the members of that team conducted self-studies was to evaluate the performance of men living in
to record for medical science the effects of expo- the space environment for 14 days to assure an
sure to the hypoxic environment of high altitudes. effective lunar scientific excursion. The results of
Since then some of these data have been used by the Gemini flights further demonstrated that man
every student of space medicine. could adapt to the weightless environment, could
Utilizing the Saturn V launch system, man has perform useful tasks, and could enter the Earth
successfully completed an epoch-making lunar atmosphere and readapt to Earth gravity.
exploration program. Through the use of this same The Apollo Program originally included the
propulsion system, the United States has launched conduct of a series of medical studies for the early
orbital missions. After the tragic Apollo 204 ac-
• NASA Lyndon B. Johnson Space Center, Houston,
cident, the decision was made to delete the medical
Texas. studies and to dedicate all resources to the corn-

lmmlmlqG PAGE BLANK NOT FILM_


4 BIOMEDICAL RESULTS FROM SKYLAB

plex lunar landing program. Consequently, medi- unchanged throughout the Skylab Program. This
cal studies were primarily conducted with the chapter will provide an introduction and overview
Apollo crewmen before and after each flight. to the Skylab medical program. The chapters
Skylab, at its inception called the Apollo Appli- which follow will present the significant results
cations Program, was a natural and necessary from the three manned Skylab missions.
follow-on to the Gemini and Apollo Programs. The
tested and proven spacecraft and launch vehicles Operational Equipment
from the Apollo missions were used in the design Several major medical subsystems were pro-
and flights of the Skylab Program. Development vided in the Skylab Orbital Workshop to sustain
of medical experiments, initiated in the mid- the crew and to protect their health.
1960’s, included a decision to design the experi- Food System.-The Skylab food system (fig.
mental program along classical lines of medical 1-1) (ref. 4) was developed to provide a balanced
and physiological research; namely, to group re- and palatable diet which also met the necessary
lated studies together according to their possible requirements for calories, electrolytes, and other
contribution to the understanding of the function- constituents for the metabolic balance experiment
ing of a major body system. Of course the results (ch. 18). Seventy foods were available from which
from the Gemini and Apollo flights influenced the the crew could select their in-flight diets. Food
planning and placement of emphasis for the new types included frozen, thermostablized, and
program. The experiment protocols developed to freeze-dried foods. Menus were planned for 6-day
study the cardiovascular, musculoskeletal, hema- turnaround cycles. Each crewman was required
tologic, vestibular, metabolic, and endocrine sys- to consume his individually planned diet €or 21
tems in the body, with few exceptions, remained days preflight, throughout the flight, and for 18

FIGURE1-1.Skylab Food System.


S K n A B MEDICAL PROGRAM OVERVIEW 5
days postflight. Approximately one ton of food was design of the food system were acceptable to the
stowed in the Orbital Workshop at launch to pro- Skylab crewmen. At the suggestion of the re-
vide approximately 400 man-days of food. The turned Skylab 2 crew, more and varied spices were
ambient foods were packaged in 6-day supply in- included in the later missions to improve the taste
crements and stowed; these were moved by the of the food.
crewmen to the galley area for direct stowage, The extension of the Skylab 4 mission for an
preparation, and eating. The galley area contained additional 28 days required 250 pounds of addi-
a freezer, a food chiller, and a pedestal which pro- tional Skylab food to be launched in the Command
vided hot and cold water outlets, attachment points Module. This extra weight and the resulting stow-
for three food trays, and body restraints which age volume were excessive, therefore, a high-
afforded each crewman the opportunity to sit down density, high-caloric type food bar was stowed in
to eat. Each food tray contained seven recessed the Command Module to provide the caloric re-
openings to hold cans or other containers, three quirements for the mission extension. The crew-
of which had heaters for warming the food. The men’s in-flight menus were modified to include
food cans were constructed with membranes or approximately 800-1000 calories of the food bars
other designed devices which restrained the food every third day. For Skylab 4, in addition to the
within the container when in zero-gravity and al- 50 pounds of high-caloric type food bars, approxi-
lowed the crew to eat with conventional tableware. mately 100 pounds of other Skylab-type food and
Drinks in a powdered form were packaged into drinks were launched in the Command Module.
individual bellows-like containers constructed with Waste Management System.-The Skylab Waste
a drinking valve. Water, when needed, was added Management System included equipment for the
from the hot o r cold water outlets located on the collection, measurement, and processing of all
pedestal. The cremnen drank from the container urine and feces and for the management of trash
by collapsing the bellows. such as equipment wrappers, food residues, et
The variety of foods provided and the general
--
cetera (fig. 1-2).

FIGURE
1-2.-Skylab Waste Management Systems.
6 BIOMEDICAL RESULTS FROM SKYLAB

Waste Management.-Equipment used by the water and a liquid soap were available in limited
crew for the collection of urine and feces, and in quantity for one shower per week for each man.
addition, equipment used for personal hygiene The Skylab crewmen reported satisfaction with
were stowed and used in the waste management the shower and other personal hygiene equipment ;
compartment. Feces were individually collected however, the crewmen did indicate that an exces-
into a bag attached under a form-fitted commode sive amount of time was required to vacuum the
seat. The bag was permeable to air and imperme- collected water and dry out the shower after use.
able to liquids. An electric blower, actuated by the Microbiological studies conducted on the Skylab
crewman during use, provided a positive airflow crewmen indicated that the personal hygiene tech-
around the anal area to carry the feces into the niques used were completely adequate.
collection bag. After each defecation, the crew- Isflight M e d i d Support System.-In-flight
man weighed the bagged stool on a mass measur- Medical Support System (IMSS) (app. A., sec.
ing device, and then labeled and placed it into a 1I.a.) was designed to provide for the conduct of
vacuum drying processor. After 16 to 20 hours of selected in-flight medical evaluation experiments
drying, the bag of fecal residue was removed from and, as required, first level medical diagnosis and
the processor and stowed for return to Earth for treatment for an ill or injured crewman (fig.
postmission analysis. 1 4 ) . The equipment was stowed in the wardroom
Each crewman’s urine was collected in an in- and included: diagnostic, minor surgery, dental,
dividual 24-hour pooling bag. A centrifugal fluid/ catheterization, and bandage kits. Sixty-two med-
gas separator was actuated a t the start of urina- ications for the three missions were stowed in
tion to create a positive airflow to carry the urine modules to insure an adequate and fresh supply
into the equipment where urine was separated Prior to flight, drug-sensitivity testing was con.
from the gas and was then collected into the pool- ducted on mission-designated Skylab crewmen. I n
ing bag. A measured quantity of lithium chloride, addition, microbiological equipment and slide
added to each pooling bag prior to flight, permitted staining capabilities were provided. Petri dishes
urine volumes to be calculated during analysis a n incubator, microscope, and slide stainer werc
postflight. In addition, the crew used a gage to available for use by the crew. The microbiologica
measure the filled pooling-bag thickness to give a equipment was used to collect airborne and surfacc
real-time estimate of daily urine output. Once microbial samples in flight. As part of his missior
every 24 hours each crewman collected a 120 preparation, each Skylab crewman underwent 8(
milliliters urine aliquot from his pooled urine bag hours of paramedical training in the use of thc
and placed this sample in a freezer for return and In-flight Medical Support System for diagnosis anc
postflight analysis. The used pooling bag was dis- in treatment of injury or illness.
carded and a new bag was installed for use each
day.
Trash accumulated from food wrappers, used
equipment bags, used towels, et cetera, were dis-
carded through an airlock into a large volume tank
in the Orbital Workshop dome.
The Waste Management System and trash air-
lock operated satisfactorily throughout the Skylab
missions and the crews reported complete satis-
faction with the design of this equipment.
Personal Hygiene.-Provisions were included in
the Orbital Workshop for daily personal hygiene.
Such items as wet wipes, towels, toothbrushes, ra-
zors and deodorants, were provided to maintain
body cleanliness. I n addition a shower contained
in a collapsible cylindrical cloth bag (fig. 1-3)
was provided to permit full body bathing. Warm FIGURE1-3.--Skylab shower.
SKYLAB MEDICAL PROGRAM OVERVIEW 7
Cardiovascular Counterpressure Garment.-
Cardiovascular counterpressure garments (fig.
1-5) were launched in the orbital workshop for all
three missions. These garments were designed to
provide mechanical counterpressure t o the lower
extremities to reduce the postural hypotension ef-
fects following landing and operations under one-
gravity conditions. The garment has a builbin
capstan in the length of each leg. Inflation of the
capstan by a pressure bulb provided a pressure
gradient of 85 to 90 millimeters of mercury (mm
Hg) pressure at the ankles to 10 mm H g pressure
at the waist. A garment was donned by each crew-
man prior to entry and it was sometimes inflated
during descent and always following landing. Sub-
FIGURE 1 - 5 4 k y l a b cardiovascular counterpressure
sequent chapters (chs. 5, 29) will discuss the garment.

FIGURE
l-€.-Skylab In-flight Medical Support System.
8 BIOMEDICAL RESULTS FROM SKYLAB

physiological protection afforded by these gar- TABLE1-11.-Added Special In-flight Tests


ments.
Skylab mission
Life Sciences Experiments
In-flight Tests
The Skylab medical experiments listed in table a 3 4
1-1 were designed to provide an indepth study of Blood flow X X
individual body systems and a t the same time pro- Facial photograph X X
vide an overlap to give comprehensive understand- Venous compliance X X
ing of man’s reaction to long-term weightless Anthropometric measurements X

flight. Added special in-flight tests are shown in Treadmill exerciser X


-
Center of mass A
table 1-11 to indicate other type studies which I R anatomical photography X
were completed in the three missions. The inclu- Taste and aroma evaluation X
sion of major in-flight medical experiments pro- Atmospheric volatile concentration X
vided the capability to study physiological Light flash observations X

responses during exposure to weightless flight as Hemoglobin X X


Urine specific gravity X X
opposed to the pre- and postflight studies as car- Urine mass measurement X
ried out in the Apollo and Gemini Programs. Re- Stereophotogrammetry X
sults of these studies are the subject of this book.
The Skylab medical experiments equipment was
located in and occupied about one-third of the floor were provided to measure respiratory volumes.
area of the crew living level of the two-storied The bicycle ergometer was used to provide a quan-
Orbital Workshop. Figure 1-6, a photograph taken titative stress level for investigation of physio-
during the Skylab 3 mission, shows this medical logical response and it was also used as the prime
experiment area. On the right is the collapsed off-duty crew exercise device. Blood pressure, vec-
shower previously described. The two consoles torcardiograms, and body temperature measure-
against the workshop wall contain the medical ments were also made as a part of the M171
experiment electronic equipment. This figure also Metabolic Activity experiment.
shows photographs of equipment for two of the The M092 Lower Body Negative Pressure De-
major medical experiments : M172 and M092. vice is shown on the upper right of figure 1-7 as
The M171 ergometer and metabolic analyzer i t was used in Skylab 2 ; this experiment was
(app. A., sec. 1.f. and 1.g) shown at the upper left monitored at all times by a second crewman. The
of figure 1-7 are being used by the Skylab 2 Pilot. leg volume measuring bands (app. A., sec. 1.b.)
The metabolic analyzer contains a mass spectrom- used with the Lower Body Negative Pressure De-
eter for measuring oxygen, carbon dioxide, nitro- vice are shown also. The electronic center for these
gen, and water vapor. In addition, spirometers

Number Experiment

FIGURE14.-Photo of medical experiments from Skylab 3.


SKYLAB MEDICAL PROGRAM OVERVIEW 9
experiments, labeled on figure 1-7 as Experiment lect, process, and preserve in-flight blood samples
Support System (app. A., sec. I.k.), contains the (fig. 1-9) (app. A., sec. 1.e.). The crewmen ac-
displays and experiment controls. quired approximately 11 milliliter blood samples
I n the upper left-hand corner of figure 1-8, the with a conventional syringe and then transferred
Skylab 2 Scientist Pilot is shown wearing the the whole blood into a pre-evacuated sample pro-
M133 electroencephalographic sleep cap (app. A., cessor (fig. 1-10). The sample processor was then
sec. 1.i). One crewman, i.e., the Scientist Pilot, placed into a centrifuge to separate the plasma
performed this experiment in each mission. The from the cells and to transfer the plasma into a
Body Mass Measuring Device and Specimen Mass separate collection vial for preservation. This
Measuring Devices (ch. 19) were evaluated as ex- transfer operation had to be automatically accom-
periments to establish the method and accuracy of plished while the blood was being centrifuged due
determining mass in the weightless environment. to problems associated with weightless operations
In addition, these devices were used to provide and fluid dynamics.
daily body weights and the mass of food residues The cross section drawing of the sample proc-
and fecal specimens. The M131 rotating litter chair essor shown in figure 1-10 illustrates how the
(app. A,, sec., 1.j.) was used to study vestibular equipment functioned. Whole blood was trans-
functions and susceptibility to motion sickness. ferred from the syringe through a septum into the
Equipment also was developed and flown to col- processor. A spring-loaded piston was attached to

measuring Dana

M-093 VCG elect1


harness and body
temp probe

Experiment support system Blood pressure cuff

FIGURE1-7.-Skylab in-flight experiment equipment.


10 BIOMEDICAL RESULTS FROM SKYLAB

M-131 Rotating
litter chair

M-172 Body-mass
measuring device

M-133 Sleep studies M-074 Small mass measuring device

FIGURE
1-8.-Skylab medical experiments.

the bottom of the sample processor and the unit processing. The quantity of information obtained
was placed in the centrifuge. Following initial from the medical studies conducted with the Sky
centrifugation, the cells and plasma were sepa- lab crewmen over a relatively short period of timc
rated. At this point, the centrifuge speed was in- is perhaps unique in medical research Over 600 OOC
creased to force the piston to drive the plasma vial biochemical analyses were made on food, blood
septum past a needle and allow the plasma to flow urine, and fecal samples. In completing two of tht
into the vial. Following this separation process, major medical experiments, more than 18 OO(
the blood was placed in a.freezer and preserved blood pressure determinations were made and ovei
for postflight analysis. 12 000 minutes of vectorcardiographic data werc
The medical experiment equipment functioned obtained.
without problems throughout the three flights.
Medical data of high quality were obtained for all Skylab Medical Operations
experiments. Vast quantities of medical data avail- The medical operational planning for Skylal
able for reduction and analysis were processed in was much more complex than any other U.S
an orderly fashion. This could not have been ac- manned space mission. The logistics planning re
complished in a timely manner without computer quired for crew feeding, sample collection, base
SKYLAB MEDICAL PROGRAM OVERVIEW 11
1974 with the last postflight Skylab 4 crewmen
evaluation tests.
The first launch (Skylab 1) was to place the
Skylab Orbital Workshop in correct orbit; i t was
unmanned. The compressed schedule of the subse-
quent manned Skylab launches and the extension
of mission duration after the first manned launch,
Skylab 2, created an extremely heavy burden on
the Skylab medical team. The medical experiment
program was unique in that it not only provided
scientific data, but, in turn, the data were used as
the basis for operational decisions for commitment
to longer duration flights. This meant that at the
FIGURE1-9,Skylab In-flight Blood Collection System. end of each of the first two manned missions, the
medical team had to make a recommendation for
line experiment data acquisition, crew medical the extension of the next successive mission. From
examinations, crew health care, data processing, figure 1-11 it can be seen that the preflight phase
and flight management into an integrated plan of Skylab 3 started before the completion of the
that meshed with program milestones required a Skylab 2 postflight phase and after baseline data
major medical team effort. collection for Skylab 4 had begun. Skylab 3 was
The Skylab medical operations program was launched only 2 weeks after the Skylab 2 postflight
initiated in June 1972 with a 56-day altitude studies were completed. Skylab 4 was launched
chamber test (ref. 5) and was completed in April only 5 weeks after completion of the Skylab 3

Direction of Direction of
centrifugal
force I Plasma
Blood separation
injection Plasma
septum

Second
septum
Whole penetrated
blood

' Double-ended
needle Plasma
Needle pierces
septum transfer

Cellular Cellular
Plasma fraction fraction
cartridge

Piston

c,
FIGURE
1-1 O.--Skylab blood sample processor.
12 BIOMEDICAL RESULTS FROM SKYLAB

postflight medical studies. This quick turnaround procedures and the training of support personnel
required careful planning, establishing priorities under simulated mission conditions.
for samples and data processing, and the dedica- Like a flight mission, the test consisted of a 21-
tion and tireless effort of all members of the medi- day prechamber phase, a 56-day chamber test, and
cal team. an 18-day postchamber test period. All preflight
Skylab Medical Experiment Altitude Test.---The and postflight medical protocols were performed
Skylab medical experiment altitude chamber test with astronaut crewmen. The inchamber test por-
was a 56-day mission simulation conducted in a tion of the program was carried out using full
6.1 meter (20 ft) diameter vacuum chamber. The mission simulation procedures, and included: crew
interior of the chamber wa._ conflg::red closely to checklist, real-time mission planning, and data
the Orbital Workshop crew quarters level which management. The communications with the crew-
consisted of the medical experiments area, ward- men were limited to a spacecraft communicator,
room, waste management compartment, sleeping as programed to be carried out in the mission.
quarters, and recreational area. The atmosphere Simulated network communications were followed
in the chamber was maintained at a composition to evaluate the problems of lost communica-
identical to that of the Orbital Workshop, with tion between flight crew and mission control cen-
70 percent oxygen, 30 percent nitrogen mixture at ter, as they would be experienced in actual flight.
a pressure of 34X103 Pa (5 lb/in:). Carbon di- A remote console was used by the medical team
oxide levels were controlled at a nominal level of to evaluate the problems of lost communica-
16.9 kP (5 in. Hg) pressure. dures for flight. This test program was successful ;
The prime objectives of the test were to acquire the required baseline data were obtained and the
background data and to exercise the data manage- encountered equipment failures and problems
ment and processing techniques for selected medi- were corrected prior to flight. The ground support
cal experiments. Other test objectives included personnel became an effective team ready to carry
the evaluation of medical experiment and opera- out the complex flight program.
tional equipment, the evaluation of operational Premission Support.--The premission support

1972 1973 1974


Activity
MIJIJIAIsloINID JIFIMIAIMIJ IJIAIslOINID JIF
56-day

altitude
chamber test

Orbital
.k -'_
workshop
(SL-1)

First
manned
mission
(SL-2)

Second
manned
mission
(SL-3)

Third
manned
mission
(SL-4)

I_ Experiments baseline acquisition D In-flight

Q Preflight period I_ Postflight

SL Skylab

FIGURE 1-1l.--Skylab medical operations program.


SKYLAB MEDICAL PROGRAM OVERVIEW

for the first manned mission started in December prehensive medical examination of both the prime
1972 with acquisition of the first baseline data for and backup crews was given 30 days before
the Lower Body Negative Pressure (M092, ch. scheduled launch and additional baseline data were
29) and Metabolic Activity (M171, ch. 36) ex- obtained for the experiments.
periments. Additional baseline tests were con- Twenty-one days before launch, the crew was
ducted in support of the medical experiments at placed in semi-isolation (fig. 1-12) to meet the
designated periods up to approximately 1 week requirements of the Skylab Crew Health Stabiliza-
before the launch of Skylab 2. These baseline data tion Program (ch. 7 ) . The objective of this pro-
were primarily obtained in an Orbital Workshop gram was to protect the in-residence flight crew
one-gravity trainer. This full scale trainer con- from illnesses which might cause them to be re-
tained fully functional medical experiments and moved from flight status and to preclude exposure
other operational hardware. Combined crew train- to infectious disease which could develop in flight.
ing and baseline data collection were conducted All personnel who were required to work with the
with both the prime and backup crewmen. A re- flight crews were designated as primary contacts.
mote medical console and data recording system To protect the crewmen, these personnel under-
was used to monitor the crewmen during training went periodic extensive medical examinations and
sessions and to train members of the medical team immunizations, were required to wear a surgical
in control procedures and in the reduction of flight mask while in contact with the crew, and were re-
data. This combination of training and medical quired to report all personal and family illnesses.
baseline data acquisition was excellent for both Isolated crew quarters were established and per-
the crewmen and medical experimenter. A com- sonnel access into designated primary work areas

Management conference witn 3Kylab I I


crew (1 week before launch)

FIGURE
1-1 2.--Skylab Health Stabilization Program.

ORIGINAL PAGE IS
OF POOR QUALps%3
14 BIOMEDICAL RESULTS FROM SKYLAB

was rigidly controlled. The Skylab Crew Health started at launch through the use of the Opera-
Stabilization Program was effective and no major tional Bioinstrumentation System (app. A, sec.
problems were encountered. II.d). The bioinstrumentation system was used to
During this period of isolation, the crew con- monitor the crew during all extravehicular activi-
sumed foods identical to those provided from pre- ties. The frequency of in-flight medical ex-
planned in-flight menus (ref. 4). Daily collections periments and tests for the Skylab 2 crewmen is
of urine and fecal samples were initiated. Medical also indicated in figure 1-14. Throughout all Sky-
examinations, microbiological and blood sampling, lab missions, the Lower Body Negative Pressure
and experiment baseline testing were continued at (M092) and Metabolic Activity (M171) experi-
o,,,,_on _p,,_ ,_.... e1 up _v 3 days _._v....
launch when the prime and backup crews were fourth day. Blood samples were collected weekly
moved to the Kennedy Space Center for the during the missions and biosampling was accom-
launch. plished daily.
In-flight Opere_tion(d Support.--The manage- During the flight phase, real-time monitoring of
ment of the in-flight medical operations support the medical experiments was accomplished only
and the necessary interactions with program man- when the spacecraft was over a tracking station.
agement personnel, personnel representing the sci- This meant, in some instances, there was a com-
entific disciplines, and the Flight Control Team plete loss of communications with the crew and
were accomplished through a medical management the telemetered data during medical testing. To
group. The medical group met each morning of overcome this problem, all experiment data were
the mission to review crew health status, to evalu- recorded onboard and subsequently telemetered
ate the current state of the medical studies, to through the tracking stations to the Mission Con-
discuss equipment or other operational problems, trol Center. The use of software programs per-
and to establish changes in experiment pVorities. mitted automatic computer reduction of the
Health trend charts were plotted each day (fig.
Day of mission
1-13) to provide experimental data which were
0 10 20 30 40 50 60 70 80
useful in understanding crew health status. These i i i i i | i 'l"

+1 .
charts included: crew weight, caloric intake,
0-
quantity of sleep, heart rate and blood pressure --1 - _*t_ • o_ ...... Commander
under dynamic stress, urine volume output, and -2
__ .... Scientist Pilot
other pertinent information. The chairman of -3

the Medical Management Group reported to a -4

Flight Management Team on all medical matters


and participated in operational decisions such as
changing crew timelines, adjusting science re- i --6- First mission
quirements to insure maximum utilization of the
_. _
crew and the current science opportunities, and
to provide advice on major operational policy
i --47 " ;=,"*",P._',. r..._ .... _ _ :_,
changes. This management scheme was extremely _5" • _ "_" _,'_#'_.,.,,_/_ m A J_ •
effective and was a key factor in the success of --6- Second mission
the Skylab Program. #t el' •
+1" • • _.*,. so*.l =_ .",Ls---_,_t _ . t
The in-flight activities of Skylab 2, illustrated in o.
'* - ; -" v. - w.

figure 1-14, shows the medical activities for a --1 " _'.%'_ =. A... =/V-
"_ . , -
--2 -
typical Skylab mission. The first 2 to 3 days of
-3
each mission were spent in the activation of the --4 I

Orbital Workshop. These activities included such -5

tasks as system checkouts and activation, transfer -6


Third mission
of equipment from the command module to the
Orbital Workshop, changing air filters, et cetera. Fa(;vnE 1-13.--Skylab crew heahh trend chart--body
In-flight medical monitoring of the crewmen weight.
SKYLAB MEDICAL PROGRAM OVERVIEW 15
experiment data with a preliminary data printout developed and equipped to acquire preflight and
to the experimeter within 24 hours after comple- postflight medical experiments data. The labora-
tion of the test. During the last few days of all tories were designed and constructed to be moved
three missions, work/rest cycles were changed to in a C-5A transport aircraft and thus permit the
adjust the circadian rhythm of the crewmen to the medical team to cover contingency splashdown in
required length of the pre-entry day and the time the event of an early mission abort. For a normal
of spacecraft splashdown. mission, the laboratories were flown to port and
The in-flight portion of the three Skylab mis- were lifted onboard the recovery carrier. Six
sions totaled 168 days during a 8.5-month period. laboratories made up the laboratory complex and
Throughout this long and arduous period, the those were equipped with backup support systems,
interest, enthusiasm, and concern for the crew
were maintained at the highest level by all mem-
--
bers of the medical and program management -L 0

teams.
Postflight Activities.-The recovery procedure
used for the Skylab crewmen was altered from the0
procedures used in the Apollo Program. Figure
1-15 illustrates how the Command Module and
the crew were retrieved and lifted directly on-
board the recovery aircraft carrier and how the Skylab I1 crew leaving
crew egressed onto a platform on the hangar deck.
Spacecraft and crew retrieval took approximately
35 minutes from time of splash.
Specialized mobile laboratories (fig. 1-16) were FIGURE
1-15.-Skylab recovery operations.

I Mission dav

Workshop activation
I
8io monitoring A A A
EVA
Exoeriments:
Lower body A A A A A A A A
negative pressure

Metabolic activity I A A A A A A A
I
Vestibular studies
I AA AA A A A

Sleep study A A A A A A A A

Blood sampling A A A A

Bio sampling 1 I
Every day
~

Circadian shift A A A

Deactivation
~BJGINAI, PAGE rs
DE POOR QUALITY
16 BIOMEDICAL RESULTS FROM SKYLAB

i.e., electrical power, heating, cooling, et cetera. In The health stabilization program was followed
addition, a data complex was included which per- throughout the first week following recovery to
mitted processing of medical data in a format provide protection for the crew from any infec-
compatible with the flight data. In use, the mobile tious disease that might result from a depressed
laboratories proved to be useful facilities ; they immune response after the long isolation period
added to the convenience of the medical operations, of the flights. In all Skylab missions postflight
they were operated without problems, and they medical testing was continued until preflight con-
provided high quality medical data. trol levels were reached.
Medical studies were initiated immediately after
recovery operations. A summary of all postflight Operational Experience
activities is shown in figure 1-17. The recovery The Skylab Orbital Workshop was launched on
day testing for Skylab 2 lasted for approximately May 20, 1973. The loss of the micrometeoroid
10 hours and included a comprehensive medical shield exposed the skin of the workshop causing an
examination and the acquisition of data for all increase in internal workshop temperatures and
major medical studies listed in figure 1-18. In the partial deployment of the solar panels reduced
subsequent missions, the length of an over-long the electrical power supply available for experi-
recovery day of medical studies was shortened to ments and systems operation. The Orbital Work-
reduce crew stress and fatigue. shop failure also caused a 10-day delay in the

Deployment in C-5A

Laboratorv
Cardiovascular lab complex
(preflight)

Hematology lab

recovery ship

FIGURE
1-16.--Skylab mobile laboratories.
SKYLAB
MEDICAL PROGRAM OVERVIEW 17

launch of Skylab 2 which impacted the medical Food test programs were initiated to study the
program. This necessitated that the health stabili- effects of the increased temperature on microbial
zation, controlled feeding, and biosample collection growth, food quality, and other characteristics.
be extended. The exposure of the skin of the work- Identical foods were placed in thermal chambers;
shop caused an elevation in both wall and space- the temperature data from the workshop were
craft air temperature. The plot shown in figure used for a thermal profile. Periodic food sampling
1-19 illustrates the temperatures in the food was accomplished to ,determine biological and
stowage area exceeded 327.59 K (130 ° F). In the chemical composition changes, and the thermal ef-
10-day period before the launch of Skylab 2, a fects on taste and palatability were evaluated. No
thermal screen was developed which the crew significant food failures were encountered during
could deploy to shield and insulate the orbital these tests and the launch of Skylab 2 proceeded
workshop. In the intervening time period, how- without major alterations to the food system. The
ever, the increase in temperature caused the fol- food test program was, however, continued
lowing concerns to the medical team: throughout the Skylab Program and selected food
samples were returned from the three missions for
Would the foods be spoiled or changed by the
analyses.
elevated temperatures?
Similar thermal testing was accomplished for
Would other medical equipment be damaged by
many miscellaneous medical items such as elec-
the increased temperatures ?
trode sensors, sealed containers, et cetera. From
Would the polyurethane walls of the workshop
these tests, it was determined that resupply of
be heated to a point where carbon monoxide
certain medications would be carried by the Sky-
or toluene diisocyanate would be emitted into
lab 3 crewmen. Additional procedures and equip-
the spacecraft atmosphere?
ment were developed which allowed the crew to
Immediate action was taken to conduct ground reconstitute the electroencephalographic electrodes
based test programs or to develop equipment which on the sleep study caps.
the crew could use to understand and/or solve the The potential toxicity problems associated with
problems. the overheating of the workshop polyurethane

Day(s) from recovery


Activity
011 12131415 I617 I 8 19110111112[1311411s1161171181121116o
Medical examination • •

Health stabilization

Micro sampling • • •

Food and bio sampling

Blood sampling • • • • • •

Experiments:
Lower body
negative pressure

Metabolic activity

Vestibular studies

Sleep studies • • •

FlCURE 1-17.--Typical postflight activities (Skylab 2).


18 BIOMEDICAL RESULTS FROM SKYLAB

wall insulation also was studied through thermal crew found no toluene diisocyanate and the carbon
testing. It was determined that toluene diisocya- monoxide concentration was less than five parts
nate and carbon monoxide could be present in the per million. The toxicological aspects of the Sky-
atmosphere. Therefore, special sampling tubes and lab Program are covered in more detail in chapter
adapters were built in the 10-day period between 10.
the launches of the Orbital Workshop and Skylab The Skylab crew deployed the first thermal
2. The equipment developed permitted the crew to screen on the second day of their mission and
withdraw an atmospheric sample from the airlock immediately the Orbital Workshop wall tempera-
and then the workshop before opening the hatch tures started to decrease. Within the next several
into these areas. In addition, special masks were days, the ambient gas temperature had dropped
provided to allow the crew to move into the or- below 26.6 ° C (80 ° F). The elevated temperature
bital workshop if the toluene diisocyanate and/or in the workshop did delay the start of some medi-
carbon monoxide levels so dictated. The Skylab 2 cal experiments and, no doubt, influenced the re-
sults of the first medical studies. However,
Splash
R+ODay through the efforts of the Skylab 2 crewmen,
-- 06:49:50
Crew in sis Pilot Scientist Pilot Commander the mission and the workshop were saved from
--07:00
onboard PRS " '
--07:30 what appeared to be an obvious total failure. Sub-
Hatch open --.4_ : --07:35

Crew entered /"


- 07:40 sequently, the Skylab 3 crew deployed an addi-
OPS mad lab Micro
--08:00
--08:10
tional thermal screen to further protect the Orbital
Micro
Micro -- 08:20 Workshop against excessive heat changes for that
Ml10 --08:30

Ml10
mission and for Skylab 4.
M110
-- 08:40
Throughout the Skylab Flight Program, altera-
--09:00
--09:10
tions in equipment and procedures were made for
X-ray each succeeding mission to capitalize on the flight
stereo --09:40
M092 --10:00 experience of the previous mission. The Skylab
Physical
lea vol. --10:50 2 crew recommended that the personal in-flight
--11:00
Meal M171
-- 11:30 exercise program be extended in both duration
X-ray stereo

Visual function -- 12:00


and type. To meet this recommendation, the exer-
M078
cise period for the Skylab 3 crew was expanded
Physical

Visual function
-- 12:50 from one-half hour to 1 hour daily and an addi-
-- 13:00

Physical
M078
-- 13:20
tional exercise device was launched with the crew
Postural stability
of Skylab 3.
test
-- 13:50
Meal
M092 Stand test No. 1 -- 14:00
Maximum safe food
leg vol. X-ray with
temperature s
inflated
327.59 130
garment

Stand test No. 2 322.04 120


with garment
316.48 110
deflated (14:18)
-- 14:30
Leg vol. v 310.93 10o_
-- 14:40
X-ray No. 2 6 =-
with garment 305.37
-- 15:00
M171 postural off stereo
stability test -- 15:20 299.82 80 _.
LBNP M092
E E
-- 15:35
Shower Post M092 Shower 294.26 7o _-
.observation -- 15:50
-- 16:00 288.71 60
Free exercise Free exercise --16:30
-- 16:50
283.15
-- 17:30
Meal Meal i i m • I I I I | i i , ,
Meal
-- 18:30 134 138 142 146 150 154 158
Retired to
Retired to bed Retired to 136 140 144 148 152 156 160
bed bed
M133 R+I Day May 14 May 311June 1 June 9
'-- 06:00
F Crew up (.;raw up Crew Up Day of year

FIGURE 1-18.---Skylab 2 recovery day medical testing. FIGURE 1-19._Dry food temperature profile.
SKYLAB MEDICAL PROGRAM OVERVIEW 19

On Skylab 4, the duration of crew exercise was on September 25, 1973. The third and last manned
further expanded to 11/2 hours daily and a unique mission, Skylab 4, was launched November 16,
treadmill device was used by the crew. In addition 1973. The crew, Gerald P. Carr, Commander, Ed-
to these equipment-associated changes, additional ward Gibson, Scientist Pilot, and William Pogue,
scientific studies were added to the programs for Pilot, spent 2017 hours, 15 minutes, and 32 seconds
Skylab 3 and 4. These additional studies demon- in flight before splashing down on February 8,
strate the flexibility afforded the medical team and 1974.
the support given to this team by program man- The Skylab medical program met or exceeded
agement and the flight crews. all of the planned objectives. The medical opera-
tions were conducted without any major problems
Conclusions and the medical equipment functioned flawlessly.
The medical data received from the crew were of
Skylab 2, the first manned Skylab mission, was excellent quality and the quantity of information
launched on May 25, 1973, with a crew of three: available from these three missions is staggering
Charles P. Conrad, Commander; Joseph P. Ker- when viewed in its entirety. Skylab represents a
win, Scientist Pilot, and Paul J. Weitz, Pilot. After significant milestone in the development of space
672 hours, 49 minutes, and 49 seconds in flight, medical knowledge. From the information pre-
they splashed down on June 22, 1973. The crew on sented, we feel confident that man can fly longer
Skylab 3 consisted of Alan L. Bean, Commander; missions as required for future space exploration.
Owen K. Garriott, Scientist Pilot, and Jack R. The Skylab crewmen have demonstrated the ver-
Lousma, Pilot. This second manned mission began satility and ingenuity of man to make repairs, to
with launch on July 28, lasted 1427 hours, 9 min- carry out observations, and to conduct scientific
utes, and 4 seconds and ended with splashdown studies.

References

1. Space Medicine in Project Mercury. NASA SP-4003, 1965.


2. Gemini Midprogram Conference, Including Experiment Results, February 23-25,
1966. Manned Spacecraft Center, Houston, Texas, NASA SP-121, 1966.
3. Gemini Summary Conference, February 1-2, 1967, Manned Spacecraft Center, Hous-
ton, Texas, NASA SP-138, 1967.
4. Skylab Food System. NASA TM X-58139, October 1974.
5. Skylab Medical Experiments Altitude Test (SMEAT). NASA TM X-58115, October
1973.
N77-33782

CHAPTER 2
Flight Control Experiences

F. STORY MUSGRAVE a

EDICAL POLICIES AND DECISIONS were made play-back basis. This real-time availability of data
by a multidisciplinary medical-management allowed the Earth-based scien.tists to assist the
team early every morning. Flight surgeons and flight crew in the performance of medical and
biomedical officers, occupying adjacent consoles other experiments.
in the Mission Operations Control Room, were re- A flight plan or crew activity schedule was con-
sponsible for the medical aspects of mission con- structed daily from approximately 150 experi-
trol. In general, the flight surgeons were concerned ments and a multiplicity of systems, housekeeping,
with crew health and the biomedical officers were and maintenance tasks. Some of the factors con-
concerned with experiment operations and data sidered in building the flight plan were:
retrieval although these functions overlapped in The premission frequency requirements for the
several areas. A Biomedical Science Support Room
individual experiments;
manned by between 4 and 12 scientists and tech- Crew availability;
nicians: Orbital characteristics ;
Provided support for the flight surgeons and Target availability; and
biomedical officers; Scientific priorities.
Retrieved and compiled experiment data;
Early in the missions the flight planning was
Assisted in the development of flight plans ; and
based primarily on pre-established mission rules
Contributed to in-flight procedures and check-
and scientific priorities. Dynamic variations in ex-
lists.
periment performance and data such as solar
On each mission, at least one of the spacecraft flares, weather over an Earth resources site, the
communicators was a physician astronaut. physiological responses of the crew and the ap-
During the dynamic or critical phases of the pearance of "targets of opportunity" such as
missions, such as launch, extravehicular activities, Comet Kohoutek, hurricanes, and volcanoes caused
and entry, real-time or recorded physiological data many changes in the scientific priorities of the
from the crewmen bioinstrumentation systems, missions.
were displayed in digital or graphic form on the Flight controllers and mission managers de-
consoles in mission control. veloped a science planning program based on the
Analog, digital, and/or graphic data from the collected requirements and desires of all the dis-
medical experiment(s) could be called from the ciplines, i.e., solar physics, medical, Earth re-
mission operations computers on a real-time or sources, technology, astronomy, and the like. A
series of interdisciplinary discussions, negotia-
"NASA Lyndon B. Johnson Space Center, Houston, tions, and trade-offs were used to formulate a
Texas. Dr. Musgrave is a physician astronaut. He was one flight plan which would optimize the scientific
of the astronauts instrumental in the development of Sky- return of the mission.
lab medical hardware, the backup Scientist Pilot for the
Early Skylab crews, through increased in-flight
first manned Skylab mission, and a spacecraft communi-
cator for the last two manned Skylab missions. efficiency and effort, were consistently ahead of the

2O
FLIGHT CONTROL EXPERIENCES 21

flight plans and experiment time-lines and re- was uplinked to the crew to allow them to follow
quested more to do. While there existed vehicular physiological trends not readily available in the
and experiment limitations and constraints, crew onboard displays.
availability and time became a surplus. This ex- On a weekly basis, there was an open-loop con-
cess of crew time permitted the attainment of sev- ference between the crew and a scientist from the
eral new and additional biomedical objectives by: medical science community. This representative
provided the flight crew with:
Changing experiment protocols;
Using existing hardware in new ways;
A summary of the data being obtained on their
Making new observations ; and
mission; the observed trends;
Launching additional hardware and experiments
A comparison of current mission data with that
on subsequent missions.
obtained in previous missions or programs;
Procedures for these new objectives were de- and
veloped, tested, and polished in ground-based sim- A mechanism for the discussion of the signifi-
ulations and then uplinked via the spacecraft cance of these data.
teleprinter for in-flight implementation.
Daily, in addition to the private crew-flight This conference served as a real-time collo-
surgeon conference, a medical status report de- quium on space physiology and medicine for the
rived from voice and telemetered experiment data flight crew and Earth-based scientists.
CHAPTER 3

Skylab 4 Crew Observations

EDWARD G. GIBSON a

a meal as opposed to the normal 6 to 7 hours as


'OR US theexperiments
medical ATM observations
were very as enjoyable
well as the as- one does on Earth. We don't know whether that
pects of the flight. We became involved in under- was an effect of zero-gravity or whether that
standing the objectives of the medical experiments effect was from charging real hard continuously
and could see some progress towards these goals the first couple of weeks.
as the flight progressed. The experiments were Another effect of the food was from the Mineral
also made enjoyable by the people with whom we Balance experiment M071 (ch. 18). It was a
worked who were very cooperative during both worthwhile experiment, but it certainly did have
the initial training and during the flight itself. We its impact on the food system. In the future, we'd
felt that the medical ground team was always be- like to see a food system where there would be
hind us in two ways: in getting the medical data more flexibility of choice in what one wants to
and in making sure that we were in a reasonable eat, when one wants to eat it, and how one wants
condition to carry out all the other objectives of to season it. An open pantry versus a preplanned
the mission. rigid diet such as we had would be an optimum
As the ship's doctor for Skylab 4, I'll comment situation from the crew operational standpoint.
briefly on several areas: food, exercise, scheduling,
Exercise
medical training, the effects of the fluid shift,
vestibular effects, and several miscellaneous items. As already has been mentioned, we exercised
for 11/2 hours a day. I think we came back in as
Food good a shape, maybe better in some respects,
We experienced hunger on two different occa- than the previous crews. We attribute this to the
sions because of the types of diet we were on. In experience gained on the other flights. First of
order to extend our mission from 56 to 84 days, all we exercised longer, and second, we knew
we supplemented our meals with high-density just what exercises we should do. For the arms,
food bars every third day. During those days, we we used a Mark I exerciser, which is an inertial
had the same amount of minerals and number of wheel resistance device. It worked well. For the
calories as we had on other days but the amount legs, we took along a new device which, for us, I
of food bulk was greatly reduced, so we ended up think made a significant difference; this was the
fairly hungry on every third day. Second, we Thornton treadmill which is described in chapter
noticed, especially early in the mission, that we 21. We were able to exercise the calves of our legs
tended to get hungry in 3, 4, maybe 5 hours after in a way which just couldn't be done on any of
the other devices we had onboard. Also, for
"NASA Lyndon B. Johnson Space Center, Houston, cardiovascular conditioning, we worked out on
Texas. Dr. Gibson, a scientist astronaut who was the the bicycle. We were glad we had that onboard
Scientist Pilot on Skylab 4, is a specialist in solar physics. because we always felt good after we used it.
He was extremely enthusiastic about the Apollo Telescope
But when one is working for a long time on the
Mount (ATM) and the conduct of that experiment in his
mission. bike, 15, 20, 30 minutes or so at fairly high work-

22
SKYLAB 4 CREW OBSERVATIONS 23

loads, one needs mental diversion. If we had a nose. Preflight we had some training from the
window right by the bicycle, it would have been NASA surgeons and some of the physicians in
good. We did use a tape recorder and music and Houston, and they were always enthusiastic and
I found the music stimulated us and we could go exceptionally helpful. My only regret is that we
a lot longer and harder with it. This small point didn't get involved with it earlier. We started
changed the amount of exercise which we could training only after we were pretty heavily in-
consistently do. volved in all of the other mission training phases.

Scheduling Fluid Shift

There has been a progressive change in sched- This is perhaps one of the major points that
uling during the manned space flight programs we are still pondering. Early in the flight we
from the early types of flights to the ones we had experienced a sensation of head fullness. This is
in Skylab. Mercury, Gemini, and Apollo were caused by a shift of the body fluids to the upper
relatively short, high-effort, go-to-the-hilt-for-a- part of the body when one first enters into zero-g.
short-period-of-time missions. To plan everything One notices that the eyes turn red which, in my
down to the last detail is the best way to fly that case, happened after about a day or so. The eye
type of mission. Skylab, however, had very long sockets themselves become a little puffy, the face
missions. One had to become a jack-of-all-trades, a little rounder and a little redder, veins in the
and one had to use selective judgment in gather- neck and forehead become distended and one's
ing the data in several types of experiments. That sinuses feel congested. These conditions did not
implies, and indeed it was the case in Skylab 4, change significantly in-flight, they just tapered
that in-flight one needs a certain time to organize, off. The eyes gradually cleared but the congested
especially early in the mission. This is detailed sinuses, while not too bothersome, were always
fully by Dr. Owen Garriott in chapter 17. The there. On our flight the Pilot, Bill Pogue, noticed
other two Skylab crews reported similarly that the effects of fluid shift during the rendezvous;
one needs a certain time to analyze one's situation he had the head fullness during the docking, ex-
and to develop new techniques, whether it be how perienced some headache and some general mal-
to completely redo an experiment technique be- aise and felt, as he described it, pretty much like
cause it is just not working or whether there is he had the flu. To be helpful, we said, "Bill, why
just a better way to hold a checklist. Early in the don't you have some food, it will make you feel
mission something like 2 to 3 hours per day better." He took some tomatoes and very shortly
would have been useful to have as a time to get after that returned them to us. That was the only
organized. Shopping list items could be used to episode of vomiting we had on our flight. After
fill any left over time. Allowing the crew to work approximately 24 hours, Bill's headache disap-
up to their peak efficiency gradually versus trying peared. The congestion for all of us remained,
to force them to work at a predicted efficiency although I think it was probably a little more
should produce more effective results for the severe for Bill. The Commander and I noticed
mission as a whole. this feeling of head fullness and the accompanying
symptoms for the first 2 weeks or so. For the
Training
last 2 weeks of the mission the Pilot felt good and
In-flight Medical Support System. In our train- essentially equivalent to 100 percent on the ground.
ing, we learned a little bit about microbiological Several variables were observed to affect the
techniques, extracting teeth, suturing, and the fluid symptoms and the sensation of head fullness.
drawing of blood. I felt fairly comfortable with One was exercise. We always felt a lot better for
my ability to do any of the procedures in-flight about a half hour to 2 hours after we exercised
had we needed any of them. We certainly did do on the bicycle. Perhaps the effect of just drawing
a lot of blood drawing. Fortunately, we did not the blood down into the larger muscles of the body
have to get into any of the other aspects: sutur- took it away from the head and left it feeling
ing, tooth extraction, or diagnosis of major illness, clearer. The Commander on our flight also expe-
although we did have a few small things to diag- rienced this lessening of fullness to some degree
24 BIOMEDICAL RESULTS FROM SKYLAB

after eating. The last effect is associated with the rotating chair) after we had made several flights.
time of day. As on Earth, if one is bothered by Next let us consider the relationship between
something, it always feels worse towards the end our vestibular stimuli and nausea by making a
of the day; the same was true up there with the comparison between myself and Bill Pogue. Bill
sensation of head fullness. did get sick early in the mission. If anybody should
We were also able to see the leg volume changes not have gotten sick, it was Bill. He had many
because of the fluid shift. First of all, we could years of flight experience and used to fly with the
see the muscles shrink when we got up there. It Thunderbirds, the Air Force Aerobatic demon-
was obvious to the eye, and it could be confirmed stration team. When he was first tested, he was
by measurements. A couple of times we measured able to go at 25 revolutions per minute (r/min)
the calf after exercise on the treadmill. It in- in the rotating chair for 150 head motions. We
creased about a half inch or so after a reasonable called him "old lead ear." He had no problem
amount of exercise and then it shrank down fairly whatsoever on the ground. On the other hand, I'm
rapidly (15 to 30 minutes) as soon as we stopped. relatively new at the flying game. I had about
When we used the Lower Body Negative Pres- 2000 hours of flying time before I went up and
sure Device in-flight, the distress was subjectively was just normal in my tolerance in the chair.
higher than on the ground. This effect is discussed Maybe 12.5 r/min was what I could take initially,
in chapter 29. About 4 to 6 weeks into the mission although I was able to work up to 30 before I went
was worst for us, and that, too, is confirmed by because of the T38 flying. Both of us did about
the data. We used the symptoms of presyncope the same amount of moving about in the Command
as a cutoff for the Lower Body Negative Pressure Module, which was very small. But Bill got sick
test. We monitored pulse pressure and heart rate, after about 7 or 8 hours into the mission. I ex-
but primarily, we used the subjective symptoms perienced minimal symptoms and never really
of the individual. In some cases, the pulse pres- anything in the way of discomfort at all. So, the
sure and heart rate would get into the same ranges conclusion here is that we have got to look for
as they had been on a previous day for that in- something else other than what we normally call
dividual, but he might say: "No, that's it. I feel "motion sickness" as a generator of nausea! We
as though I'm going under and you better termi- suggest fluid shift may be intricately tied up in
nate now." Other times we could go right through this reaction.
the test without any problem. We really had to We never had stomach awareness when we were
consider the crew symptoms in addition to all up there. We experienced a sensation of tumbling
the other variables. after we were in the rotating chair and during
acrobatics in the workshop. After 15 or 20 for-
Vestibular Effects
ward rolls or gainers in a row I got really severe
Preflight we flew T38 aerobatics primarily to nystagmus but I never had any coupling to the
reduce our sensitivity to motion sickness. We also stomach.
did some work in a rotating chair with the use of One other interesting point relating to the
scopolamine/dexdroamphetamine sulfate (scop/ vestibular area was our in-flight perception of
dex). We never used scop/dex when flying a T38 orientation. For example, being upside down in
because it gave us a feeling of being lightheaded the wardroom made it look like a different room
and we did not want to be flying in that condition. than the one we were used to. After rotating
The preflight T38 flying, I thought, was the most back to approximately 45 degrees or so of the
significant part of our vestibular-type training. attitude which we normally called "up," the at-
We did aileron rolls while putting our heads in titude in which we had trained, there was a very
one of six different orientations. Fifteen to 25 sharp transition in the mind from a room which
rolls in a row while putting the head down, to one was sort of familiar to one which was intimately
side, or back, or one of the three opposite direc- familiar. All of a sudden it was a room in which
tions could greatly stress one's semicircular ca- we felt very much at home and comfortable with.
nals. We noticed significant improvement in our We observed this phenomenon throughout the
ability to tolerate vestibular stress (airplane and whole flight. I also noticed the feeling of *'down."
SKYLAB 4 CREW OBSERVATIONS 25

I experienced it a couple of times when I was comfortable as we got out of the Command
working in the multiple docking adapter or the Module.
airlock. When moving around in those vehicles, We all felt very thirsty on the recovery ship
I attached no direction to my motion at all. But, despite the fact that we had really forced the
after I looked out the window for a long period fluids before we returned. This was an expected
of time, in particular the window for the Earth reaction.
Resources Experiment Package, and then moved After return to one-g, the joints, especially the
away from the window and looked from the mul- knees, felt sore after a little exercise. My leg
tiple docking adapter to the airlock, I strongly muscles were sore; for the Commander, it was
felt that I was looking "down." In the back of my his back.
mind I said, "I'm going to fall if I don't hold on."
Miscellaneous Items
Of course, I knew that it was not true, and just
pressed right on. But that thought did flicker I did notice a ballistocardiographic effect a
through my mind several times. The other "down" couple of times when I was trying to take pictures
I noticed was a very exhilarating one, and that through a window and was just holding on to the
was outside during the extravehicular activities. adjoining structure rather lightly; I noticed that
When I went out to the end of the Apollo Tele- the whole Skylab cluster was beating at around
scope Mount, had my feet in the foot restraint 60 beats per minute. This was evidenced several
and leaned back, I felt very far away from the times. It required that I hold myself down rather
space station. I no longer felt a part of it, and firmly to get around this.
when I looked down, I suddenly realized that it Many of us noticed, subjectively and without
really was a very long 432 kilometers (270 mi). taking measurements, that the fingernails and toe-
On return, we first experienced one-gravity nails tended to grow a little bit slower in-flight.
after 84 days in weightlessness, during the first Rather than trimming them once a week it was
deorbit burn. We all noticed a rather strange on the order of once a month or so.
sensation in the inner ear. It was like a tumbling We all experienced light flashes. We noticed on
sensation, similar to what one gets when lying our flight that they were well correlated with the
on a table and someone puts cold or warm water South Atlantic anomaly. After some major flares
in your ear. We did not feel that we were tumbling on the Sun during one night, we saw a high num-
in a given direction; it was just an awareness of ber of flashes. Most of them appeared as a white,
a sensory input that we had not experienced for double-elongated flash, perhaps double in some
a very long period of time although we had no cases as other people have described, and Bill
real parallel to that sensation on the ground. After Pogue and I also saw the ones that looked like a
recovery, we found rapid head movements pro- whole multitude of pollywogs; very short ones,
duced vertigo. Most crews have noticed this. Also, many of them of low intensity. For us, the latter
the brain did not seem to be coupled to the mus- kind occurred on the second orbit after we saw
cles in the same way as it was before we left; the very bright ones, suggesting they are of lower
that is, we all felt very heavy. Every movement energy but of many more particles. Also, I saw
we made had to be worked at; rolling over in one green flash. Not a slightly green flash but a
bed, moving an arm, walking; all had to be made good old St. Patrick's Day green flash, sad ex-
with conscious effort. This lasted for a couple of ceptionally bright.
days and was more severe at the beginning than It was a surprise to us that we had no major
at the end of those 2 days. We could go around illness, especially on our flight. We were working
corners fairly well, if we were careful. We tended hard most all the time and got rather tired. We
to walk with our feet spread apart. I think that stayed tired for about the first half to two-thirds
had we had any contingency on the return we of the mission. If we had done that on the ground,
would have been able to handle those which we I don't think we would have gotten by without
had planned for, but certainly we were a bit less getting at least a "good" cold. Up there, we did
able to handle them than when we left. This was not have any major problems and I cannot specu-
to be expected, and I still think we all felt fairly late the reason for it.
26 BIOMEDICAL RESULTS FROM SKYLAB

We all found it was useful to sleep using the The duration of our mission was 84 days. We
device that we had up there. It was a cot outfitted felt that we could have gone significantly longer
with four straps which held us down and made us than that, on the order of a year, from the crew
feel as though we were sleeping in something standpoint. We felt good physically, especially the
similar to bed. On several occasions, I tried sleep- last month. Part of this feeling of well-being re-
ing by just floating free in the workshop. It was sulted from having achieved the necessary effi-
kind of fun, but I could only catnap that way. I ciency to become comfortable with our schedule.
floated pretty much with my arms out, as I would We have learned from Skylab that man makes
in a relaxed position underwater. I'd mash into a his best contributions on tasks which use his
wall rather slowly and 5 minutes later come up intellect and require his jud_ent and that his
against another one. My mind was always half proficiency on these types of tasks increases with
awake, waiting for the next contact. I could never mission duration. Thus, there should be strong
really get a sound sleep that way. motivation for future long-duration missions.
7 - 33 7 84

CHAPTER 4

Skylab 2 Crew Observations and Summary

JOSEPH P. KERWIN a

T IS REALLYNICE to talk to the other crews and was it so different from what was expected but
find out how consistent one's descriptions of it remains, subjectively, one of the primary mem-
the signs and symptoms of weightlessness are. ories that one gets from this "Alice in Wonder-
The environment is the same so it is just a matter land" world of weightlessness.
of describing it in different words or different Our crew was fortunate enough not to run into
similes. the motion sickness problem in any clinical or
There are two major themes that run through full-blown form. Therefore, among our first pleas-
my mind. Number one, of course, is that it really ant or different impressions was the impression
is extremely clear to an individual, when he is in of a very changed relationship between ourselves
weightlessness, that rather profound changes are and the outside world and, I would say there was
rapidly taking place in his body. One feels this no vestibular sense of the upright whatsoever. I
strange fullness in the head and this sensation certainly had no idea of where the Earth was at
of having a cold, and one sees the puffy look on any time unless I happened to be looking at it. I
the faces of his fellow crewmen and hears their had no idea of the relationship between one com-
nasal voices. He feels his body assume the strange partment of the spacecraft and another in terms
posture that one has in weightlessness, with the of a feeling for "up or down"; this has some pe-
shoulders hunched up, the hands out in the front culiar effects when one passes from one compart-
and the knees bent. Sleeping in that posture is ment into the other and walls turn into ceilings
not comfortable initially but every time one re- and ceilings turn into floors in a very arbitrary
laxes, one's body goes back to that posture. One way. But all one had to do is rotate one's body to
can almost see the fluid draining out of the legs the more familiar orientation and it all comes to
of his fellow crewmen making them look little right. What one thinks is up, is up. After a few
and skinny like crows' legs, and one knows that days of getting used to this, one plays with it all
one's physiology is changing. But that wasn't the the time; one just stands there and does a slow
primary theme. The primary theme was one of roll around his bellybutton. The feeling is that one
pleasant surprise at all the things that didn't could take the whole room and by pushing a but-
change, at all the things that were pleasant and ton, just rotate it around so that the screens up
easy to do. As Crew Commander Pete Conrad here would be the floor. It's a marvelous feeling of
pointed out, we lost a few bets up there because power over space--over the space around one.
of our appetites. The very first system that gave Closing one's eyes made everything go away. And
us a pleasant surprise was the vestibular system. now one's body is like a planet all to itself, and
All of us keep talking about it because not only one really doesn't know where the outside world
is. The first time I tried it, my instinct was to grab
hold of whatever was nearest and just hang on,
I NASA Lyndon B. Johnson Space Center, Houston,
lest I fall. It was the only time in the mission
Texas. Dr. Kerwin, the Scientist Pilot in Skylab 2, was the
first U.S. physician astronaut in space. He is currently when I had anything like a sensation of falling.
chief of the scientist astronauts. I was telling that to my wife, and she pointed out

27
28 BIOMEDICAL RESULTS FROM SKYLAB

that that's like the reflex that a baby has. When the amount of food the crew was allowed to eat
you begin to drop it, it just reaches out and increased and their exercise increased, they were
clutches. And we thought, it would be nice to write essentially eating the same amount of food as they
a story about a sort of evolution of the human ate on the ground. That to me is a mystery. I still
being in zero-g, because one certainly gets used don't understand how in an environment in which
to it in a hurry and it certainly is different. You certainly muscular work is reduced, the caloric
will read in great detail in chapter 11 about the demand and the relationship between caloric in-
third and last effect of weightlessness, the effect take and body weight remain just about the same
on the vestibular system. Ed Gibson alluded to as they do on the ground, I think that's a very
this effect in chapter 3 where he states that rota- interesting problem that we haven't yet been able
tion and head movement in weightlessness do not to solve.
elicit motion sickness. I don't believe Dr. Graybiel The first step in a rational description of the
will state it quite that strongly, but certainly we physiology of weightlessness is a medical history
never reached the threshold. And that was most and physical examination. This we follow with
surprising. laboratory findings and the clinical course of the--
Another very pleasant surprise was our ability I hate to call it a disease because it's not--but, of
to maintain physical fitness--our ability to main- this change. Such a description has many uses, not
tain the same exercise level as we had been main- the least of which will be to permit the diagnosis
taining on the ground. I really don't think that of disease in weightlessness, where the presenting
any of us expected that before the flight as we felt signs, symptoms, and so-called normal laboratory
that the combination of reduced mechanical effi- values are going to be different. Now our sample
ciency and muscular deterioration or atrophy was population has been much too small to have expe-
definitely going to reduce our ability to work on rienced significant illness in orbit, and it's been
the bicycle. Well, we were wrong again. Once we too small to allow us to predict changes in the
had mastered the technique or the mechanics of incidence of diseases or the course of diseases due
how to ride a bicycle in a weightless condition, to the weightless environment. I think this is a
which took us about 10 days, we found that es- matter of time and that these are the kind of
sentially we remained at the preflight baseline things we need to know in order to fly frequently
throughout the mission. I believe some of the and to fly for long durations and to make space
crewmen on the subsequent flights increased their flight in the Shuttle era and beyond a routine
ability to do that particular task, simply through event, because we do not want to place physical
a training effect, and that was a very pleasant limitations on our crews and our visiting scien-
surprise. tists. There are many examples that come to mind:
To me, the most astonishing thing was our for instance, when you fly older people, what is
ability and desire to pack in the groceries, and the rate at which they wash out nitrogen when
there's a long preflight history to that. We fought they prebreath ? Does it change merely as a func-
and scratched with the Principal Investigators tion of age, or is it because physical fitness and
on that diet for 4 or 5 years. We finally settled obesity come into the picture, too ? We don't know.
on an in-flight diet estimation, which kind of went That's a small data point that's going to be op-
like this: We had several 6-day periods of food erationally important to us when we begin to fly
intake measurement prior to the flight. These data people in their 50's and their 60's. I think the first
were taken and were modified by certain standard step is to use animal subjects to make the measure-
height/weight/surface area tables, and so forth, ments necessary to clear up the picture, and to
to get a best estimate of our average caloric in- observe the response of animals to various chal-
take, and then we subtracted 300 kilocalories from lenges. I think the effect of hypoxia in weight-
that. Most of us were certain that even that lessness would be very interesting to observe.
amount of food was going to be too great. And lo Certainly, I'd love to see whole generations of
and behold! We discovered that after a few days animals reared and exposed to weightlessness for
of decreased appetite in flight we were able to eat their entire lifespan, to see how far this evolu-
all our food. Indeed, as the missions progressed tionary process will really go. And I think eventu-
SKYLAB 2 CREW OBSERVATION AND SUMMARY 29

ally we will get to the point where we will dare to on Skylab. Each and every investigator was
study disease states, first in animals and then in competent, efficient, and thoughtful of us, the
human beings. I think that by studying a disease subjects. Only en masse, were they ever a bit
in weightlessness, we will learn more about both overwhelming, as when on recovery day everybody
the environment and the disease. There are many wanted that significant data--"right now." Medi-
possibilities: from fundamental studies on cor- cal research on Skylab has helped us to document
onary and pulmonary perfusions, to bone and soft that human beings can operate efficiently in space.
tissue healing, to the effect of drugs, hypoxia, and It's this fact, rather than medical research per se
radiation, to observations on the course of stasis that will justify continuation of manned space
ulcers and to how does edema in right heart fail- programs. It appears that man's potential effi-
ure behave in this environment. If we can make ciency in zero-g is as high as it is any place else.
fundamental advances in any one of those sub- The degree to which this potential is realized is
jects, we'll pay the freight for the whole medical a function of the experience and training of the
program. I feel that an imaginative approach to crew and of the degree to which their needs are
medical research will have an opportunity to be met in-flight. Thus, the function of medicine is
used in the 80's. not only to discover those needs but to meet them.
As a human subject for this kind of research, And the research program we design must hamper
I would like to conclude with a few observations. the crew's efficiency as little as is possible and
We had a super relationship with the medical team still get the data.
CHAPTER 5

Skylab Crew Health--Crew Surgeons' Reports

JERRY R. HORDINSKY a

derived from the experiment data and was also


RIOR TO THE Crew
sions,the of thevariousSkylab
FLIGHTSSurgeons mis-
had responsibility dependent on the following monitored areas for
for the followingmedical areas: clinically related information:

To supervise the health of the Skylab crew- Radiological health,


members and their families. Skylab environmental data, including toxico-
To render clinicalassistancein the development logical evaluation; and
of the In-flightMedical Support System Medical data obtained from the Operational
(IMSS) checklistand equipment, as well as Bioinstrumentation System during the sched-
to monitor the crew IMSS trainingprograms uled extravehicular activities.
at the various professionaltrainingsites.
Postflight, the Crew Surgeon coordinated all the
To conduct IMSS drug sensitivity testing (top-
medical activities relating directly to the crew.
ical and oral), and electrocardiographic, He was the medical team leader on the recovery
vectorcardiographic,and electroencephalogra-
ship and had prime responsibility for the con-
phic skin sensor sensitivitytesting. tinuous clinical care of the crew especially during
To monitor medical experiment baselinedata.
the medical experiments, and later at Johnson
During the preflight, in-flight, and postflight Space Center.
periods,the Crew Surgeons gave carefulsurveil-
Skylab 2
lance to the followingareas of medical concern:
Medical examinations performed on the three
Illnessevents and required medications; crewmen at specified intervals beginning 40 days
Trends in the FlightCrew Health Stabilization
preflight did not reveal any major change in any
Program; crewmember's health status. They remained in
Nutrition--intake and output;
good health throughout the preflight phase, ex-
Personal daily exercise;
cept for the Pilot who developed a 24-hour illness
Work/rest schedules;and
resembling a viral gastroenteritis about 1 month
Sleep periods,quantity/quality.
before flight, just coincident with the initiation
During the flightphase of the Skylab missions, of the Flight Crew Health Stabilization Program.
the Crew Surgeons reliedto a great extenton the In-flight, on mission day 1, the Commander
daily privatemedical conference with the crews developed a left serous otitis media, which re-
over an air-to-groundloop from the NASA Mis- quired the extended use of an oral decongestant
sion Control Center to monitor crew health.For as well as a topical nasal decongestant. On mis-
continuous clinicalevaluation of the crew, the sion days 3 through 7, the Commander also used
Crew Surgeon had access to medical parameters a topical steroid cream to relieve the symptoms
of a probable mild contact dermatitis of his right
• NASA Lyndon B. Johnson Space Center, Houston,
arm. Complying with a preflight decision, the
Texas. Scientist Pilot took one scopolamine/dextroam-

3O
SKYLAB CREW HEALTH---CREW SURGEONS' REPORTS 31

phetamine sulfate capsule just after insertion, and movement. One hour after insertion, the Pilot took
the medication was not repeated. Prior to extra- an antimotion sickness capsule, scopolamine/
vehicular activity, the Scientist Pilot and the Pilot dextroamphetamine sulfate, with good relief. The
utilized a topical nasal decongestant prophylac- crew entered the Orbital Workshop 9 hours and 45
tically; the Pilot also took a systemic decongestant. minutes after lift-off. Following strenuous work to
No significant arrhythmias developed in-flight. activate the Orbital Workshop, the Pilot vomited
Early terminations of the Lower Body Negative once. During the second mission day, the Com-
Pressure experiment (ch. 29) by the Scientist mander and Scientist Pilot also experienced some
Pilot and Pilot were sporadic, and in this mission motion sickness during continued Orbital Work-
the maximum level of exposure to lower body shop activation; they took scopolamine/dextro-
negative pressure was reduced following early amphetamine sulfate, as required, for alleviation
termination of the Lower Body Negative Pressure of symptoms. This indisposition caused a loss of
test. work time during the first 3 days of flight. Two
The Commander and Pilot took hypnotic medi- additional days elapsed before all symptoms had
cation of choice on the night of mission day 27 to dissipated. Since medical experiments were not
help accommodate a change to their work/rest run until mission day 5, subjective voice reports
schedule for entry and splashdown. Entry itself by the crew were the only means of health assess-
on the 29th day was nominal. Postsplash (on the ment during this time. On mission day 5, after the
water) the heart rates were: Commander, 84; first medical experiments were conducted, objec-
Scientist Pilot, 84; and Pilot, 76 beats per min- tive clinical data were available to aid in evaluat-
ute. Aboard the ship on recovery day vertigo, ing the crew's health. In general, the crewmembers
postural instability (especially with eyes closed), remained in excellent health except for a few minor
reflex hyperactivity, and paresthesias of the lower clinical problems and rare sporadic early termina-
extremities were prominent findings. The Scien- tions of the Lower Body Negative Pressure experi-
tist :Pilot developed seasickness while still in the ment by the Commander and the Scientist Pilot.
Command Module and the most prominent symp- The Pilot reported a painless sty on the left
toms cleared in 4 to 6 hours. Scaling of the skin upper eyelid on mission day 29, which responded to
of the hands was noted on the Commander and an ophthalmic antibiotic ointment and cleared by
the Scientist Pilot. The Pilot experienced a vagal mission day 32. On mission day 33, the Com-
response (decreasing heart rate, pale and sweaty mander reported the beginning of a boil under his
appearance) in the recovery period of the Meta- right arm. Instructions from the ground to the
bolic Activity experiment (ch. 36), which lasted Commander were to avoid using stick-type de-
just a few minutes. Muscle and joint soreness, odorant, and the wearing of garments which
generally confined to the lower back and lower fitted tightly under the arms. No medications were
extremities, were first noted on the first day post recommended and the condition cleared in about
recovery. During the ongoing postflight period of 48 hours. A recurrence of the boil in approximately
surveillance, no significant medical problems de- the same area on mission day 50 again lasted only
veloped as an apparent result of the long duration 48 hours, and did not require any medication.
in weightless space flight. No drugs were taken The crew maintained high levels of daily exer-
except for vitamins. cise during the mission. Extravehicular activities
were successfully completed on mission days 10,
Skylab 3
28, and 57 without medical problems.
Preflight, no infectious diseases or other medical The crew slept 6 hours on the night prior to
problems were experienced by the crew during the entry and were awake approximately 15 hours
30-day preflight period, the last 21 days of which prior to splashdown on mission day 60. The Scien-
included the Flight Crew Health Stabilization tist Pilot took an antimotion sickness capsule
Program. approximately 40 minutes prior to the entry burn,
Launch and orbital insertion were nominal. while the Commander and Pilot took their anti-
Shortly after orbital insertion, the Pilot began to motion sickness medication approximately 5 to 10
experience nausea; this was aggravated by head minutes after the burn. Prior to the burn, all
32 BIOMEDICAL RESULTS FROM SKYLAB

three crewmen inflated their orthostatic counter These findings were well documented in order to
measure garments. The entry was nominal. At permit evaluation of any in-flight changes. The
about 20 to 30 minutes after splashdown while crew remained in good health throughout the pre-
still in the Command Module, the Scientist Pilot flight period.
checked the pulse rate of each crewman and ob- This crew also had no formal scheduled in-flight
tained the following values: Commander, 88; Sci- medical examinations. Data from experiments and
entist Pilot, 70; and Pilot 62 beats per minute. "as necessary" medical evaluations continued to
Pulse checks by the Crew Surgeon immediately provide the necessary information for monitoring
after the Command Module was aboard the re- of health status. A heart rate and blood pressure
covery ship were similar. Blood pressures were stress evaluation for clinical reasons would be ob-
within acceptable ranges for these crewmen. All tained on any individual at least every 4 days, if
three crewmen egressed the Command Module on for some reason the experiments Lower Body
their own power. Negative Pressure experiment M092 (ch. 29),
Postflight the cardiovascular deconditioning ob- Vectorcardiogram experiment M093 (ch. 33), and
served was carefully documented, but no clinically Metabolic Activity experiment M171 (ch. 36)
serious events occurred. As in Skylab 2, vertigo, could not be run. This longest mission happily was
postural instability, hyperreflexia, dry skin, and characterized by the absence of any major illness
slight fissuring of the hands were noted. On re- or injury. However, it is important to point out
covery, a previous back strain suffered by the that in this mission there were numerous sympto-
Commander recurred from a situation combining matic events that required variable amounts of
"lifting" and loss of balance. On recovery day the medication (ref. 1).
Commander developed presyncope during the For all Skylab 4 crewmen, the initial medica-
stand test. The Pilot had a vagal response, also tion was the prescribed antimotion sickness drugs ;
associated with presyncope, during the recovery the Scientist Pilot did not experience motion sick-
phase of the Metabolic Activity experiment M171 ness and the Commander had minimal malaise for
(ch. 36). The overall rate of recovery postflight 3 days. The Pilot had significant nausea with
was more rapid than that observed in the first vomiting for I day and then malaise for 2 more
manned Skylab mission. days. The second major recurrent use of medica-
tion was lip balm and skin cream to prevent dry-
Skylab 4 ing of the lips and skin, respectively. The sleep
In Skylab 4, the Flight Crew Health Stabiliza- medications were utilized intermittently through-
tion Program lasted 27 days due to a 6-day slip in out the mission by all the crewmen. Decongestants
the launch for evaluating and correcting potential (topical and systemic) were used during the
launch vehicle problems. The crew underwent pre- mission. These were used both prophylactically
flight evaluations, which were augmented by sev- during the extravehicular activities and for spe-
eral new experiments, such as echocardiography cific symptomatic relief of the feeling of fullness
and pulmonary function evaluation. Several items in the head, nose, and ears.
noted in the medical history and clinical examina- The Scientist Pilot utilized aspirin twice for
tions and requiring attention for the upcoming transient headaches on mission days 17 and 67.
flight were: a history of low back pain (lumbo- On mission days 75 through 79, he utilized wet
sacral strain) experienced by the Commander in packs to help resolve a minimal papular rash on
the preflight period, and the concern as to whether the left neck and ear area.
there would be recurrence of this pain on his return The Pilot had a rash in the upper mid-back area,
to Earth; some recurring variable left ear drum in- which was treated as a fungal infection, and which
jection and lability of blood pressure noted during did resolve after about a week and a half.
the preflight period in the Scientist Pilot; and the The observed in-flight problems were not related
history of recurrent nasal congestion and a tend- to preflight problems except remotely; one could
ency toward lability of blood pressure in the state that the Pilot's prior history might have
Pilot. Cardiovascular review of these men showed indicated the greater susceptibility to upper res-
no evidence of nor tendencies toward arrhythmias. piratory congestion.
SKYLAB CREW HEALTHmCREW SURGEONS' REPORTS 33

In following the crew, the Daily Health Status act the effect of the zero-g environment; the crew
Summary sheet was a comprehensive guide. It had the highest overall average of quantifiable
was updated for this particular mission and was work output from their exercise.
kept by the person in aeromedical monitoring The maintenance of nutrition was satisfactory;
position working in direct support of the Mission the Skylab 4 crew ate at essentially preflight ca-
Operation Control Room Surgeon. Data for this loric levels and were quite satisfied with the taste
summary were prepared from the Evening Status of the food. The high density food bars, utilized
Report which gave sleep, medication, exercise, to extend provisions when the Skylab 4 mission
and experiments M071 (Mineral Balance, ch. 18), was extended to 84 days, were tolerated well by
M073 (Bioassay of Body Fluids, ch. 23), and M172 the crew although they left a subjective sense of
(Body Mass Measurement, ch. 19) data, from the hunger. As in Skylab 3, vitamin supplementation
dump tapes, and from the private medical con- was maintained. The weight losses for the Skylab
ference. The latter permitted subjective and ob- 4 crewmen were less than those for the crewmen
jective crew observations about their responses to of the other two missions.
the stressor tests [Lower Body Negative Pressure The work/rest cycle was a key problem in this
(ch. 29) and Metabolic Activity (ch. 36)] as well last mission. During the early phase of this mis-
as the general status of living in zero-g. sion the crew was scheduled at a pace comparable
Vectorcardiographic data became especially to the pace attained by Skylab 3 crewmen in the
valuable as the Pilot began demonstrating vector- latter part of their mission. New experiments,
cardiographic parameters differing significantly stowage confusion, onboard equipment malfunc-
from preflight. None of these deviations from pre- tions, and the sheer length of the mission were all
flight "norms" were considered clinically abnor- contributing factors to produce psychological
mal. In summary, there were neither clinically stresses which were sl6wly resolved over the first
significant cardiac arrhythmias nor vectorcardio- half of the mission.
graphic changes in-flight. As the end of the mission approached, two late
Instrumental in maintaining crew health was single-block shifts of sleep time were made, as the
maintenance of a proper environment. It should preferred mode, to adjust the crew to the circa-
be stressed, there were no significant problems in dian shift required. Crew comments postflight in-
maintaining the limits of environmental conditions dicated this was a suitable and effective approach
of total pressure, oxygen, and carbon dioxide. to the time shift required. Earlier piecemeal shift-
Other parameters, such as temperature and rela- ing in Skylab 2 and Skylab 3 was not subjectively
tive humidity, were more variable. These parame- as effective.
ters were influenced by the orbital inclination and In preparation for entry, scopolamine/dextro-
Sun angle of the Skylab complex and the perform- amphetamine sulfate was prescribed for all three
ance of the supplementary thermal protection de- crewmen at approximately 2 hours prior to in-
vices; additionally, potential off-gassing from the tended splashdown. The crew inflated their counter
heated spacecraft was satisfactorily circumvented. measure garments prior to burn and re-inflated
Personal cleanliness was fairly well maintained them to compensate for the increasing internal
by use of the shower or by sponge baths but pressure as the Command Module was pressurized
proved to be time consuming. during descent. As in Skylab 3, the splashdown
The increased quantity and quality of exercise was initially in stable-2 (heat shield up), and
available to the crew were important in maintain- changed to stable-1 (heat shield down) within a
ing the crew health of Skylab 4. For each successive nominal time frame.
mission the exercise time had been increased from Initial "on water" pulse rates were: Com-
one-half hour, to 1 hour, to 1V2 hours per day, mander, 70; Scientist Pilot, 80; and Pilot, 80
respectively. In Skylab 4 the bicycle ergometer, beats per minute. Blood pressure and pulse read-
the Mark I (an isokinetic force generating pul- ings taken inside the spacecraft were acceptable
ley), the Mark II (springs), and Mark III (the and the crew egressed and walked essentially
standard Apollo exercise device), the treadmill, unassisted.
and isometric exercises were available to counter- The triad of vertigo, postural instability and
34 BIOMEDICAL RESULTS FROM SKYLAB

reflex hyperactivity was again noted postflight. vealed the crew to be in as good or better status
This time it was the Commander who experienced than the crews of the two earlier missions.
a vagal response with presyncope at the end of
Conclusions
forced expiration in pulmonary function testing.
Petechiae were noted in the lower legs of all three From a clinical point of view, all of the physio-
crewmembers late on recovery day, and during the logical and psychological responses noted in the
day afterwards. Muscle and joint soreness during Skylab missions were either self-limiting or rep-
exercise developed postflight, but only to a mini- resented work-around problems requiring minimal
mal degree. The postflight period was free of any counteraction. As such, these changes do not pre-
illnesses or injuries. Postflight physiological re- clude extending man's duration in zero-gravity for
adaptation, as measured by the experiments re- longer periods of time.

Reference
1. The Proceedings of the Skylab Life Sciences Symposium. November 1974. NASA
TM X-58154, 1:70-73.
N77-33786
CHAPTER 6

Skylab Oral Health Studies

LEE R. BROWN, a WILLIAM J. FROME, b SANDRA HAN-


DLER, c MERRILL G. WHEATCROFT, _ AND LINDA J. RIDER ¢

radiographs did reveal two asymptomatic, previ-


RAL
seriesHEALTH CONSIDERATIONS
of manned space flights for the
included Skylab
three ously unrecognized areas of pathosis about the
general areas of responsibility. These areas were: apex of the teeth of two crewmen. Both problems
were successfully resolved.
Clinical dentistry;
During the last 9 months prior to the Skylab
Provisions for in-flight care and the In-flight
missions, six crewmen required treatment for den-
Medical Support System-Dental; and
tal problems which were other than routine re-
Research dedicated to the identification of po-
placement of restorations and dental prophylaxes.
tential oral problems in manned space mis-
These ranged from a large, symptomatic, recur-
sions of long duration.
rent apthous ulcer, to significant inflammation and
Clinical Dentistry discomfort from local gingival inflammation, to a
periapical abscess. All were resolved successfully
Clinically, the emphasis in the dental health
with no recurrence.
program was on the prevention of dental disease.
This was accomplished by a carefully supervised In-flight Care
home care program which was supplemented with
The possibilty for an unanticipated dental prob-
oral examinations and evaluations at least every 6
lem occurring in-flight which could significantly
months. Regular topical applications of stannous
impair a crewman's ability to work effectively
fluoride were also provided all crewmen. However,
was computed at 0.92 percent for a 3-man 28-day
because of consideration of other studies during
mission. This figure was based on studies of dental
the Skylab missions, the topical fluoride applica-
experiences in other isolated environments, i.e.,
tions were discontinued 6 months preflight for
polar expeditions, United States Navy FBM sub-
each crew.
marine patrols, and from a 3-year study of the
Because of risks of inflammation to the dental
astronaut population. The most likely problems
pulp, no dental restorations were provided the
which could impair a crewman's effectiveness in-
crewman during the last 90 days prior to flight.
flight were judged to be either a painful tooth due
The oral health of all crewmen was at a sufficiently
to pulpitis or severe, localized gingival inflamma-
high level that the 90-day provision was realistic.
tion with or without a periodontal abscess. The
Complete oral Panorex radiographs were made
pulpitis would be most likely to occur in a tooth
of each crewman prior to his mission. These
which had previously been restored with a deep
restoration which suddenly had become symp-
University of Texas, Houston, Texas. tomatic. This is a common ground-based dental
b NASA Lyndon B. Johnson Space Center, Houston, problem and the resulting potentially debilitating
Texas.
pain could occur for a number of reasons, includ-
c University of Texas, Dental Science Institute, Houston,
Texas. ing decreased resistance of the host and/or in-
d University of Texas Dental Branch, Houston, Texas. creased virulence of the organisms involved.

35
36 BIOMEDICAL RESULTS FROM SKYLAB

Dental caries was not considered as a problem in prime and backup crews of all Skylab missions re-
missions of up to 3 months' duration because ceived 2 days of intensive training in pertinent
of the high level of oral health of all crewmen and dental procedures at Lackland Air Force Base,
the frequent dental evaluations they received. Texas. The training included lectures, demonstra-
Because of the risks involved, it was decided that tions, and supervised clinical procedures. The
a means be developed for treating the most likely supervised clinical procedures performed on vol-
dental problems that might arise. To this end the unteer patients included complex procedures such

Local anesthetic

(Lidocaine HCL)

Dental gauze

Forceps
mandibular - anterior

Syringe tower - front

Forceps

%
maxillary - posterior

upper-back

Sedative

Forceps
matenal
maxillary - anterior

upper - front

restorativ_

Forceps

mandibular- posterior
lower - back

File

Elevator
Applicator

Mirror, light ,.

Scalers, curette

FIGUnE 6-1a.--In-flight Medical Support System Dental Kit.


SKYLAB ORAL HEALTH STUDIES 37

as tooth removal. Instruments and medications the treatment capabilities of each crewman as he
were provided as the In-flight Medical Support was observed during the training program. No
System-Dental. As aids, this In-flight Medical Sup- dental problems occurred during the Skylab series
port System-Dental included a manual with line of missions which required use of the In-flight
drawings of complete intraoral radiographs of Medical Suport System-Dental.
each crewman as well as integrated, illustrated,
Oral Research
diagnostic, and treatment procedures. Examples of
these aids are illustrated in figures 6-1a, 6-1b, and Skylab crewmembers were monitored to assess
6-1c. Other aids included air-to-ground communi- the effects of their missions on:
cation with a dentist and/or surgeon who had as The population dynamics of the oral microflora;
aids intraoral photographs and radiographs, di- The secretion of specific salivary components:
agnostic casts, complete treatment records with and
narrative summaries, and complete knowledge of Clinical changes in oral health.
i

Symptom Diagnostic procedure Diagnosis/treatment

1 3 4

i_ Associated withJ No JYes j


discomfort Near gumline _ Abscessed gum
on cheek localized (periodontal_
J Painmouth
in or _._
specific tooth 1
._ Specific
or gum
area Examine
inflammation for
around tooth
I '-
• If inflammation is in the
area of third molar

tN°
Possible causes:
IYes 5 _pericoronitis
INo 7

A. Broken crown P 6

B Broken or missing swollen,


pain Facial
restoration l Continuous _ ---- Canker sore or ulcer (herpes
Gums
bleed red,
easily I
lesion), no treatment indi-
C. Cracked tooth swelling cated, will pass in 7 to 14
days
D Abscessed tooth _Yes 10 11
(periapical abscess)
I No 8 _No 9 Bad taste
E. Abscessed gum significant in mouth and
J t _ercuss teeth " Gum infection (gingivitis)
(periodontal abscess) Running
temperature breath odor
• Increase oral hygiene
F. Ulcers in mouth on while chewing [ Kith instrumen,
efforts with floss and
gums, inside cheeks or sensitive
toothbrush
Sharp
to hot pain
or cold __ No
or lips, or on palate
(canker sores or

herDesvirus lesion) No ._ • Perform differential diag-


Ii=
_,. Gum infection tooth sensitive
_t Only one nosis for other than dental
IYes 12
(gingivitis) J problem such as sinusitis,
H. Pulpitis (most common 15 infectious diseases, etc.,
serious problem)
tooth with /'Examine area_ 16 consult ground
I. Pericoronitis instrument

ml_ teeth for local _ Found abscess Yes _- Periapical abscess


/near swellingrootsor of _
I J
i near root tip I

klump on gum/ ' INo 17

18
/Examine °ffending_ I
No
and no other | tooth for broken LmJ Problem
J Sharp pain ] -/cr°wn or broken _ vj Visible?
symptom =- Fractured crown or fillin_l

Yes kor crack in filling / I

19

evidence of
infection, no
dentin or pulp Tooth removal probably
I Intense pain or
exposed
required

b ___ Cracked tooth or pulpitis


Treat for pain - if pain is
very intense and does not
subside, removal probably
required

FIcunE 6--lb.--Diagnostic Data_Dental.


38 BIOMEDICAL RESULTS FROM SKYLAB

CAUSE SYMPTOMS TREATMENT PROCEDURE REMARKS

Dull pain May reverse, use analgesics


(intermittent)
Sensitive to if not, removal may be necessary
....._-Ea rly percussion, heat,
Puipitis _ and cold
Antibiotics
_'_'Late
Sharp pain Remove tooth may be
(continuous) prescribed
by ground
Heat or percussion Probably no tissue swelling
(Inflammation of
increases pain
dental pulp)
C_!d d#.crea_es or
increases pain
Aspirin or Darvon (_
does not relieve
pain

Mild pain (intermit- Identify offending tooth


tent or continuous) Employ local anesthesia
Tooth decay
(Caries_ Cavitation of Remove soft decayed material
enamel using curette
Brownish*black Isolate tooth with gauze packs
_Unlikely cause _ See required
spot and dry out cavity
mixing procedures
I due to time Heat, cold, or Mix sedative restorative material
I required to sweets may elicit and pack into cavity with applicator
Ldevelop pain Have patient bite while cement is soft,
remove excess using curette

Bite again

Part of tooth File off rough edges of broken


Crown fracture, visibly missing tooth using file Bite down
broken or Mix sedative restorative material to check
missing filling and cover exposed area occlusion

Smooth surface

Crack could
Severe pain If pain persists - remove tooth have gone
Cracked tooth undetected
when chewing
on X-rays

Tooth may feel induce drainage of pus by: Antibiotics

Periapical elongated to (A) Incision of pus pocket, or may be


abscess patient (B) Digital pressure on gum near prescribed

( I nfaction at Percussion may root of tooth by ground

apex of tooth) elicit sharp pain If pain persists - remove tooth Pain will subside

Area of pointed upon release of

swelling pus pressure

Dull throbbing pain Probe around tooth with curette Antibiotics


Periodontal may be
Sharp pain when Remove any foreign object
abscess prescribed
biting Induce drainage of pus by incision
(Gum infection) Tenderness of by ground
Rinse with warm water
surrounding tissue

Pain on opening Clean under tissue flap Antibiotics may


mouth Brush thoroughly, rinse and floss be prescribed
Periocoronitis
Continuous dull by ground
(Inflammation Rinse vigorously with warm water
Becomes more
ache and swelling
of gum flap) around lower comfortable in
third molar 24-36 h.

Aphthous ulcer Discomfort is


(White spot on sometimes
oral mucosa) mistaken for No treatment is indicated - Antibiotics are
toothache usually of no
normal healing occurs in
value
7 to 14 days
Canker sore Burning sensation,
_Red ulcer) not sharp pain

FIGURE 6-]c.--Treatment Data--Dental.


SKYLAB ORAL HEALTH STUDIES 39

Not only is oral health important to personal of the technique by Jordan et al. (ref. 1). Crevicu-
performance during prolonged space missions, but lar fluid was obtained by inserting a paper point
the oral region serves as a portal of entry for into the gingival sulcus of an upper bicuspid ac-
pathogenic agents, acts as a reservoir for infec- cording to the method of Brown et al. (ref. 2).
tious micro-organisms, and plays a role in cross- Each specimen was placed aseptically into a sterile
contamination and disease transmission. tube containing 2 milliliters of 0.1 percent peptone
Laboratory detectable intraoral changes can and 0.85 percent sodium chloride. The peptone-
precede clinical manifestations of acute and saline solution served as both a transport and
chronic infectious disease. Clinically detectable dilution medium.
alterations of oral tissue can identify changes To produce stimulated saliva, the crewmembers
caused by local and/or systemic disorders of mi- chewed sterile paraffin and expectorated into a
crobial and nonmicrobial origin. sterile jar until a 5 milliliter indicator mark was
Oral hygiene procedures consisted of brushing reached. The time required for each crewman to
the teeth 2 minutes twice a day and flossing once a collect this volume was recorded and used to cal-
day. Tooth brushes with multitufted, nylon, culate the saliva flow rate.
bristles were used in conjunction with an ingesti- All specimens were transported in cracked ice
ble dentifrice 1 and thin, unwaxed dental floss. to the University of Texas Dental Science Insti-
Irrigating devices, mouthwashes, topical fluorides, tute for immediate processing which occurred
or other oral medication were not used. about 1 hour after collection.
All crewmen were placed on a space-food diet at Speciment Processing.--Serial tenfold dilutions
about 21 days preflight. The backup crewmen con- of each specimen were plated onto a variety of
tinued on the space diet until launch and the prime bacteriologic media (refs. 3, 4, 5, 6, 7, 8, 9, 10, 11,
crewmen until 18 days after recovery. 12, 13, 14) for the enumeration of up to 17 micro-
Equipment and Procedures.--Eighteen astro- bial categories. Duplicate platings were incubated
naut crewmembers making up the prime and at 37 ° C either aerobically or anaerobically. The
backup crews for the three Skylab missions were bacteriologic media, microbial categories, and an-
monitored for quantitative changes in oral micro- aerobic procedures are shown in figure 6-2.
organisms, saliva partitions considered potentially Specific microbial types from selective and dif-
important to oral health, and alterations in clinical ferential media were verified by subculture and by
indices of oral health and preexisting dental pertinent physiologic reactions when necessary.
disease. In addition to the microbial assessments, stimu-
Microbiological Assessments.--Specimen collec- lated saliva was used to determine total protein,
tion. Oral specimens were collected from the crew- secretory IgA, and lysozyme. Salivary protein de-
members weekly or semiweekly from three terminations were made by the Lowry procedure
intraoral sites from 31 days preflight to 18 days (ref. 15). Secretory IgA was assayed by electro-
postflight for Skylab 2, from 51 days preflight to immunodiffusion (ref. 16) where the samples are
20 days postflight for Skylab 3, and from 57 days electrophoresed through a medium containing
preflight to 17 days postflight for Skylab 4. All monospecific antisera. Plates were precoated with
collections took place between 0700 and 0800 hours 0.1 percent agarose in 0.05 percent glycerol and
before oral hygiene procedures or breakfast. layered with buffered agarose containing antisera.
The specimens included dental plaque, crevicu- Wells were filled with standards or saliva. Samples
lar fluid (exudate absorbed from the gingival were electrophoresed until the point of equivalence
sulcus area), and stimulated saliva. These param- with the highest standard was attained. The plates
eters were selected because of their ultimate were then processed for staining and the migra-
relation to the development of dental caries, perio- tion distances were measured. Samples with values
dontal disease, and alveolar bone loss. beyond the standard range required dilution. A
Dental plaque was removed using a modification plot of log concentration versus log migration dis-
tance yielded a linear curve for quantification
1 Ingestible dentifrice developed by Ira Shannon, D.D.S., (ref. 17). Lysozyme values were determined by
M.S., Veterans Administration Hospital, Houston, Texas. radial quantitative diffusion using heat-killed
40 BIOMEDICAL RESULTS FROM SKYLAB

Micrococcus lysodeikticus cells as a substrate ac- grouped data. Primary comparisons were made
cording to the procedures of Osserman and Law- within three segments of data: (a) preflight-
lor (ref. 18). Plates were layered with a cell prespace diet (31 and 21 days preflight or 29 and
suspension in buffered molten agarose. Wells were 19 days preflight), (b) preflight-space diet (14 and
cut and filled with standards of saliva. Diffusion 3 days preflight or 13 and 4 days preflight), and
was allowed to proceed overnight. Values were (c) recoverey space diet (4, 13, and 18 days post-
determined from a plot of log concentration versus flight from the prime crew only).
diameter of lysed zone. Clinical Evaluations.--Clinical scores of dental
The microbiologic enumeration and immuno- plaque, dental calculus, and gingival inflammation
logic ua_a
"_^"......were .¢culucu _^.1 for appropriate -*-*'-*: were derived from oral evaluations at two pre-
cal analysis. Both a one-way and two-way flight and one postflight examination intervals.
unbalanced analysis of variance were used for The examination intervals were relative to the
multiple comparisons of individual, paired, and projected duration of each flight. The initial pre-

Gingival sulvus fluid


_ ] Stimulated saliva ]

Microbial enumeration and identification

I I
I
Aerobic cultures: 2-3 days at 37 ° C ] Anaerobic cultures: Displacement (95% N 2 - 5% CO 2 )t,

I Gaspak and 13rewer (95% H= - 5% CO2)-3-7 days at 37°C

I Plating media and microbial categories enumerated

Total aerobes Heart Infusion agar Total anaerobes, diphtheroids


Neisseria with defibrinated horse blood (5%) (catalase +, -)

Strep. salivarius Mitis salivarius agar Strep. mutans

Strep. sanguis plus tellurite sol. and with or


18-24 h ANt
Strep. mitis without bacitracin and 20% sucrose
24 h room temp.

Staphylococci Staphylococcus 110 agar

Veillonella agar
Veillonella
with Tween 80 ® and vancomycin
Lactobacilli
-Homofermentative Rogosa SL agar

-Heterofermentative with glacial acetic acid

Trypticase Soy agar*


Fusobacteria
with crystal violet and vancomycin

Yeast Sabouraud - dextrose agar

Heart Infusion agar


Bacteroides
with laked blood, menadione, NaHCO 3,
kanamycin and vancomycin

Enterics Desoxycholate agar

"BBL; other media-Oifco


PPLO agar and Heart Infusion agar

tSteel wool coated with acidified yeast extract sol., horse serum, Mycoplasma

copper sulfate solution thallium acetate, and penicillin

_AN = Anaerobes

FIGUnE 6--2.--Flow chart for sampling and enumerating cultivable oral micro-

organisms.
SKYLAB ORAL HEALTH STUDIES 41

flight oral examination was on days 30, 51, and 57 ever, in this flight Staphylococcus aureus and
for Skylab missions 2, 3, and 4, respectively. In enteric organisms showed increasing trends to-
all missions the final preflight oral examinations ward the later stages of sampling.
were accomplished on day 4 and the postflight on The microbial data from the Skylab 4 mission
day 4 after recovery. Following the scoring of gin- were very similar to that of the Skylab 3 mission.
gival inflammation on the initial preflight exami- The anerobic components to show increases in
nation, a thorough prophylaxis was performed. On the gingival sulcus fluid were Bacteroides sp. and
day 4, the final preflight examination, gingival Veillonella sp. There was also a rise in S. sanguis
inflammation, dental plaque, and calculus were and Neisseria sp.
scored to calculate a preflight increment (base- Figure 6-3 represents the cumulative preflight
line) for each of the oral health indices. All plaque data of all 18 crewmen, before and after they
and calculus were again removed to permit re- were placed on the carbohydrate enriched space
covery scores to be used as in-flight increments. diet. At these levels of significance expressed on a
Since gingival inflammation scores could not be percentage basis, there were significant increases
brought to a zero baseline, as in the case of plaque after diet of the following total anerobes, Diph-
and calculus, the difference in scores between the theroids, S. sanguis, Neisseria sp., Bacteroides sp.,
initial and final preflight evaluations was used as Veillonella sp., and Fusobacterium sp. Most of the
the preflight baseline. The difference between the oral microbial changes noted during each mission
final preflight and recovery scores was used as the
in-flight increments of gingival inflammation. P<N%
A plaque score was obtained for each astronaut 6_

by the use of disclosing wafers which stained the


After d_
plaque adhering to the tooth surfaces. Calculus
scores were obtained for each crewmember by Bef°rei H
5-
dividing the number of tooth surfaces that had
calculus by the number of teeth. The inflammation
index was scored according to the method of Loe
and Silnes (ref. 19) which graded the gingivae 4-

surrounding each tooth.


Dental radiographs were made of each crew-
member at 6 months and 30 days preflight to pro-
vide baseline records for subsequent comparison. 3-

A complete series of oral radiographs were taken 8


at 6 months preflight. To minimize radiation ex- o 0.

posure, only bitewing radiographs were taken at .J


Ix
30 days preflight. 2_

The clinical evaluations were statistically com-


pared by "t" analysis using both the means differ-
ence and difference between means statistics (ref.
20).
ol
AN DIPH SANG NEIS BACT VEIL FUSO
Results.--In Skylab 2 the microbial data showed
increases in various anerobic components, i.e., Key:
AN = Total anaerobes
Bacteriodes sp., Veillonella sp., Fusobacterium sp.
DIPH = Diphtheroids
Other increases were in Neisseria sp. and Strepto- SANG = Streptococcus sanguis
coccus mutans. NEIS = Neisseria sp.
BACT = Becteroides sp.
Fewer microbial changes were noted in Skylab VEIL = VeiUonella sp.
3. For example, in stimulated saliva the anaerobic FUSO = Fusobacterium sp.
components showing increases were Veillonella
FI(;UkE 6-3.---Cumulative microbial counts from the
sp., Fusobacterium sp., Leptotrichia sp., and Myco-
gingival fluid of 18 crewmen before and after space
plasma sp. S. mutans counts were variable. How- diet initiation prior to three Skylab flights.
42 BIOMEDICAL RESULTS FROM SKYLAB

appeared to be associated with diet change as evi- of the diet during the preflight period, were more
denced by the statistically significant post diet pronounced after flight. However, the postflight
increases. values were excluded in the diet related analysis
The saliva partitions--saliva flow rates, salivary to avoid any possible flight influence.
lysozyme, and protein concentration levels--as- Increases in secretory IgA observed in two of
sayed in this study of the prime crew of Skylab 2 the Skylab 4 crewmembers were observed in all
remained relatively constant throughout this three crewmembers of Skylabs 2 and 3. As in the
period. But the secretory IgA levels showed previous studies, the changes were believed to
pronounced increases beginning just prior to result from subclinical infections. Concurrent
flight and COIl ...............................
LlllUlllg" LIII'OUgIIOU b the postflight fluctuations in _anw,_
--': .......... pl,_,,,,
*^'_ lysozyme and
sample period. It is believed that these changes saliva flow rates, also observed in previous studies,
were probably due to responses to a subclinical are unexplained.
viral infection. In these studies, observed incremental increases
The mean values for changes in salivary parti- of dental calculus and gingival inflammation were
tions of the prime crewmembers of Skylab 3 are consistent, with the exception of the Skylab 3
secretory IgA which showed increases and these crew where these changes were not observed to
increases occurred concurrently with saliva flow the same degree. Individuals free of oral health
rate increases and salivary protein decreases. Rea-
sons for the latter changes are presently unex-
Preflight _--_
plained.
82.3
In the Skylab 4 mission secretory IgA levels
Recovery
again increased and the levels of protein and lyso-
zyme as well as saliva flow rates showed trends
similar to the Skylab 3 flight. The increase in
secretory IgA in the crewmen for the Skylab 4
mission occurred in only two of the three crew-
men. The IgA levels of the Scientist Pilot remained
relatively constant.
A comparison of clinical scores of oral health 60 °

before and after the Skylab 4 mission (fig. 6-4)


revealed prominently elevated increments of den- 54.3
tal calculus and gingival inflammation postflight 7,
as compared with the prefight values. This trend
46.3
was observed for all missions.
While the overall oral health level of all crew-
men remained very good postflight, some deterio-
ration had occurred as measured by these indices.

Discussion

The oral microbiological, immunologic, and clin-


ical results of the Skylab series of manned space
flight missions were relatively consistent. Oral
microbial changes usually occurred after the in- 23.0

corporation of the space diet prior to flight. Statis-


tical comparisons of cumulative preflight data
from the 18 (prime and backup) crewmembers,
before and after diet inclusion, revealed diet re- Calculus Inflammation

latedness for the majority of the microbial in-


FIGURE 6.-4.--Mean clinical scores of dental calculus and
creases observed during the missions. Some of the
gingival inflammation of the prime crewmembers of
changes, although apparent after the inclusion Skylab 4.
SKYLAB ORAL HEALTH STUDIES 43

problems seem to be less susceptible to detri- IgA were believed to result from a subclinical in-
mental changes under a specific challenge than fection. Concurrent diminutions of salivary lyso-
those with preexisting dental problems. zyme are unexplained. The clinical changes in oral
health were considered to be influenced more by a
Conclusion
crewmember's preexisting state of dental health
Skylab crewmembers were monitored for mis- than by any health hazardous mission related
sion related effects on oral health. Those labora- effect.
tory and clinical parameters considered to be Assuming no future clinical detection of mission-
ultimately related to dental injury were evaluated. related intraoral complications, the most signifi-
Of these, the most distinctive changes noted were: cant aspect of these investigations was the
relative nonexistence of health hazardous intra-
Increased counts of specific anaerobic and strep-
oral changes.
tococcal components, primarily of the saliva
and dental plaque microflora.
Elevations in levels of secretory IgA concurrent Acknowledgments
with diminutions of salivary lysozyme.
We gratefully acknowledge the contributions of
Increased increments of dental calculus and gin-
gival inflammation. John R. Hemby and Darrell G. Fitzjerrell of the
General Electric Company for the design and de-
The microbial changes were mainly diet related velopment of the Skylab In-flight Dental Diagnos-
rather than flight related. Elevations of secretory tic and Treatment Manual.

References

i. JORDAN, H. V., B. KRASSZ, and A. MOILER. A method of _ampling human dental


plaque for certain "caries-inducing" streptococci.Arch. of Oral Biol.,13:919-927,
1968.
2. BROWN, L. R., S. S. AL]-EN, M. G. WHEATCROI_r, and W. J. FROME. Hypobaric cham-
ber for oral flora study in simulated spacecraft environment. J. of Dent. Res.,
50:443-449, 1971.
3. ROGOSA, M., J. A. MITCHELL, and R. F. WXSEMAN. A selectivemedium for the iso-
lation and enumeration of oral lactobacilli. J. of Dent. Res., 30:682-689, 1951.
4. ROGOSA, M., R. J. FITZGERALD, M. E. MACKINTOSH, and A. J. BEAMAN. Improved
medium for selectiveisolationof veillonella.
J. of Bacteriol.,76:455-456, 1958.
5. OMATA, S. R., and M. N. DISRALY. A selectivemedium for oral fusobacteria.J. of
Bacte_iol.,72:677-680, 1956.
6. KRAUS, F. W., and C. GASTON. Individual constancy of numbers among the oral
flora.J. of Bacteriol.,71:703-707, 1956.
7. RICHARDSON, R. L.,and M. JONES. Bacteriologiccensus of human saliva.J. of Dent.
Res., 37:697-709, 1958.
8. SHKLAIR, I. L., M. A. MAZZARELLA, S. G. GUTEKUNST, and E. M. KIGGINS. Isolation
and incidence of pleuropneumonia-like organisms from the human oral cavity.
J. of Bacteriol., 83:785-788, 1962.
9. McCARTHY, C., M. L. SNYDER, and R. B. PARKER. The indigenous oral flora of man.
I. The new-born to 1-year-old infant. Arch of Oral Biol., 10:61-70, 1965.
10. RITZ, H. L. Microbial population shifts in developing human plaque. Arch. of Oral
Biol., 12:1561-1568, 1967.
11. GIBBONS, R. J., and J. B. MACDONALD. Hemin and vitamin K compounds as required
factors for the cultivation of certain strains of Bacteroides melaninogenicus. J. of
Bacteriol., 80:164-170, 1960.
12. SOCRANSKY, S. S., R. J. GIBBONS, A. C. DALE, L. BORTNICK, E. ROSENTHAL, and
J. B MACDONALD. The microbiota of the gingival crevice. I. Total microscopic and
viable counts of specific organisms. Arch. of Oral Biol., 8:275-280, 1963.
13. SONNENWIRTH, A. C. The clinical microbiology of the indigenous gram-negative
anaerobes. Synopsis from Oral Presentation at the Clinical Microbiology Round
Table, ASM Meeting, Atlantic City, New Jersey, 1965.
44 BIOMEDICAL RESULTS FROM SKYLAB

14. FINEGOLD, S. M., t. B. MILLER, and D. J. POSMAK. Further studies on selective media
for baeteroides and other anaerobes. E_q.ah_ngsforschung, pp. 517-528. Berlin,
1965.
15. LOWRY, O. H., N. J. ROSEBROUGH, A. L. FARR, and R. J. RANDALL. Protein measure-
ment with the folin phenol reagent. J. of Biol. Chem., 193:265-276, 1951.
16. MERRILL, D., T. HARTLEY, and H. CLAMAN. Electroimmunodiffusion (RID) : A sim-
ple, rapid method for quantitation of immunoglobulins in dilute biological fluids.
J. of Lab. and Clin. Med., 69:151-159, 1967.
17. I_OPEZ, M., T. TSU, and N. HYSLOP. Study of electroimmunodiffusion: immunochemi-
cal quantitation of proteins in dilute solutions. Immunochemistry, 6:513-526,
1969.
18. OSSERMAN, E. F., and D. P. LAWLOR. Serum and urine lysozyme (muramidase in
monocytic, and monocytocytic leukemia). J. of Exp. Med., 124:921-951, 1966.
19. Lo_., H. and J. SILNES. Periodontal disease in pregnancy. I. Prevalence and severity.
Acta Odontologica Scandinavica., 21:533-551, 1963.
20. SCHEFFE, H. The analyses of variance, pp. 112-119. John Wiley and Sons, Inc., New
York, 1959.
N77 - 33 7 87 I
CHAPTER 7

Analysis of the Skylab Flight Crew


Health Stabilization Program

J. KELTON FERGUSON, a GARY W. MCCOLLUM, a AND


BENJAMIN L. PORTNOY b

sion. The 21-day period was chosen as it covered


A WELL-DEFINED
tion Program Flight
was firstCrewintroduced
Health Stabiliza-
into the the incubation period for a majority of infectious
space program on the Apollo 14 mission. The pro- disease organisms. A 7-day postflight isolation
gram was initiated following a number of prime period was added to protect the crewman from
crew illnesses and crew exposure to persons with any increased susceptibility to infectious diseases
infectious illnesses during mission critical periods. as a result of the lengthy mission. Additionally,
As a result of these incidences, it was recognized postflight illness in the crewmen would have been
throughout the National Aeronautics and Space detrimental to the understanding of medical re-
Administration that crew illness could cause loss sults and the transfer of information to the crew-
in valuable crew training time, postponement of men of the next mission. The principal objective
missions, or could even compromise crew safety of the program was to reduce the probability that
and mission success. a crewman would come into contact with an in-
The purpose of the Flight Crew Health Stabili- fectious disease agent during the critical time
zation Program was, therefore, to minimize the periods of each mission. The initial steps taken
possibility of adverse alterations in the health of to accomplish this objective were:
flight crewmen during the preflight, in-flight, and
To establish the primary work areas of the
postflight periods. The Apollo 14 Flight Crew
crewmen during the isolation periods.
Health Stabilization Program was successfully
To establish isolated crew housing at both the
completed without an illness occurrence in the
Johnson Space Center and at the Kennedy
crewmen. Following the Apollo 14 mission, the
Space Center with methods to prevent crew
program was effectively used for the remainder of
exposure to infectious disease agents.
the Apollo missions.
To establish a medical program for those per-
The need for such a program became even more
sonnel who were required to work with the
evident in the development of the Skylab missions.
crewmen during the isolation period.
The extended periods of crew time in space planned To establish a Medical Surveillance Office as the
for Skylab increased the probability of in-flight
coordination center for the operational aspects
crew illness. The decision was made, therefore, to
of the program (table 7-I).
provide a comprehensive Skylab Flight Crew
Health Stabilization Program. Each functional area at the two National Aero-
nautics and Space Administration Centers identi-
Procedure
fied their personnel who would require access to
A 21-day isolation period was established for the the crew during the isolation period. Personnel
Skylab crewmen prior to the launch of each mis- requiring direct crew access (within 2 meters)
were known as class A primary contacts. Those
"NASA Lyndon B. Johnson Space Center, Houston,
Texas. who worked in primary work areas, but were not
U.S. Public Health Service, Center for Disease Control, in direct contact of the crewmen, were called class
Atlanta, Georgia. B primary contacts.

45
46 BIOMEDICAL RESULTS FROM SKYLAB

TABLE 7-I.--Skylab Flight Crew Health Stabilization Program

Primary Contavts
Class A and Class B
Illness reporting (voluntary)
t$
Crew Medical Surveillance O_ce Primary Work Areas
(Crew Surgeon) Program coordination Active surveillance
Living quarters _=# Training Security
Mobile trailers (JSC) Records and data Preventive measures
Crew quarters (KSC) Medical status reports Surgical masks
Food t$ Biorespirators
Travel Clinic Air filters
Medical examinations
PC qualification---disqualification
Badge control

For each primary work area identified, the area filters were used in these living areas. Measures
was inspected and procedures were established to were taken to prevent crew exposures to illness
minimize the possibility of crew exposure to path- while traveling between primary work areas. Non-
ogenic micro-organisms. Positive air pressures and primary contacts were kept 100 feet and down-
80 percent (ASHRAE 1) air filters were used in wind from the crewmen. Biorespirators were near
the principal training area. A security guard and the crewmen at all times to be used if an emer-
a nurse were stationed at the door of the primary gency occurred.
work areas on the days that crewmen would be in The medical program for the primary contacts
the area. On these days, only properly badged pri- consisted of an extensive initial physical examina-
mary contacts were allowed to enter the area and tion with laboratory screening (ref. 1). Immuni-
a brief medical screening was given to class A zations were required for those persons who were
primary contacts by the nurse as the only active not immune to a selected group of infectious dis-
surveillance provided in the program. All class A eases. After the examination the records of each
primary contacts were required to wear surgical person were reviewed by a physician, and the
masks when in the presence of the ciewmen. Bio- individual was either approved or disapproved as a
respirators were available for use by nonprimary primary contact. Further scheduled examinations
contacts if an emergency occurred. Crew confer- were provided later in the program only for class
ences with nonprimary contacts were accomplished A primary contacts, which also included food
by closed circuit television. handlers, maids, and other specialized personnel
Crew housing at the Johnson Space Center was having close direct, or indirect, contact with the
provided by two mobile homes placed inside a crewmen.
large building. A third mobile home adjacent to On completion of the initial medical examina-
the building served as the food service center. All tion, all primary contacts were instructed by let-
food and drink consumed by the crew during the ters, brochures, and meetings to report any illness,
isolation period was specially prepared Skyl_b or contact to an infectious illness, to the Medical
food. Quality control had been designed into the Surveillance Office. Primary contacts who re-
food program, and it was, therefore, not necessary ported medical problems related to infectious ill-
to add additional controls. A fourth mobile home ness were referred to the clinic for medical
was available for isolation of any crewmen who examination. If a primary contact was found to
might become ill. Housing at the Kennedy Space have an infectious illness, he was temporarily
Center was provided in the existing crew quarters withdrawn from the program and the primary
area, and high efficiency particulate air (HEPA) work area. The primary contact did not return
to the work area until a medical examination in-
1 American Society of Heating, Refrigerating and Air-
dicated that the infection was no longer present.
Conditioning Engineers. Medical surveillance of the primary contacts and
ANALYSIS OF THE SKYLAB FLIGHT CREW HEALTH STABILIZATION PROGRAM 47

illness reporting were continued throughout each Active surveillance of class A primary contacts
mission to provide epidemiological support data produced a total of only 23 referrals to the clinic
for any crew illness occurring during the mission. from a total of 3483 examinations (table 7-III).
A report form was completed by the clinical The small number of possible illnesses discovered
staff for each illness occurrence (ref. 2). The re- by this procedure suggests that active surveillance
port was forwarded to the Medical Surveillance indirectly influenced the primary contacts to re-
Office to be coded for the type of illness by a port their illnesses voluntarily. In this indirect
predetermined list of operational definitions of in- way, the presence of a nurse at the entrance of
fectious illness (ref. 3). An analysis of these data the work area may have protected the crewmen
was performed. from infectious agents.
A total of 197 illnesses were reported to the
Results and Discussion
Medical Surveillance Office during the Skylab pro-
The list of approved primary contacts changed gram. Of these reports, 88 percent were reported
throughout the Skylab program. Names were from Johnson Space Center and the remaining 12
added or deleted as required. The population of percent were from the Kennedy Space Center
primary contacts for each flight was assumed to (table 7-IV).
be the number recorded on the master list at the The rate of illness reported by the primary con-
end of each mission (table 7-II). At all times tacts declined from Skylab 2 to Skylab 4 (table
class A primary contacts were only slightly less in 7-V). During Skylab 2 the rate of illness report-
number than class B primary contacts. The total ing was 10.7 illnesses/1000 primary contacts per
number of primary contacts ranged from 620 to week. During Skylab 3 the rate declined to 8.4
709 throughout the Skylab Program until 21 days and during Skylab 4 to 6.7. The drop in illness
into the Skylab 4 mission; program coverage pro- rate is especially dramatic since the lowest rates
vided only for 140 personnel for the remainder occurred during the winter season when most
of the Skylab 4 mission. In all cases, the great respiratory infections were expected.
majority of primary contacts were located at the The upper respiratory infection was by far the
Johnson Space Center. most frequently reported illness by primary con-

TABLE 7-II.--Population of Primary Contacts for the Skylab Missions

Number of primary contacts Location of primary contacts


Skylab
mission
Class A Class B Total JSC KSC Other

2 280 340 620 561 36 23


3 316 393 709 620 33 56
4 (Pre-) _ 300 333 633 550 35 48
4 (Post-) _ 108 32 140 12I 0 19

1 Preflight plus first 21 mission days.


2 Minion day 22 through 7 days after recovery.

TABLE 7-III.--Active Surveillance of Class A Primary Contacts

Skylab mission
Total
Active surveillance number

Class A contacts examined 1124 1104 1255 3483


Contacts referred to clinic 4 0 19 23
Examining days 29 22 29 80
Contacts examined/day (avg) 39 50 43 44
48 BIOMEDICAL RESULTS FROM SKYLAB

TABLE 7-IV---Location of Primary Contacts Reporting Illness

Number of illnesses reported


Skylab
m_sswn TotaUmission
JSC KSC

2 67 3 70
3 61 20 81
4 (Pre-)' 36 1 37
4 (Post,-)' 9 0 9

Total t ._
&to oA
_-z 197.
-

a Prefl|ght plus first 21 mission days.

Mission day 22 through 7 days after recovery.

TABLE 7-V.--Rate of Illness Events Reported by Primary Contacts

Skylab mission
Primary contact group
2 3 4 (Pre-) 1 4 (Post-) s

Class A contact s 10.5 8.6 8.8 ' 15.0


Class B contact 10.9 8.2 ' 4.8 3.6
Both 10.7 8.4 6.7 6.2

1 Preflight plus first 21 mission days.

s Mission day 22 through 7 days after recovery.

a Rate expressed as number of illnesses reported per 1000 persons per week.
4 Based on 5 or less events.

TABLE 7-VI.--Type of Illnesses Reported by Primary Contacts

Total reported Percent reported


(all missions) per Skylab mission

Symptom complex 1
Percent of 2 3 $
Number _ total g

Upper respiratory
infection .09 81 79 83 80
Bronchitis 8 4 6 2 4
Pneumonia 0 0 0 0 0
Upper enteric illness 13 7 9 4 9
Lower enteric illness 13 7 6 9 4
Fever present 20 10 6 14 11
4 9 2
Headache _resent 11 6
Skin infection present 12 6 7 7 2
Other infectious illness 2 1 1 1 0

x One illness may contain more than one symptom.

g Skylab 2 and 4 only; see text.


ANALYSIS OF THE SKYLAB FLIGHT CREW HEALTH STABILIZATION PROGRAM 49

TABLE 7-VII.--Location of Primary Contacts tacts (table 7-VI). Symptom complexes other
Reporting Contact to an Infectious Illness than the upper respiratory infection were rela-
tively low and equally distributed in number. All
Number of contacts reported of the percentages were below 10 percent with the
Total/mission exception of the reported presence of fever which
JSC KSC reached 14 percent on Skylab 3 and 11 percent on
Skylab 4.
2 49 0 49
As with the illness reporting, the vast majority
4 (Pre-) _ 19 1 20
of reports of contact to illness originated from the
4 (Post-) s 4 0 4
primary contacts at the Johnson Space Center
Total 72 1 73
(table 7-VII). Of a total of 73 reports only two
x Preflight plus first 21 mission days, came from other sources on the Skylab 2 and
s Mission day 22 through 7 days after recovery.
Skylab 4 missions. Skylab 3 contacts to illness are
not reported here due to an error in recording
reports. The rates of reporting contacts to illness
TABLE 7-VIII.--Rate of Contacts to Illness
are shown in table 7-VIII. Although Skylab 3
Reported by Primary Contacts
data are not available, the reporting trend appears
to decrease in rate in the same manner as illness
Skylab mission
reporting.
Primary contact group 1" e _ (Pre-) _ _ (Post-)' Exposure to persons with upper respiratory in-
fections was the most frequently reported contact
Class A ' 10.8 4.6 "3.6
Class B 4.7 2.8 0.0
with illness, with 57 percent and 67 percent re-
Both 7.5 3.6 • 2.7 ported for Skylab 2 and Skylab 4, respectively
(table 7-IX). A greater percentage of upper and
1 Preflight plus first 21 mission days.

Mission day 22 through 7 days after recovery. lower enteric illness contacts were reported for
s Rate
persons
expressed
per week.
as number of contacts to illness reported per 1000
Skylab 4 than for Skylab 2. None of the Skylab 4
• Based on 4 events or leBs. reports involved skin infections while 18 percent

TABLE 7-IX.--Types of Illnesses With Which Primary Contacts


Reported Contact

Total reported Percent reported


(AII missions) per Skylab mission

Symptom complete 1
Percent of
Number _ total"

Upper respiratory
infection 44 60 57 67
Bronchitis 3 4 4 4
Pneumonia 2 3 2 4
Upper enteric illness 9 12 10 17
Lower enteric illness 9 12 8 21
Fever 8 11 6 21
Headache 7 10 8 13
Skin infection 9 12 18 0
Other infectious illness 4 5 8 0

x One illness may contain more than one symptom.

s Skylab 2 and 4 only; see text.


5O BIOMEDICAL RESULTS FROM SKYLAB

of the Skylab 2 reports involved contact with skin fections included a number of upper respiratory
infections. infections, viral gastroenteritis, and one rubella
Figures 7-1 and 7-2 show plots of weekly re- exposure. These infections are notably absent with
ported illnesses and exposure to infectious diseases the beginning of the Flight Crew Health Stabili-
for Skylab 2 and Skylab 4. Correlation in the zation Program on Apollo 14 through the Skylab
reporting of the two events can be observed on both 4 mission. During the missions of Skylab 3 and
Skylab 2 and Skylab 4. The decreasing rate of Skylab 4 a minor skin infection, or rash, occurred
reporting contacts parallels the decreasing rate of on two of the crewmen of each mission. It is doubt-
illness reporting. The pattern of reporting for ful that either of the latter could have been pre-
illness events throughout the Skylab Program is vented by the measures taken in the health
illustrated in figure 7-3. An increased rate of re- stabilization programs as each problem appears to
porting occurred during the preflight and post- have occurred for reasons other than preflight
flight isolation periods. Immediately after launch, exposure. The results indicate that the Flight
reporting decreased and remained low during the Crew Health Stabilization Program has success-
missions. Primary contacts responded to the Sky- fully accomplished its goal in reducing the number
lab Flight Crew Health Stabilization Program of illness exposures to flight crewmen.
when it was obvious to them that reporting would
Conclusion
be helpful. To the primary contact the most obvi-
ous time for reporting was the time when the The majority of illnesses and contacts to ill-
crewmen were physically present. nesses reported by the primary contacts was the
A summary of the illness occurrences in the upper respiratory infections. Enteric illnesses rep-
Apollo and Skylab crewmen at mission critical resented the next most common illness, but these
times is presented in table 7-X. A high rate of in- were relatively rare compared to the upper re-
fection occurred in crewmen from Apollo 7 spiratory infections. The Skylab Flight Crew
through Apollo 13 in the absence of a Flight Crew Health Stabilization Program included a number
Health Stabilization Program (refs. 4, 5). The in- of preventive measures to reduce the spread of
respiratory infections. This emphasis was well
placed.

2°EA
18

16 _ Illness
8 A : ': ':::t with illness

with illness S
12

--=_10
/',,I.
_o
_
14f
8
//_ I)- .... -13 Contact
/
E
Z
o/
z 2F ' t ll_l l_ #l_l /
O , I I I I m i_

29 6 13 20 27 3 10 17 24 1 8 15 22 29 5 12 19 26 2 7 14
7 14 21 28 5 12 19 26 2 7 16 23 30
Sept. Oct. Nov. Dec. Jan. Feb.
April May June
Week of onset, 1973 Week of onset, 1973-74

FlCUl_E 7-1.---Skylab 2 Flight Crew Health Stabilization FIGURE 7-2._Skylab 4 Flight Crew Health Stabilization
Program.
Program.
ANALYSIS OF THE SKYLAB FLIGHT CREW HEALTH STABILIZATION PROGRAM 51

-- Skylab 2 --
20 m m Skylab 3 Skylab 4 J

18-- -- I I
16-- --
I f
I
m

14--

12--
--

--
L
10-- --

-- m

8 m __ m

z
6--

4
I
--17 J, I ]!" I

2,
jl il
IIII III I
II1,
o " JI illl III '
IIII I'-I
1-17,,, F-I
7 21 19 2 16 30 14 28 11 25 8 22 20 3 17 1 15 29 12 26 9
14 28 12 26 9 23 7 21 4 18 1 15 29 13 27 10 24 8 22 5 19 2 16
Apr. May June July Aug. Oct. Nov.
Sept. Dec. Jan. Feb.

Week of onset, 1973-74

FIGURE 7-3.--Skylab Flight Crew Health Stabilization Program pattern of reporting.

TABLE 7-X.--Effect of the Flight Crew Health Stabilization Program


on the Occurrence of Illness in Prime Crewmen

Health stabilization program absent Health stabilization program operational

Number of Number of
M_ssion Illness crewmen Time Mission Illness crewmen Time
type _ involved period = type _ involved period _

Apollo 7 URI 3 M Apollo 14


8 VG 3 P, M 15
9 URI 3 P 16
10 URI 2 P 17 SI 1 P
11 Skylab 2
12 SI 2 M 3 SI 2 M
13 R 1 P 4 SI 2 M

t Illness type: = Time period:


URI, Upper respiratory infection. M, During mission.
VG, Viral gastroenteritis. P, Premission.
SI, Skin infection.
R, Rubella exposure.
52 BIOMEDICAL RESULTS FROM SKYLAB

By training primary contacts to report illness controlled, population of primary contacts should
and by using a nurse in active surveillance, the be continued in future programs. A Flight Crew
Skylab Flight Crew Health Stabilization Program Health Stabilization Program for future space
seems to have been effective in reducing the num- missions, therefore, should emphasize the initial
ber of infectious illness contacts with the crew- and continuous training of primary contacts, lim-
men during the isolation period. The effort made ited and active surveillance, specific preventive
to reduce the number of primary contacts was of measures for upper respiratory infections, and
greatest importance to the goals of the program. the need for concurrent analysis of epidemiological
Limiting crew contact to a defined, and medically data throughout the program.

_e_eFence8

1. The Proceedings of the Skylab Life Sciences Symposium. I:99-120. Houston, Texas.
NASA TM X-58154, November 1974.
2. The Proceedings of the Skylab Life Sciences Symposium. I:117. Houston, Texas.
NASA TM X-58154, November 1974.
3. The Proceedings of the Skylab Life Sciences Symposium. I:118-119. Houston, Texas.
NASA TM X-58154, November 1974.
4. BL'T.RY,C. A. Apollo 7 to 11: Medical Concerns and Results. Presented at the XVIIItb
International Congress of Aerospace Medicine, September 18, 1969, Amsterdam,
Netherlands. NASA TM X-58034, November 1969.
5. WOOLEY, BENNIE C., Apollo Experience Report--Protection of Life and Health.
NASA TN D-6856, June 1972.
N77-33788

CHAPTER 8

Skylab Environmental and Crew Microbiology


Studies

GERALD R. TAYLOR, a RICHARD C. GRAVES, a ROYCE M. BROCK-


ETT, b J. KELTON FERGUSON," AND BEN J. MIESZKUC"

HE OBJECTIVES of the Skylab mircrobiology each mission. The Command Module was sampled
studies were to detect the presence of poten- on launch and recovery days for each mission. In
tially pathogenic micro-organisms on the crew- all cases samples collected in-flight were stored
members and their spacecraft and to obtain data differently, and for a longer time than were pre-
which would contribute to an understanding of the flight and postflight samples. Therefore, direct
response of the crew's microbial flora to the space correlation of the resulting data is not always
flight environment. These data were interpreted applicable.
in light of the theories of microbial simplification,
intercrew transfer of medically important micro- TABLE 8-I.--Crew Sample Collection Sites 1
organisms, in-flight autoinfections, and postflight
microbial shock, which have been proposed by
Sample
various authors (ref. 1). designation Area sampled
Before and after each flight, the 12 areas out-
lined in table 8-I were sampled from each astro- Neck 13 cm _ below hairline at base of neck.
naut. Two calcium alginate swabs, wetted in Ears s Right and left external auditory canals
with two revolutions of each swab in
phosphate buffer, were used to sample the nostrils
each ear canal.
and each externalbody surfacearea.A single, dry Axillae 6.5 cm s below hair area on each side.
alginateswab for virological analysiswas used to Hands 6.5 cm _ on right and left palms.
sample the throat.Phosphate bufferwas used to Navel The internal area of the umbilicus, and a
wash the oropharyngeal cavity.Additionally,a surrounding 13 cm s area with at least
two revolutions made with each swab.
midstream urine sample was collectedfrom the
Groin 5 cm strip from rear to front on right and
firstvoid of the day and fecalspecimens were col-
left inguinal area between legs.
lectedat the convenience of the subject.In-flight Toes 2 Area between the two smallest toes of each
crew samples,as noted on table8-I,were collected foot.
16 days beforeterminationof each Skylab mission Nares _ Both nostrils.
and returned under chilled conditionsfor analyses. Throat swab s Surfaces of tonsils and posterior pharyn-
geal vault swabbed with each of two dry
Samples were collected before,during,and after
calcium alginate swabs.
each Skylab mission,as shown in figure8-1. The Gargle 60 cm 8 phosphate buffer used as gargle
OrbitalWorkshop was sampled up to 10 times,in- and washed through oral cavity three
cluding one preflightsample set. In-flightair times.
samples were collected2 days before the end of Urine 60 cm s midstream sample.
Feces Two samples of 100 mg each taken from
center of the fecal specimen.
"NASA Lyndon B. Johnson Space Center, Houston,
Texas.
a All samples collected before and after each flight.
United States Air Force School of Aerospace Medicine, s These samples also collected in-flight 16 days before return from

Brooks Air Force Base, San Antonio, Texas. SkyLub.

53
54 BIOMEDICAL RESULTS FROM SKYLAB

Sample sites March April /lay June July August =September October November December January Febr_Jary

Skylab 2 crew

Skylab 2 CM

Skylab 3 crew &=,,__a _ ^ -, a o_,


Skylab 3 CM

Skylab 4 crew

Skylab 4 CM

OWS hardware "_=l Brat


A A A A A A

OWS air

& = Sample collected °Q==w==,_ = Postflight period

in am -= Preflight period OWS -= Orbital workshop

= In flight period

FIGURE 8-l.--Skylab microbiology sample collection scheme (1973-74).

In excess of ten thousand selected microbial iso- sites from all three Skylab 4 astronauts immedi-
lates were analyzed by quantitation, identification, ately upon recovery. Further, this species persisted
and characterization. For this report, the effects in the nasal cavity of the Pilot throughout the
of space flight conditions on microbial populations postflight quarantine period. Subsequent investi-
will be examined only to the first level of complex-
ity. That is, only alterations affecting the total 400

autoflora will be evaluated. More detailed analyses


conducted at increasing degrees of complexity will 350

be published elsewhere.
300
Results and Discussion .L. f/////

V////_
_5
Changes in the Habitability of the Skylab En- 250

vironment.--Microbial Content of In-flight Skylab _/////_


Air.--The concentration of bacteria recovered := 20O
from air samples obtained 2 days before return
from each Skylab visit are displayed in figure 150
8-2. Low levels of in-flight bacterial contamina-

MB
tion were observed on the first two missions, 100
whereas the recovery from Skylab 4 was consider-
iIi1_1

ably higher. These higher counts were due en- 5O


iiiiii
iiiii/

tirely to an influx of Serratia marcescens, a ......

micro-organism which has been shown to produce 0


Skylab 2 Skylab 3 Skylab
various infections in man (ref. 2). Whereas this
species was not recovered from any preflight crew FIGURE 8-2.----Concentration of bacteria in the Skylab air
sample analysis, it was recovered from multiple from samples collected 2 days before mission termination.
SKYLAB ENVIRONMENTAL AND CREW MICROBIOLOGY STUDIES 55

gation demonstrated several potential sources ples collected prior to launch are typical of a clean
of this micro-organism in the Skylab environment. (although obviously not sterile) environment. The
However, these potential sources could not be reduction of aerobic bacteria recovered from the
sampled in-flight and, therefore, a direct correla- Skylab 2 in-flight samples is probably a reflection
tion could not be made. By active microbial mon- of the thermal problems experienced in the Orbital
itoring, the release of this microbial contamination Workshop after launch. Although there was a
into the Orbital Workshop was traced from possi- simultaneous tenfold increase in the presence of
ble sources, was detected in the Skylab air, was anaerobic bacteria, the Skylab 2 crew apparently
subsequently recovered as a new species from all entered a very clean environment, which remained
three crewmembers, and was ultimately shown to relatively clean during the mission.
colonize the nasal passages of one astronaut. The recovery of both aerobic and anaerobic bac-
Bacterial Recovery from Sample Sites within teria from the Skylab 3 mission increased another
the Skylab Orbital Workshop.--The total concen- 1 to 2 loglo units, with no apparent reason except
trations of viable bacterial cells recovered from for increased length of habitation by the crew-
the Skylab spacecraft surface sites at various members. During the 84-day Skylab 4 mission the
sampling periods are presented in figure 8-3. These total concentration of aerobic bacteria remained
in-flight samples were collected to evaluate the nearly constant although anaerobe recovery de-
level of microbial contamination occurring in the creased significantly. This drop was due to the
Orbital Workshop. The results of analyses of sam- loss of Propionibacterium acnes which contributed

Aerobic bacteria Anaerobic bacteria

_E 5 --

"E_ 4 - m
o

8
_3- m
o I
>: i

2
m

///

nl
rn

1 --

_(, /

0 ¸ r//_ /ZZ
Preflight A B A B A B Preflight A B A B A B

Sk¥1ab 2 Sk¥1ab 3 Skylab 4 Sk¥1ab 2 Skylab 3 Skylab 4

Sample period

A=Sample collected 16 days before return from orbital workshop

B=Sample collected 2 days before return from orbital workshop

FIGURE 8-3.---Concentration of bacteria on surfaces in the Skylab spacecraft.


56 BIOMEDICAL
RESULTS
FROM
SKYLAB
strongly to the anaerobe population of the other numbers were low until the Skylab 4 mission. Al-
two Skylab missions. This loss of P. aches reflects though overall humidity was low on the Skylab 4
a similar loss of anaerobic bacteria from the skin mission, local areas of high humidity cannot be
surfaces of the astronauts {these data will be entirely eliminated. The reasons for the large in-
presented later in this paper). Therefore, this de- crease in fungal isolations on Skylab 4 have been
crease in anaerobic bacterial contamination of the well established. Early in the Skylab 4 mission, it
Skylab, was shown to directly reflect a decrease was discovered that "mildew" was present on the
in these same microbes in the contaminating res- liquid-cooled garments which had been previously
ervoir, the skin of the astronauts. stowed aboard. A sample was taken off this growth,
The recovery of aerobic bacteria from 15 sites and one liquid cooled garment was returned for
within the Apollo Command Modules, sampled im- additional sampling. In general, the species of
mediately before and after each mission to the fungi isolated from surface samples and air sam-
Skylab, are summarized in figure 8-4. Whereas ples were the same species isolated from the liquid
cooled ga_znent. These same micro-organisms also
contaminated the Petri dishes of the ED31 experi-
4 ment flown on Skylab 4. It is apparent that the
4 liquid-cooled garments were the source of spore
m
contamination since some of these garments had
eo 3 not previously been removed from their original
containers, but were subsequently found to harbor
o these micro-organisms.
o 2
o

t i 25
o
I

I
er_
o A B A B A B
2O
Skylab 2 Skylab 3 Skylab 4

Sample period

A=Sample collected the morning of CM launch (F--0) O


•_ 15
S=Sample collected recovery day (R+O) ¢a
O i

FI(;URE 8-4.---Concentration of aerobic bacteria on surface


in the Command Module. i
E
z I
there was some variation in the contamination

" H
level of the different Command Modules, there
were no major differences between preflight and
postflight values for a particular Command Mod-
ule. Therefore, the variations noted in the Orbital
Workshop could not be shown to affect population
levels in the Command Modules. 0
H I"]
Preflight A B A B A
Fungal Recovery from Sample Sites within the
Skylab 2 Skylab 3 Skylab 4
Skylab Orbital Workshop.--It had been suggested
Sample period
that molds would present problems on long-term
space flights, especially if high humidities were A=Sample collected 16 days before return from orbital workshop
B=Sample collected 2 days before return from orbital workshop
experienced (ref. 3). Figure 8-5 shows the num-
ber of fungal isolations from the Skylab vehicle FIcuI_E 8-5.--Fungai isolations from surfaces in the Skylab
before launch and during each mission. These spacecraft.
SKYLAB
ENVIRONMENTAL
ANDCREW
MICROBIOLOGY
STUDIES 57

This contamination was also reflected in the re- level of fungal contamination of the crew post-
covery of fungi from the crew samples collected 16 flight.
days before return from Skylab. For Skylab 2 and Postflight Variation in the Major Components
Skylab 3, a total of two and zero filamentous of the Autoflora.--Aerobic Bacteria.--Prior to the
fungi, respectively, was isolated from the crew in- Skylab missions, several authors had theorized
flight. On Skylab 4 a total of 11 fungi were iso- that major microflora changes might occur during
lated, including a significant contamination to the space flight and that these changes might not be
astronauts. It is important to note that this con- compatible with man's health and welfare on ex-
tamination to the crew was demonstrated 62 days tended missions (refs. 4, 5, 6, 7, 8, 9, 10, 11, 12, 13,
after the first exposure to the liquid-cooled gar- 14, 15). The theoretical change which was most
ments, indicating either continued contamination often proposed called for a "microbial simplifica-
from inanimate sources, abnormally slow return tion" which may be defined as a major decrease in
to normal levels, or both. the number of different types of micro-organisms
The number of fungal species isolated from the in the autoflora. To evaluate this hypothesis, the
15 Command Module sites before and after each variations of the aerobic bacterial portion of the
Skylab mission is shown in figure 8-6. These data total autoflora within sample collection sites were
analyzed as shown in figure 8-7. This analysis
10 -

+6

+5
8 -
Number of sites
with R+0 values +3
higher than
o +2
6 -
preflight range
-5
o IN I I

_,o i I i i
e_ 4 -
Number of sites
z
with R+0 values
-2
lower than
-a
preflight range
-4

Legend:

A B A B A B Bars above the line indicate the number of areas tested for
Skylab 2 Skylab 3 Skylab 4 which values were obtained that were higher than the pre-
flight range. Bars below the line indicate the number of
Sample period
areas with decreased values postflight (R+0). All values
represent the mean of three astronauts. Ten sites were
A=Sample collected the morning of CM launch (F--0)
sampled from each astronaut.
B=Sample collected recovery day (R+0)

[] = Total count of viable cells


FIGURE 8--6.--Fungal isolation from surfaces in the Com.
[] = Number of different genera
mand Module.
• = Number of different species

illustrate that the fungal contamination of the FIGURE 8-7.--Postflight change in aerobic bacteria.

Orbital Workshop during the Skylab 4 mission did


not affect the Command Module samples collected shows that the frequency with which recovery day
on recovery day. Although the Command Module values lie outside the preflight range is similar for
was attached to the Orbital Workshop during this the 10-day Apollo 14 mission and the three Skylab
period of contamination, it was a separate entity, missions. More specifically, the total number of
out of the area of heavy use, and away from the viable cells recovered was frequently higher post-
contaminating space suits. This relatively clean flight whereas the number of genera and species
Command Module probably contributed to the low decreased in all missions except Skylab 4. There-
58 BIOMEDICAL RESULTS FROM SKYLAB

fore, it is possible to make the following observa- ple areas following Skylab 3 mission. These post-
tions concerning recovery of aerobic bacteria flight increases were due to an unusually high
following these space flights. Values obtained from level of contamination with Propionib_cterium
immediate postflight sample analyses are fre- acnes on the skin of the Skylab 3 astronauts which
quently outside of the established preflight range. matched exactly the increased contamination of
When different, these values most often reflect an Skylab surfaces mentioned earlier.
increase in total number of viable cells and a de- The summaries presented in figures 8-7 and 8-8
crease in the number of different genera and spe- indicate that, whereas the trends are not inviolate,
cies recovered. the following conclusions may be stated. Gross
Anaerobic Bacteria.--A similar analysis of the numerical changes in the autoflora cannot be cor-
anaerobic bacterial portion of the total autoflora related with mission duration up to 84 days. Total
is shown in figure 8-8. The analysis presented in numbers of viable bacterial cells tend to increase
for aerobes and decrease for anaerobes. The num-
+4 I
Number of sites +31
ber of different aerobic genera and species change

2 nln
with R+0 values little, whereas there is generally a decrease in the
higher than number of different anaerobic types recovered.
preflight range +_l I I I= Yeasts and Filamentous Fungi.--We have previ-
ously shown, as demonstrated in figure 8-9, that

Number of sites
with R+0 values
lower than
preflight range

-7
Uo!IiiUl
ai, A

.:
E
o 40-
Preflight
isolation

iiiiiiiiiiiiiiiii!i!!!!
In-
f,ight
Postflight
isolation

iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii!iiiiil
ii!i!!i!iii!ii!ii!ii!iiiii!iiiiii!!iiii
iiiiiiiiiiiiiiilliiiiiiiiiiiiiiiiiiiiiiiii!iii!iiiiiii!ii!i_i
iiiiiiiiiiiiiiiiiiiiiiiiiiiiiii!iiiiiiiiiiii!iiii;iiiiii!_i!i
::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::

Legend: -- iiiiiii!iiii!iiiiiiii!!!!!iiiiii!i!iiiiii!ii!!!!iii!i!ii!!ii
----Apol,ol4
30 iiiiiiiiiiiiiiiiiii!iiiiiiiiiiiiiiiiiiiiiiiiiiiiiii!iiiii!ii
..... Apo,o 15
Bars above the line indicate the number of areas tested for
which values were obtained that were higher than the pre- o iiiii!iiiii!ii!iiiiiiiiii!iiii
flight range. Bars below the line indicate the number of 20 ii!:i;iiii!i!iiiiiiiiiiii:iiiii!iiiiiii;iiii!;ii!i!iii!i_
areas with decreased values postflight (R+0). All values ._ iiiiiiiiiiiiiiiii;iliiii;iiiii;iiiiii;;;iiiil;iiiiiiiiil;i|
represent the mean of three astronauts. Ten sites were iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii!
sampled from each astronaut. _o _o- iiiii!iiiiiiiiiiiiil;il;iiiiiiiiiiiiiiiiiiii!iiiit
=
[] = Total count of viable cells

[] = Number of different genera


o
-_ 10 20 30 40 50 60
• = Number of different species
I-- Days

FIGURE 8--8.--Postflight change in anaerobic bacteria.


FIGURE 8-9.--Total number of fungal species recovered
from each set of Apollo 14 and 15 crew samples (ref.
this figure illustrates that the anaerobic portion 16).
of the autoflora behaves quite differently than the
aerobic portion. The frequency and direction of
postflight change is different from each Skylab for the Apollo missions there was, typically, a
mission, but apparently is not related to mission significant reduction in the number of isolated
duration (as the 10-day Apollo 14 and the 84-day fungal species up to the launch day. This was
Skylab 4 results are most similar). Following the taken to be indicative of severely restricting op-
Apollo 14, Skylab 2 and Skylab 4 missions, fewer portunities of contamination to the crew for 3
viable anaerobic cells and fewer genera and spe- weeks before flight. Analysis of postflight Apollo
cies were recovered from up to 70 percent of the data indicated that exposure to the space flight
sites sampled. However, this is not a universal environment for up to 2 weeks resulted in an even
event as all of these values increased in some sam- greater reduction with a relative increase in inci-
SKYLAB ENVIRONMENTAL AND CREW MICROBIOLOGY STUDIES 59

dence of the potential pathogen, Candida albicans tion and responded to treatment with Tinactin®.
(ref. 16). In spite of the gross contamination, the probable
Essentially the same pattern may be demon- mycotic infection, and the epic length of the space
strated from the Skylab 2 and Skylab 3 data, as flight, approximately the same number of fungal
shown in figure 8-10. However, fungal recovery isolates were recovered from the Skylab 4 crew-
was not depressed following the 59-day mission of members throughout the 17-day postflight quaran-
Skylab 3, indicating increased exposure to fungi tine period. This indicates that with adequate
within the Skylab. Results of the same analyses preparation, monitoring, and treatment (if neces-
for Skylab 4 are also shown in figure 8-10 where sary) it is possible to control mycological prob-
essentially the same pattern is again demonstrated. lems in space for missions of this length where the
This is an important observation in light of the humidity is generally low.
previously mentioned in-flight contamination of Behavior of Medically Important Components
the Orbital Workshop and Skylab 4 crew and the of the Autoflora.--Opportunity for Postflight
fact that the Skylab 4 Pilot sustained a "rash" in- Microbial Shock.--A summary of the numerical
flight which was presumed to be a mycotic infec- means of recovered isolates of medically impor-

Preflight Postflight

isolation isolation
Preflight

Skylab 2
........ Skylab 3
50-
..... Skylab 4

40- i In'flight iiiiii


ii iiii!
...............................

_::_::?:
::::iiiiiiii
iii
_3o
! iiiiii!:i!iiiiiii|i

iiiiiiiiiii,.
-_ 20 I
E o

10-

0
I i
]'i i
1 ii !'
I I i I I i I ! I I I
9O 80 70 60 50 4o 30 20 10 0 o lO 2o 3O

Days

FIGURE 8-10.--Total number of fungal species recovered from each set of Skylab crew
samples.

tant micro-organisms from all nine prime Skylab 20


crewmembers is presented in figure 8-11. This
summary indicates that the incidence of these > Y'2"2"2_P

species on the body decreased during the preflight _ 15 - t, 16.3:


;15.8>
//////
:14.4, //////
quarantine period, to establish a low point the /././././._
/////i
morning of launch. This event no doubt reflects -6
'-_ 10 - //////
decreased contact with these species during this
quarantine period. The largest number of medi-
cally important micro-organisms is recovered ==
from the immediate postflight sample set after
_/////
which the value returns to its near normal pre- _ o _/////_
Before During Launch Recovery During
quarantine value.
preflight preflight day, F-0 day, R+O postflight
Several authors have warned that returning quarantine quarantine quarantine
space travelers may experience a "Microbial
Shock" and may respond negatively to renewed F[6URE 8-ll.--Mean of combined incidence of recovery of
medically important bacteria from all three Skylab mis-
contact with potentially pathogenic micro- sions.
6O BIOMEDICAL RESULTS FROM SKYLAB

organisms which are absent in the space flight cross-contamination, colonization, and in-flight in-
environment (refs. 7, 12, 17, 18, 19, 20). fection with Staphylococcus aureus. Most strains
This warning is based on the assumption that of this species, which is one of the most infectious
contact with potential pathogens during space of the common inhabitants of man's autoflora, may
flight would be limited, resulting in a reduction of be distinguished by their reaction with specific
immunocompetence. However, these data show bacteriophages. This allows us to monitor the ex-
that there is an increase in the distribution of po- change of these microbes with greater resolution.
tential pathogens immediately following space The phage-type pattern of S. aureus recovery for
flight. This result supports earlier findings re- Skylab 2 is shown on table 8-II. These data show
ported for shorter duration space flights (refs. 14, that the same S. aureus phage type was repeatedly
17, 21, 22, 23). Therefore, if a reduction in total recovered from the nasal passages of the Pilot,
immunocompetence was to occur during these mis- indicating that this crewmember was a carrier of
sions, it is difficult to see how this reduction would this micro-organism. Although spread to the Or-
be in response to decreased contact with medically bital Workshop was demonstrated, there was ap-
important components of the autoflora. As with parently no transfer to the other crewmembers
the Apollo missions, there was no clinical or micro- in-flight. Therefore, being restricted to a confined
biological evidence of any "Microbial Shock" fol- space for 28 days with an S. aureus carrier does
lowing any of the Skylab missions. not necessarily result in cross infection.
Intercrew Transfer of Potentially Pathogenic A more complex situation is outlined in table
Miero-organisms.--Transfer of pathogenic micro- 8-III. The data summarized in this table indicate
organisms between crewmembers during space that the Skylab 3 Commander and Pilot were
flight has previously been reported for missions up both nasal carriers of S. aureus, carrying phage
to 18 days (refs. 17, 21, 22, 24). During the Sky- type 3A and 29/79, respectively. Prior to the
lab series it was possible to demonstrate in-flight flight, S. aureus was not recovered from any of

TABLE 8-II.--Staphylococcus aureus Recovered During Skylab 2 Mission

Commander Scientist Pilot Pilot Orbital workshop


Sample
period
(days) Sample Phage Sample Phage Sample Phage Number Phage
site type site type site type of sites type

Preflight
F -70 (1) (1) (1) (1) Nasal 52 (1) • (1)
F -40 (,) (1) (1) (1) Nasal N.T.' (1) (1)
Urine 80
F -25 Nasal N.T. (1) (1) Nasal N.T. (1) (1)
F -15 (1) (1) (1) (1) Nasal 6/80 (1) (1)
F -0 (1) (1) (1) (1) Nasal 80 (1) (1)
Gargle 80
Scalp 80

In-flight (1) (1) (1) (1) Nasal 80 1 N.T.


Nasal 52/80 1 80

Recovery
R +0 (,) (1) (1) (1) Nasal 52/80 (1) (1)
R +7 (i) (i) (i) (I) (1) (1) (i) (I)
R + 18 (I) (I) (I) (i) Nasal 80 (I) (i)
Gargle 52/80
Nasal 52/80

1 Indicates no S, aureus isolated.

N.T., Nontypable.
SKYLAB ENVIRONMENTAL AND CREW MICROBIOLOGY STUDIES 61

TABLE 8--III.--Staphylococcus aureus Recovered During the Skylab 3 Mission

Sample Commander Scientist Pilot Pilot Orbital workshop


e_iod
days) Sample Phage Sample Phage Sample Phage Number Phage
_ite type site type site type of sites type

Preflight
F - 45 Nasal 3A (1) (1) Nasal 29/79 (1) (1)
2 skin sites 29/79
F - 14 Nasal 3A (1) (1) Nasal 29/79 (1) (1)
4 skin sites 3A (1) (1)
F - 5 Nasal 3A (1) (1) Nasal 29/79 (1) (1)
F - 0 Nasal 3A (1) (1) (1) (1) (1) (1)

In-flight Nasal 3A Nasal 29/79 I skin site N.T2 6 sites 3A


2 sites 29/79

Recovery
R + 0 Nasal 3A Nasal 3A Nasal 29/79 (1) (1)
1 skin site 3A Gargle 3A Gargle 29/79
1 skin site 29/79
1 skin site 3A
R + 7 Nasal 3A Nasal 3A (1) (1) (1) (1)
3 skin sites 3A
R + 18 Nasal 3A Nasal 3A Nasal 29/79 (1) (1)
Gargle 3A
2 skin sites 3A

1 Indicates no S. aureus isolated.

2 N.T., Nontypable.

the Scientist Pilot samples. Analyses of in-flight- draining, in-flight contingency samples were not
collected samples show that the workshop became taken, so we do not know for sure the identity of
contamined with both phage types and that type the causative agent. However, we do know that the
29/79 was temporarily transferred to the Scien- causative agent of both of these maladies is usu-
tist Pilot. Postflight analyses show that type 3A ally S. aureus, and both of these individuals were
had spread to the Pilot but, as could be expected carriers of this micro-organism. Therefore, it is
(ref. 25), did not colonize this subject who was accurate to say that we have traced the develop-
already a carrier of another phage type. Phage ment of a pathogenic micro-organism from its
type 3A was repeatedly isolated from the post- preflight carrier state in two crewmembers
flight specimens of the Scientist Pilot, indicating through in-flight contamination of the Orbital
actual colonization. This is a clear demonstration Workshop, and colonization on the third crew-
of in-flight intercrew transfer of a pathogenic member. Also, it is highly probable that this
species where the contaminant could be shown to species was responsible for the active in-flight
have established itself as a member of the auto- infections of the two S. aureus carriers.
flora of the new host.
It is important at this point to relate these ob- Conclusions
servations to crew in-flight illness events during A general overview of some of the general con-
the Skylab 3 mission. The Pilot, a 29/79 carrier, tamination of the Skylab vehicle and of the major
developed a hordeolum (sty) which was success- activities of the microbial autoflora of the Skylab
fully treated with Neosporin®. The Commander, a astronauts has been presented. These data show
3A carrier, developed axillary swellings of a fu- that. while gross contamination of the Skylab
runcle (boil) type which were treated with warm environment was demonstrated and there were
compresses. As neither of these infections were several in-flight disease events (presumably of
62 BIOMEDICAL RESULTS FROM SKYLAB

microbial origin), such events were not shown to selected species and groups, will be published
be limiting hazards for long-term space flight. separately.
Evaluation of the major groups of micro-
organisms comprising the microbial populations Acknowledgments
tested, tended to support the theory of microbial
simplification for anaerobic bacteria, but not for The authors wish to thank all of the many in-
other microbes. Intercrew transfer of pathogens dividuals who contributed to this study. Special
was demonstrated. The data mediate against the thanks go to every member of the Northrop Serv-
theory of postflight microbial shock. The question ices, Inc., Microbiology Team at the Johnson Space
u_ .,-,._._ a,_,_,x_b_,z_ remains unanswered be- Center for thcir indispensable support. In particu-
cause none of the in-flight disease events were eval- lar, the following people are recognized: Theron
uated microbiologically. O. Groves, Mary R. Henney, C. J. Hodapp, Kath-
Further general evaluations of the dynamics of ryn D. Kropp, Florence J. Pipes, and Charles P.
the autoflora as a whole, and specific analyses of Truby.

References

1. TAYLOR, G. R. Space microbiology. Annu. Rev. Microbiol., 401:23--40, 1974.


2. WILFERT, J. N., F. F. BARRETT, W. H. EWING, M. FINLAND, and E. H. KASS.
Serratia ma/rcescens : Biochemical, serological, and epidemiological characteristics
and antibiotic susceptibility of strains isolated at Boston City Hospital. Appl.
Microbiol., 19:345-352, 1970.
3. HERRING, C. M., J. W. BRANDSBERG, G. S. OXBORROW, and J. R. PULEO. Comparison
of media for detection of fungi on spacecraft. Appl. Microbiol., 25:566-569, 1974.
4. BENGSON, M. H., and F. W. THOMAE. Controlling the hazards of biological and
particulate contamination within manned spacecraft. Contamination Control,
4:9-12, 1965.
5. BERRY, C. A. Preliminary Clinical Report of the Medical Aspects of Apollos 7 and
8. NASA TM X-58027, 1969.
6. BERRY, C. A. Apollo 7 to 11: Medical Concerns and Results. NASA TM X-58034,
1969.
7. BERRY, C. A. Summary of
medical experience in the Apollo 7 through 11 manned
spaceflights. Aerospace Med., 41:500-519, 1970.
8. CHUCKHLOVIN, B. A., P. B. OSTROUMOV, and S. P. IVANOVA. Development of staphy-
lococcal infection in human subjects under the influence of some spaceflight
factors. Kosmicheskaya Biologiya i Meditsina, 5:61-65, 1971.
9. Fox, L. The ecology of micro-organisms in a closed environment. In Life Sciences
and Space Research, 9:69-74, W. Vishniac, Ed. Akademie-Verlag, Berlin, 1971.
10. GALL, L. S., and P. E. RIELY. Effect of Diet and Atmosphere on Intestinal and
Skin Flora. NASA CR-661, 1967.
11. LEBEDEV, K. A., and R. V. PETROV. Immunological problems of closed environments
and gnotobiology. Uspekhi Sovremennoy Biologii, 71:235-252, 1971.
12. LUCKEY, T. D. Potential microbic shock in manned aerospace systems. Aerospace
Mcd., 37:1223-1228, 1966.
13. NEFEDOV, YU. G., V. M. SHILOV, I. V. KONSTANTINOVA, and S. N. ZALOGUYEV. Micro-
biological and immunological aspects of extended manned space flights. In Life
Sciences and Space Research, 9:11-16, W. Vishniac, Ed. Akademie-Verlag, Berlin,
1971.
14. SHILOV, V. M., N. N. LIZKO, O. K. BORISOVA, and V. YA. PROKHOROV. Changes in the
microflora of man during long-term confinement. In Life Sciences and Space Re-
search, 9:43-49, W. Vishniac, Ed. Akademie-Verlag, Berlin, 1971.
15. WHEELER, H. O., W. W. KEMMERER, L. f. DIETLEIN, and C. A. BERRY. Effects of
spaceflight upon indigenous microflora of Gemini crew members. Bacteriological
Proceedings, p. 16, 1967.
16. TAYLOR, G. R., M. R. HENNEY, and W. L. ELLIS. Changes in the fungal autoflora of
Apollo Astronauts. Appl. Microbiol., 26:804-813, 1973.
SKYLAB
ENVIRONMENTAL
ANDCREW
MICROBIOLOGY
STUDIES 63

17. MIKHAYLOVSKIY, G. P., N. N. DOBRONRAVOVA, M. I. K07_R, M. M. KOROTAYEV, N. I.


TSIGANOVA, V. M. SHILOV, and I. YA. YAKOVLEVA. Variation in overall body
tolerance during a 62-day exposure to hypokinesia and acceleration. Kosmiches-
keaya Biologiya i Meditsina, 1:66-70, 1967.
18. SHILOV, V. Microbes and space flight. Aerospace Med., 41:1353, 1970.
19. SPIZIZEN, J. Microbiological problems of manned space flight. In Life Sciences and
Space Research, 9:65-68, W. Vishniac, Ed. Akademie-Verlag, Berlin, 1971.
20. WILKINS, J. R. Man, his environment, and microbiological problems of long-term
space flight. Biotechnology, pp. 133-143. NASA SP-205, 1967.
21. TAYLOR, G. R. Apollo 14 Microbial analyses. NASA TM X-58094, 1972.
22. TAYLOR, G. R. Recovery of medically important microorganisms from Apollo astro-
nauts. Aerospace Med., 45:824-828, 1974.
23. ZALOGUYEV, S. N., M. M. SHINKAREVA, and T. G. UTKINA. State of the automicro-
flora of skin tissues and certain natural immunity indices in the cosmonauts A. G.
Nikolaev and V. I. Sevast'ianov before and after flight. Kosmicheskaia Biologiia
i Meditsina, 4 :54-59, 1970.
24. FERGUSON, J. K., G. R. TAYLOR, and B. J. MmSZKUC. Microbiological investigations
performed during the Apollo program. Biomedical Results of Apollo, NASA
SP-368, 1975.
25. MARPLES, M. J. The normal flora of the human skin. Brit. J. of Dermatol., 81,
suppl. :2-13, 1969.
/

N77-33789

CHAPTER 9

Radiological Protection and Medical


Dosimetry for the Skylab Crewmen

J. VERNON BAILEY, a RUDOLF A. HOFFMAN, a ROBERT A. ENGLISH a

ADIOLOGICAL PROTECTION PLANNING for the ment were written only for the relatively radia-
Skylab missions encompassed two major tion sensitive intervals of extravehicular activity.
areas; those radiation exposures that were "ex- Therefore, the astronauts were provided instru-
pected" whose components were known with rela- mentation and training to insure that the crews
tive certainty and those radiation exposures that aboard Skylab could act autonomously during pe-
were "unexpected" or completely indeterminant. riods of planned or unexpected communication
The expected radiation components were the loss.
trapped protons and electrons of the Van Allen The onboard instruments available for crew
Belts (figure 9-1), galactic cosmic rays, and the readout included a portable rate survey meter and
emissions of onboard radiation sources (table 9-I). three (plus a spare) personal radiation dosimeters
The possibilities of unexpected exposure included which display integrated dose in 10 millirad inte-
energetic solar particle events, high altitude nu- grals. The personal radiation dosimeters and rate
clear tests, and potential problems with onboard survey meter provided the dual functions of extra-
sources. vehicular activity dosimetry and dose rate moni-
Premission analyses indicated that dose equiv- toring, plus vehicle area monitoring in the
alents from the nominal environment of trapped intervals between extravehicular activities.
(Van Allen Belt) particles and galactic cosmic Routine monitoring of dose rates at a fixed loca-
radiations would be well below the limits adopted tion aboard the Skylab vehicle was performed by
by National Aeronautics and Space Administra- an ionization chamber instrument, the Van Allen
tion from the National Academy of Sciences rec- Belt Dosimeter. Electron and proton fluences
ommendations for manned space flight (table (particles/cm 2) were monitored by an electron-
9-II) (ref. 1). These analyses indicated that the proton spectrometer mounted on the exterior of
Skylab 2 mission (28-day duration) would be the spacecraft. Rate data from these instruments
within the 30-day limit category, while Skylab 3 were telemetered or recorded for later transmis-
and 4 (59 days and 84 days, respectively) would sion to ground, and were not available for direct
be within the 90-day category. Because the nomi- crew readout.
nal environment would result in doses well below
these limits, operational radiation support was Passive Dosimetry
geared toward rapid identification and reaction
Each crewman was provided with a passive
to any enhanced radiation situation.
dosimeter packet to be worn continuously
Spacecraft Radiation Monitoring throughout the mission. The packet weighed ap-
proximately 14 g (one-half oz), and was designed
Mission rules establishing mandatory onboard
to be worn on a soft strap on the ankle or wrist.
decisions concerning a radiation enhanced environ-
The packet contained the following dosimetry
materials for postflight analysis: densitometric
• NASA Lyndon B. Johnson Space Center, Houston,
Texas. film, nuclear track emulsions, polycarbonate and

64
RADIOLOGICAL PROTECTION AND MEDICAL DOSIMETRY FOR THE CREWMEN 65

8O

-60

40

20

2O

40

60
6o
100 120 140 160 E180W 160 140 120 100 80 60 40 20 WOE 20 40 60 80

Longitude, degrees

FIGURE 9-l.--Trapped radiation environment boundary for Skylab.

cellulose nitrate track detectors, lithium fluoride ysis, and radiological health. Spacecraft data,
(TLD-700) chips, and tantalum/iridium foils. satellite information, and solar observatory re-
In addition to passive dosimeters worn by the ports were utilized in evaluating the space en-
crewmen, passive dosimeters were placed within vironment, especially relative to radiation
the Orbital Workshop's film storage vault for the enhancement. The crewmen reported their per-
intervals from the beginning of Skylab 2 to the sonal radiation dosimeter readings (as integrated
end of Skylab 2 (28 days) and from the beginning dose) on a daily basis, plus additional readings
of Skylab 2 to the end of Skylab 3 (123 days). The before and after each extravehicular activity.
film vault dosimeters were placed in locations with These readouts confirmed a continuously nominal
aproximate 2_ shielding values of 13 and 23 g/cm 2 radiation environment throughout each of the
aluminum. _ Relative to proton range in tissue, three missions.
these depths in aluminum correspond to soft tissue Although there were no radiation enhance-
depths of approximately 10 and 19 cm, respec- ments, the mission was not totally uneventful
tively. from a radiation standpoint. A few highlights are
as follows.
Ground Radiation Monitoring
Solar Activity.--The Skylab missions were
Radiation protection support was provided by flown during a period when solar activity was
specialists in communications, computational anal- approaching a minimum in the Sun's solar cycle.
Nevertheless several events of scientific interest
Due to the rectangular shape of the film vault, actual
2_r mean values are somewhat greater than 13 and 23 occurred during the Skylab missions, however,
g/cm _. The remaining 2_r shielding is >_ 23 g/crn _ for botl_ particle emissions from these events were of low
locations. energy and relatively low intensity. These char-
66 BIOMEDICAL RESULTS FROM SKYLAB

TABLE 9-I.--Radiation Sources Aboard the Skylab Vehicle

Activity

Item Sou_'ce
identification Location material Per No. of
item items Total

Photometer cali- Forward Pm-147 8 mCi 1 8 mCi


bration source compart-
experiment T027. ment.

Light source for Experiment H-3 100 mCi 200 mCi


otolith goggles compart-
experiment M131. ment.

Dial lettering Forward Pm-147 NA NA 200 mCi


experiment S019. compart-
ment.

M552 Ampoules. Stowage Ag-ll0m 20 _Ci 80 _Ci


compart-
ment.

M558 Ampoules. Stowage Zn-65 13 #Ci 3 39 _Ci


compart-
ment.

Docking target External Pm-147 300 mCi 66 19.8 Ci


axial. on the MDA.

Docking target External Pm-147 300 mCi 66 19.8 Ci


radial. on the MDA.

COl Partial Internal Am-241 454.2 #Ci 12 5.5 mCi


pressure sensors on AM.

G&N main frame Command Th-232 NA NA 34.1 #Ci


(PSA and CDU). module.

Astronaut Worn. H-3 4.21 mCi 12.6 mCi


chronographs.

rnCi, millicurie. NA, not applicable.


#Ci, microcurie. MDA, Multiple Docking Assembly.

acteristics, coupled with the shielding effect of the Therefore, visual observation of ground sites in
Earth's magnetic field, reduced radiation doses the vicinity of the test area was completely
from solar particles to below the limits of detect- avoided.
ability for onboard dosimetry instrumentation Onboard Radiation Source Problems.--One of
( < 10 millirad per event). the larger onboard sources (approximately 200
Nuclear Events.-- A series of four nuclear de- mCi of promethium-147) was radioluminescent
vices were detonated by France at their Murora markings on knobs and dials of an experimental
Test Site during Skylab 3. The tests produced no device, the experiment S019 "Articulated Mirror
ionizing radiation problems for Skylab. However, System." Roughly half of the total activity was ap-
the possibility of eye damage to the crew from ac- plied to digital readout belts and wheels within a
cidental observation of a test was recognized. readout subassembly. Two malfunctions occurred
RADIOLOGICAL PROTECTION AND MEDICAL DOSIMETRY FOR THE CREWMEN 67

TABLE 9-II.--Radiation Exposure Limits meantime, an alternative alignment method was


devised and tested. The alternative method was
Bone Skin Eye successful and was utilized for the remainder of
Constraints in rem (5 cm_ (0.1 mm) (3 ram)
the mission.
1 yr avg daily rate 0.2 0.5 0.3
30-day max. 25 75 37 Dosimetry Results
Quarterly max. 35 105 52
Yearly max. 75 225 112 Integrated radiation doses at a tissue depth
Career limit. 400 1200 600 equivalent to lens of the eye were obtained daily
by crew readout of personal radiation dosimeters.
These dosimeters were worn the first 4 days of
with the device in-flight. First, a number of radio- each mission and on all extravehicular activities.
luminescent numerals (about one mCi each) be- During the duration of each mission, the instru-
came detached from one of the dial wheels, and ments were placed in the designated assigmed po-
second (perhaps because of the first), a belt of sitions shown in table 9-III. Mean dose rates for
numerals became jammed and failed to indicate similar positions in consecutive missions show a
instrument position in the 10's and 100's places of trend toward increased values as use of food,
rotational attitude. water, propellants, and other expendables reduced
The possibility of numeral detachment had been the overall spacecraft shielding. Thermolumines-
recognized late in the preflight preparations for cent dosimeter results of the crew-worn passive
the missions and the dial subassembly had been packets are shown in table 9-III for comparison
gasket-sealed to preclude escape of promethium- with the rates found throughout the spacecraft.
147 into the spacecraft atmosphere. The problem An upper limit estimate of the hard galactic
during the flight became one of how to obtain radiation contribution is approximately 18 milli-
valid experimental results, either by fixing the rad per day; the approximate lower limit is 12
jammed belt (without release of promethium-147) millirad per day. Comparison of these rates with
or by finding an alternative alignment method for the overall mean dose rates shown in table 9-III
the experiment. Ground based testing with a train- indicates that the galactic component accounted
ing model of the experiment equipment deter- for 30 to 50 percent of the observed film vault
mined that the numeral belt could not be freed doses, and roughly 20 to 30 percent of the crew
without breaking into the sealed dial unit. In the dose means.

TABLE 9-III.--Mean Daily Doses Within Skylab Vehicle

Skylab missions (tad/day)


Location
2 3 4

Crew TLD (Mean _.+ a) 0.057+0.003 0.065±0.005 0.086±0.009


Film vault, drawer B 0.041 0.038
Film vault, drawer F 0.037 0.030
Command mod., B-1 0.080 10.073 0.084
10.085
Stowed crew PRD's:
Experiment comp 0.054 0.047 0.070
Sleep compartment 0.083 0.082 0.091
-Z SCI airlock 0.071 0.110
+Z SCI airlock 0.126
Mean, outside vault _+ a 0.069+0.013 0.77±0.021 0.091±0.021

1A constant, dose independent, integration rate (0.12 rad/day} was observed in this instrument post-
flight. If initiated at launch, true in-flight rate would be 0.073 rad/day; if initiated at splashdown, rate of
0.085 rad/day would be valid.
TLD, Thermoluminescent Dosimeters.
PRD, Personal Radiation Dosimeters.
68 BIOMEDICAL RESULTS FROM SKYLAB

The majority of the remaining dose originates quality factor) is slightly dominant at shield
from protons of the Van Allen Belts and softer depths up to 23.3 g/cm 2 aluminum. At blood form-
secondary radiations generated by passage of the ing organ depth (5 cm tissue), quality factor is
primary particles through spacecraft materials. estimated equal to 1.5. In comparison, a quality
The evaluation of dose equivalents for mixed factor of 1.6 is found for the crew-worn dosimeters
radiations in space is a complex subject and it is beneath 0.3 g/cm 2 of tissue equivalent shielding.
recommended that the reader consult the litera- Neutron Dosimetry.--Details of the iridium/
ture for rigorous discussion on this subject. There tantalum neutron dosimetry system have been
are, however, some notable findings which should published previously (ref. 2). Thermal (0.02 to
be covered. 2.0 e!ectronvo!ts) and intermediate (2.0 to 2×103
Primary Electrons.--Van Allen Belt electrons electronvolts) neutrons were found to contribute
did not penetrate into the spacecraft, nor were to crew dose equivalent at a combined rate of ap-
they found to penetrate deeply enough (3 mm proximately 0.1 millirem/day.
tissue equivalent) during extravehicular activities Direct measurement of fast neutron fluence by
to register on either the passive dosimeters or suspended track analysis of crew-worn nuclear
personal radiation dosimeters. Consequently, elec- emulsions was not possible due to the high track
tron doses to the skin (tissue depth: 0.1 mm below densities obtained on the Skylab missions. How-
0.2 g/cm _ of space suit shielding) were calculated ever, upper limit dose calculations have been made
from electron-proton spectrometer data. based on nuclear emulsion disintegration star anal-
Dose Versus Shield Depth.--Doses to the blood yses (to determine neutron production rates) and
forming organs (tissue depth: 5 cm) were found iridium/tantalum evaluation, assuming that all
to average 0.66 of the doses observed to the skin. activation is due to tissue albedo. Both methods
These dose averages were obtained by integration show excellent agreement with upper limit rates
of outputs from the dual sensors of the Van Allen
Belt Dosimeter. The value of 0.66 also is in good TABLE 9-IV.--Skylab Mission Dose Comparisons
agreement with a value obtained by interpolation
Crewman and parameter Skylab 2 Skylab 3 Skylab 4
between crew-worn and film vault dosimeter re-
sults. Commander (rad, TLD) 1.62 3.67 18.02
The sole difference between skin and eye doses p+ EVA (rad, PRD) 0.13 0.01 0.25
(0.1 mm and 3.0 mm tissue depth, respectively) is e- EVA (rad, CALC) 1.07 1.50 1.34
the added dose to skin from electrons during extra- Skin (rem) 3.66 7.37 14.17
Lens (rein) 2.59 5.87 12.83
vehicular activities.
BFO (rein) 1.60 3.63 7.94
Quality Factor Versus Shield Depth.--Film Scientist Pilot (rad, TLD) 1.66 _ 3.73 7.36
vault shielding was found to be relatively ineffec- p+ EVA (rad, PRD) 0.10 0.06 0.10
tive from a simple dose reduction standpoint e- EVA (rad, CALC) 0.85 2.65 6.07
(table 9-III). Despite the small dose reduction, Skin (rem) 3.51 8.62 17.85
Lens (rem) 2.66 5.97 11.78
however, quality factor could have decreased sub-
BFO (rem) 1.64 3.69 7.29
stantially if the dose reduction was solely due to Pilot (rad, TLD) 1.81 4.21 6.80
filtering of lower energy particles. On the other p+ EVA (rad, PRD) 0.09 0.09 0.06
hand, secondary buildup processes tend to in- e- EVA (rad, CALC) 0.25 1.15 5.22
crease quality factor as a function of shield depth. Skin (rem) 3.15 7.89 16.10
Lens (rem) 2.90 6.74 10.88
These competing effects could not be calculated
BFO (rem) 1.79 4.17 6.73
accurately prior to the mission. Therefore, we have PRD mean, 4 LOCS (rad) 1.98 4.71 7.81
relied primarily on postmission nuclear emulsion
1 CALC wrist equivalent for 8.68 measured at ankle.
analyses of the film vault dosimeters to deter-
CALC wrist equivalent for 4.75 measured in sleep comp.
mine space radiation quality as a function of
NOTE: Quality factors used for proton doses to skin and eye - 1.6.
shielding. quality factor for BFO - 1.5. Electron Dose applied to skin only: Qual-

Comparison of emulsion data from the dosime- ity factor - 1.0.

TLD. Thermolumineseent Dosimeter.


ters worn by the crew and film vault dosimeters
PRD. Personal Radiation Dosimeter.
indicates that the filtering mechanism (reduced BFO, Blood Forming Organs.
RADIOLOGICAL PROTECTION AND MEDICAL DOSIMETRY FOR THE CREWMEN 69

of approximately 12.5 millirem per day for fast dose equivalents apply specifically to long-term
neutrons with mean energy of approximately one effects such as generalized life shortening, in-
megaelectronvolts. creased neoplasm incidence, and cataract produc-
Conclusion tion. To place the mission values in perspective,
the NASA career limits were 400 rem blood form-
Table 9-IV summarizes the dosimetry results for ing organs, 1200 rem skin, and 600 rem eye lens
each crewman of the Skylab missions. As indi- and were established from ancillary radiation
cated in this table, there were certain variations exposure constraints recommended by the Na-
in passive dosimeter wearing habits which re- tional Academy of Science and based upon a
quired adjustments for data comparison purposes. reference risk of doubling the incidence of leu-
Dose equivalents received by the Skylab 4 crew- kemia and other neoplastic disease. This refer-
men were the highest received in any NASA ence risk was taken to be a dose equivalent of 400
mission to date, but remained well within the rem. These career limits also entail a statistical
limits established for the Skylab missions. Due to risk of nonspecific life shortening of from 0.5 to
the low rates involved (for example, less than 100 3.0 years (ref. 3). The Skylab 4 crewman could
millirem per day to blood forming organs), dose fly a mission comparable to one 84-day Skylab 4
equivalents for each crewman were well below mission per year for 50 years before exceeding
the threshold of significant clinical effect. These these career limits.

References
1. Space Science Board, Radiobiological Advisory Panel, Committee on Space Medicine.
Radiation protection guides and constraints for space-mission and vehicle-design
studies involving nuclear systems. National Acad. Sci., p. 15. Washington, D.C.,
1970.
2. ENGLISH, R. A., and E. D. LILES. Iridium and tantalum foils for spaceflight neutron
dosimetry. Health Phys., 22:503-506, May 1972.
3. Space Science Board, Radiobiological Advisory Panel, Committee on Space Medicine.
Radiation protection guides and constraints for space-mission and vehicle-design
studies involving nuclear systems. National Acad. Sci., pp. 12-14. Washington,
D.C., 1970.
N77-33790

CHAPTER10

Toxicological Aspects of the Skylab Program

WAYLAND J. RIPPSTEIN, JR. a AND HOWARD J. SCHNEIDER a

of these was a nonmetallic materials screening


TOXICOLOGICAL
lished during the SUPPORTCAPABILITYwas
early developmental estab-
phases program which was designed to eliminate those
of the Skylab Program. From past experiences materials that would cause problems from their
with closed-loop environmental operations, such as outgassed products. The screening program was
in submarines and manned chamber tests, it had based upon measuring the amounts of carbon
been found that the buildup of trace contaminant monoxide and total organics outgassed per unit
gases could result in conditions which could cause weight of each candidate material. Levels of ac-
mission termination. It was also recognized from ceptance were established for both carbon monox-
the experience gained in the Apollo Program that ide and total organics based upon the spacecraft
the use of newly developed nonmetallic material, habitable volume, the trace gas removal rate by
especially the fluoronated polymers, required the environmental control life support systems,
toxicological considerations, and that special con- and the cabin leak rate.
sideration be given to the testing for outgassing Where newly developed polymers were consid-
products. ered for use as electrical component potting com-
It was known early in the program that the pos- pounds or electrical wire insulators, pyrolysis
sibility of carbon monoxide buildup in the space- products of these materials were used to determine
craft cabin would also require special attention. toxicological limits. The amount of material re-
None of the environmental control life support quired to kill 50 percent of the exposed animals
systems in previous spacecraft nor in Skylab were identified as lethal dose 50 (LDso) was determined.
designed to provide carbon monoxide removal. It In these cases, material selection included both
was therefore imperative that the selection of ma- outgassing data and LDso information. To prevent
terials for use in the Skylab interior include con- inhalation exposures to toxic effects from chemical
sideration for the outgassing of carbon monoxide. compound (s) contained in the pyrolysis products,
It should be noted at this point that toxicological chemical analyses using mass spectral and gas
support provided for the Skylab Program included chromatographic procedures were performed.
considerations not only for inhalation toxicity, but These analytical procedures were also performed
also ingestion, eye contact, and skin contact toxic- when a waiver was requested on any candidate
ity. Since the latter three areas of toxicology re- spacecraft material that failed the carbon monox-
quired attention so infrequently, they are not ide and total organics screening tests.
discussed in this paper.

Procedures Problems

To provide a safe breathing, habitable environ- Following the loss of the Skylab 1 micromete-
ment for the Skylab crew, several measures were oroid shield, a significant toxicity problem de-
adopted early in the program. The most important veloped as a direct result of the overheating of the
Orbital Workshop interior wall insulation mate-
• NASA Lyndon B. Johnson Space Center, Houston, rial. The sensors for wall temperature indicated
Texas. that the interior walls of the Orbital Workshop had

7O
TOXICOLOGICAL ASPECTS OF THE SKYLAB PROGRAM 71

attained a projected temperature of 177 ° C was 11 mg/m 3, and for the toluene diisocyanate
(350 ° F) on the skin side of the insulation and tubes, 0.14 mg/m 3. Atmospheric samples were
71 ° C (160 ° F) on the interior volume side of the taken by using a syringe-type pump to flow air
spacecraft insulation. Since the insulation was through the analyzer tubes (fig. 10-1).
known to be a rigid polyurethane foam, a potential
hazard could develop as a result of the decomposi- CO monitor tube adaptor
Equalization
tion of the polymer to produce an isocyanate de- (orange color)
_ valveadaptor
rivative. Of secondary concern was the accelerated
offgassing rate of the entire nonmetallic materials Pump

contained in the Skylab habitable volume. \


Solutions
Gas sampling pump and detector tube
Using a piece of foam identical with that in
Skylab 1 (same chemical lot and age), a solids Key:

probe mass spectral analysis was conducted. Poly- TDI = Toluene


diisocyanate
mer decomposition begins at about 200 ° C (392 ° CO = Carbon
F), but toluene diisocyanate was detected in trace monoxide
quantities from 50 ° C (122 ° F) to about 200 ° C CSM = Command and
service module
(392 ° F). The manufacturer reported that an
excess of toluene diisocyanate is used in the pro-
cessing of a rigid foam and the excess toluene
diisocyanate was apparently diffusing from the CSM s=de
foam during the lower temperatures prior to
thermal decomposition. Also, the blowing agent CSM side

contained in the foam, trichlorofluoromethane, Airlock hatch-equalization valve


reached a maximum release rate at about 150 ° C
(302 ° F). No accurate quantitative results were FIGURE 10-l.--Skylab 2 gas sampling equipment.

available from these analyses due to the unavail-


ability of toluene diisocyanate standards. Further- Prior to the entry of the crew into the space
more, at the time of the overheating of the station cluster, 1 two precautionary measures were
polyurethane foam, there existed no spacecraft undertaken to ensure that the habitable areas were
requirements for acceptable atmospheric concen- safe for manned operations. The first was a series
trations of toluene diisocyanate. The maximum of pressurization-depressurization cycles of the
allowable exposure (8-hour weighted average) Skylab 1 atmosphere designed to discharge and
limits established by the Occupational Safety and dilute any contaminating gases of potentially toxic
Health Administration (ref. 1) for toluene diiso- levels. In the second measure the crew sampled
cyanate is 0.14 mg/m 3 [0.02 ppm standard tem- the air for carbon monoxide and toluene diisocya-
perature and pressure (STP)]. Reports in the nate first in the Multiple Docking Adapter and
literature (refs. 2, 3, 4, 5, 6, 7) all substantially then in the Orbital Workshop, using the supplied
support this exposure limit. analyzer tubes. The results of their analyses indi-
Prior to the launch of the Skylab 2 crew two cated no detectable toluene diisocyanate and an
types of gas analysis detector tubes and two acti- extrapolated 5 mg/m 3 level of carbon monoxide.
vated charcoal and hopcalite masks were put The crew energized the Skylab 1 Environmental
aboard the Command and Service Module to pro- Control Life Support System which contained
tect the unsuited crewmen upon their initial entry 9.02 kg (20 lbs) of activated carbon, specifically
into the Orbital Workshop to sample its atmos- designed to remove trace levels of contaminating
phere. The tubes were of the colorimetric design
and included one type for carbon monoxide and
1 The space station cluster is made up of the Command
another for toluene diisocyanate detection. The Module, Orbital Workshop, Multiple Docking Adapter, and
lower sensitivity of the carbon monoxide tubes Airlock Module.
72 BIOMEDICAL RESULTS FROM SKYLAB

compounds. From prior tests it was known that lar weights for the identified compounds ranged
the spacecraft-type activated carbon would very from 60 to 584. These data revealed that there
efficiently remove toluene diisocyanate. After a 30- was no coolant fluid leaking into the interior of
minute atmospheric circulation period, the crew the Orbital Workshop.
was given instructions to enter the space station When the three atmospheric samples taken on
for manned operations. This mission and Skylab mission days 11, 46, and 77 were compared, the
missions 3 and 4 were accomplished without any results indicated only minor differences in the
other atmospheric trace gas problems. levels of contamination. This indicated that a
In addition to potential offgassing problems state of equilibrium had been attained earlier
from excessive internal temperatures in the Orbi- between the gas generation rates of the contami-
tal Workshop, a leak was suspected in the coolant nant sources and the removal rate by the Environ-
system of the spacecraft. To determine the com- ment Control Life Support System.
position and concentration of any atmospheric
Conclusion
trace contaminants a unique device was used
(app. A.II.c., fig. A.II.c-1). The device consisted The experiences and data gained in the Skylab
of two small glass tubes, mounted in parallel in an program have demonstrated that the crew was
aluminium cartridge, such that an atmospheric gas provided with as safe an environment as could be
flow could pass equally through both tubes at the attained using the current state-of-the-art trace
same time. Each of these tubes was partially gas removal technology. The knowledge gained in
filled (4.5 ml/tube) with a gas chromatographic solving the trace contaminant problems encoun-
absorbent material. Aproximately 60 liters (STP) tered in the Skylab Program will greatly aid in
of cabin atmosphere were passed through the de- providing safe, habitable spacecraft environments
vice during a time span of 15 hours. Three such for the future missions of man in space.
samples were taken by the Skylab 3 crew on mis-
sion days 11, 46, and 77. Acknowledgment
The analyses of the absorbed contents of the The authors of this paper wish to acknowledge
three samples (three pairs of tubes) indicated the the important contribution of E. S. Harris of the
presence of more than 300 compounds in the Sky- National Institute for Occupational Safety and
lab atmosphere during the occupancy of the Sky- Health (formerly Head of the NASA-JSC Toxi-
lab 3 crew. Of this number, 107 (ref. 8) were cology Laboratory) in directing the toxicology
identified by mass spectral methods. The molecu- program in support of Skylab.

References
1. Federal Register. August 13, 1971. OSHA Rules and Regulations, Table G-l,
36(157) :15101.
2. ZAPP, J. A. Hazards of isocyanates in polyurethane foam plastic production. AMA
Arch., Ind. Health, 15:324-330, April 1957.
3. NIEWENHUIS, R., L. SCHEEL, K. STEMMER, and R. KILLENS. Toxicity of chronic level
exposures to toluene diisocyanate in animals. AIHA J., 26:143-149, 1965.
4. DUNCAN, B., L. SCHEEL, E. J. FAIRCHILD, R. KILLENS, and S. GRAHAM. Toluene
diisocyanate inhalation toxicity: pathology and mortality. AIHA J., 23:447-456.
5. BRUGSCH, H. G., and H. B. ELKINS. Toluene diisocyanate (TDI) toxicity. New Eng.
J. Med., 268:353-357, February 14, 1963.
6. Hygienic Guide Series. Toluene diisocyanate (tolylene diisocyanate, TDI). AIHA J.,
28:90-94, 1967.
7. DERNEHL, C. U. Health hazards associated with polyurethane foams. J. Occup. Med.,
8:59, 1966.
8. The Proceedings of the Skylab Life Sciences Symposium, I:163-166. NASA TM
X-58154, November 1974.
SECTION H

Neurophysiology
f

N 7- 3791

CaAPTER 11

Experiment M131. Human Vestibular Function

ASHTON GRAYBIEL, a EARL F. MILLER II, a AND JERRY L. HOMICK b

1. SUSCEPTIBILITY TO MOTION SICKNESS 17 percent. It is interesting that all incidents oc-


curred in early missions, an incidence of about 36
RIOR TO Skylab missions, nine U.S. and four percent.
U.S.S.R. crewmen reported motion sickness in The classical example of motion sickness ex-
orbital flight (table 11.1-I). Soviet investigators perience in space flight was provided by Titov.
have described in detail vestibular side effects
For a very brief period immediately after transi-
experienced by cosmonauts on transition into tion into orbit Titov felt that he was flying upside
weightlessness (refs. 1, 2, 3, 4, 5, 6, 7, 8), and it is down. Soon thereafter he described dizziness as-
noteworthy that reflex motor phenomena were sociated with head movements and sometime be-
reported far more frequently than was motion tween the fourth and seventh orbit (6 or more
sickness. Postural illusions were experienced im- hours) he became motion sick, the first recorded
mediately after transition into orbit and, while
instance in space flight.
usually short-lived, some cosmonauts continued In the U.S. space program motion sickness aloft
to experience the illusion until the g-load that was was not reported until the Apollo missions (ref.
associated with reentry reappeared. Illusions
9), although seasickness after splashdown was not
evoked by rotary motions of the head or head and an infrequent occurrence. In the Apollo Command
body (sensations of turning and dizziness) were Module where stimulus conditions were far more
experienced not only early in flight but also over favorable for eliciting motion sickness than in
prolonged periods. Among the 24 cosmonauts 4 the Mercury Program, on the lunar surface, or in
experienced motion sickness, an incidence of about the Gemini Command Module, 9' among 25 Apollo
astronauts were motion sick. In the Mercury
• Naval Aerospace Medical Research Laboratory, Pensa- spacecraft the astronauts were restrained in their
cola, Florida. Dr. Miller is deceased.
couches, helmets (which were removed only oc-
NASA Lyndon B. Johnson Space Center, Houston,
Texas. casionally) prevented quick head movements and

TABLE ll.l-I.---Manned Space Flight Programs

United States Russia

Incidence of Incidence of
Program Number of motion Program Number of motion
space pilots sickness space pilots sickness

Mercury 6 0 Tostok 1
Gemini 16 0 Toskhod 3
Apollo command
module 25 9 Soyuz 13 0 e

Apollo lunar
landing 12 0

74
EXPERIMENT
M131.HUMANVESTIBULAR
FUNCTION 75

the visual cues were adequate and plentiful. In 3 Commander, took part in the Apollo 12 mission
the Gemini spacecraft helmets were not worn but which included landing on the Moon; neither had
there was limited opportunity for free-floating ac- reported any symptoms of motion sickness during
tivities. The 12 astronauts exposed to lunar condi- those missions. In other motion environments in-
tions did not experience motion sickness, but dividual differences in susceptibility were demon-
inasmuch as all were insusceptible in orbital flight, strated in a range below average susceptibility.
the benefit of a fractional g-loading was not tested. Functional tests of the astronauts' vestibular
Moreover, their helmets prevented quick head organs revealed no definite abnormalities. These
movements except about the vertical axis and vis- tests included a battery of tests for postural equi-
ual cues were excellent. librium for which the scores, although not shown
In this report a distinction is made between two in table ll.l-II were within the normal range. Of
categories of vestibular side effects (ref. 10). One particular interest in view of the physiological
category comprises a great variety of "immediate deafferentation of the otoliths in weightlessness,
reflex motor responses," such as postural illusions, however, are the low values for ocular counter-
sensations of rotation, nystagmus, and what often rolling, which is a test of otolithic function. The
is termed dizziness or vertigo. The other category, counterrolting index (one-half the maximum roll
motion sickness, is a delayed epiphenomenon (su- when tilted right and left) was only 158 minutes
perimposed on any responses in the reflex cate- of arc in the Skylab 2 Commander and Skylab 3
gory), involving vestibular influences that cross a Scientist Pilot; whereas, among 550 normal sub-
temporary or "facultative linkage," to reach non- jects the average was 344 minutes of arc (ref.
vestibular sites where first-order responses that 15).
lead to motion sickness symptoms have their im- A test (ref. 16) for grading susceptibility to
mediate origin. First-order responses may, in motion sickness and yielding a single numerical
turn, elicit second and higher order responses or score (Coriolis Sickness Susceptibility Index) was
complications until the organism is generally in- carried out. The scores for the astronauts are com-
volved. Symptoms of motion sickness are usually pared with susceptibility in 624 normal subjects
elicited when too rapid a transition is made from in figure 11.1-1. However, it should be pointed out
one motion environment to another (ref. 11). The that it was demonstrated prior to Skylab missions
primary or essential etiological factor is of vestib- that the scores obtained in this test do not predict
ular origin, inasmuch as under such a transition susceptibility to motion sickness in the weightless
persons _vith loss of vestibular function do not phase of parabolic flight (ref. 17). The results of
become motion sick (refs. 12, 13). Secondary such a comparison are as follows: Changes in
etiological factors are always operative, however. susceptibility to motion sickness among 74 sub-
In healthy, normal persons visual inputs and jects, as determined by comparing systematic
psychological factors are usually the most impor- quantitative measurements made during weight-
tant ones ; in some motion environments just open- less phases of parabolic flight and on the ground,
ing the eyes may precipitate motion sickness. In showed 20 subjects reached the end point, 15 sub-
most motion environments visual inputs are not jects did not, 16 remained about the same, and 23
essential for the elicitation of motion sickness; increased. It is seen that susceptibility on the
blind persons who have never perceived light may ground predicted susceptibility aloft in about 22
readily become sick (ref. 14). percent of the subjects.
Stimulus Conditions.--Under operational condi-
Procedure
tions the astronauts made major transitions from
Astronauts.--Table ll.l-II summarizes findings land to orbital flight, to sea, and back to land.
in the nine Skylab astronauts dealing with their While aloft, transitions were made between the
susceptibility to motion sickness in different mo- Command Module and the workshop and, during
tion environments and their responses during tests extravehicular activity, between the spacecraft and
of vestibular function. the outer environment. During entry there were
The Skylab 2 Commander had participated in variations in g-loading that terminated at splash-
the Gemini V mission and, along with the Skylab down, followed by transitions from the Command
76 BIOMEDICAL RESULTS FROM SKYLAB

_9
¢¢

_ I I _ _ ._

• [_.._ I= _._ [_=_

A'_ "_

] •
_.
_

L_
_1
_--

_ " _,-_

•,$ ,,$

°°I
i I

I
A A A A A A A

_9 _9 r,9
EXPERIMENT M13 1. HUMAN VESTIBULAR FUNCTION 77

NORMALS N = 624

CDR = Commander
SPT = Scientist Pilot
PLT = Pilot

7O

6O

5O

40

30

2O

10

r]FL n n
i i i i i i i i i l I i i i i i i i I i i I i i I ; I i i I I I I I ! ! 11 If l
10 15 20 25 30 35 40 45 50 75 100

Motion sickness susceptibility scores

FIGURE 11.l-l.--Frequency distribution of motion sickness susceptibility scores of 624


normal subjects with scores of the nine Skylab astronauts indicated. The method used
was similar to that used in Skylab missions.

Module to the recovery aircraft carrier, and finally accelerations that, combined with the passive ex-
from the carrier to land. posure to sea motions, generated cross-coupled
In considering the transitions from one motion angular accelerations (stimulating the semicircu-
environment to another it is necessary to take into lar canals at suprathreshold levels) and Coriolis
account not only the "new" environment, but also accelerations stimulating the otolithic receptors
the current status of adaptation effects acquired (refs. 18, 19, 20).
in antecedent environments. Skylab conditions in Under experimental conditions (on and after
the workshop were far more stressful than those mission day 8 aloft and on the ground) a stressful
in the Command Module, and highly complicated motion environment was generated by requiring
vestibular and visual inputs were encountered in the astronauts, with eyes covered, to execute head
the workshop. Accelerative stimuli there were movements while in a rotating litter chair (figs.
associated with passive as well as active move- 11.1-2 and 11.1-3). The rotating litter chair
ments and visual stimuli were, potentially at least, could be revolved at constant velocities up to 30
disorienting. Thus, the opportunity was present to revolutions per minute (r/min) (ref. 21). The
reveal individual differences in susceptibility to experimental procedures involved alternate clock-
motion sickness, based on vestibular inputs as wise and counterclockwise rotations, but rotation
well as on complexly interacting vestibular and was more often clockwise than counterclockwise.
visual stimuli. Each discrete head and body movement ("over"
At sea the astronauts were passively exposed and "back") through an arc of 90 degrees in each
to motion environments that stimulated the vestib- of the four cardinal directions (front, back, left,
ular organs. The active execution of head (and right) required 1 second, and was followed by a
body) movements contributed angular and linear "hold" for 1 second in the upright position. Move-
78 BIOMEDICAL RESULTS FROM SKYLAB

ments were made in sets of 5 (the forward move- the ground. These impulse linear accelerations
ment was executed twice), and after each set the were transient but well above threshold for stim-
astronaut kept his head in the upright position for ulation of the otolith receptors. When the rotating
20 seconds. The maximum number of head move- litter chair was rotating, the intensity of the
ments required in a test was 150 (1 endpoint) stimuli generated by head movement was a func-
unless mild motion sickness (the other endpoint) tion of the rotational velocity, and although the
was reached earlier. angular and cross-coupled angular accelerations
The rotating litter chair was used in the station- stimulating the semicircular canals aloft were
ary as well as the rotating mode. In the stationary the same as on the ground, the impulse and
mode when head movements were executed aloft, Coriolis accelerative forces generated aloft were
the canals were stimulated in the same way as on not combined with a gravitational vector. These
the ground, but the otolith organs were stimu-
lated in an abnormal manner because the impulse MI31-HUMAN VESTIBULAR FUNCTION
linear accelerations generated were not combined OCULOGYRAL ILLUSION MODE
r-_--ANGUL AR ACCE L--'-_-3
with a gravity vector as they would have been on is b9

4 e

J 3 IO 12 zz

i iz 13 24

r_- RESPONSE

LeFT NON{ R_GHT NEXT STEP

MAIN PWR

Stowage cabinet

r-DIRECTION'm TACHOMETER

MOTION SENSITIVITY MODE


r-_R PM_ CADENCE VOLUME
io _ s

zs

io
20

z_ N z

OffF II

ENTER

Rotating litter chair

FI(;URE l l.l-2.--The rotating litter chair motion sickness FlcunE ll.l-3.---Console used in connection with the ro-
test mode. tating litter chair.

!
EXPERIMENT M 13 1. HUMAN VESTIBULAR FUNCTION 79

forces, nevertheless, were substantial at all levels movements to make the estimates and record them
of angular velocity used, and at 30 r/min the by depressing the appropriate push-buttons in the
centripetal force was, respectively, 0.3 g and 0.6 g response matrix of the rotating litter chair Con-
at radii of 1 and 2 feet. trol Console. One-hundred and fifty head move-
The Diagnosis of Motion Sickness.--The diag- ments or a score _>5 points automatically
nostic criteria for motion sickness used in the Sky- triggered a signal that the test had been completed.
lab experiments are summarized in table ll.l-III Under operational conditions the astronauts'
and are described in detail elsewhere (ref. 22). ability to diagnose different levels of severity of
In brief, the severity of motion sickness symp- motion sickness was enhanced by their training in
toms was given a numerical score; 16 points and connection with the preflight experimental evalua-
above comprised the range of "frank motion sick- tion of motion sickness susceptibility. Nonethe-
ness," and less than 16 points, the range of "mild less, under operational conditions diagnosis was
motion sickness." more difficult than under experimental conditions
Under experimental conditions the diagnosis of because the identification of the stressful stimuli
acute motion sickness was aided by the close tem- was not always easy, the symptomatology of
poral relation between exposure to stressful stim- "chronic" or prolonged motion sickness (experi-
uli and elicitation of responses. In all Skylab enced aloft) differed in some respects from that of
experiments the motion sickness endpoint, moder- acute motion sickness.
ate malaise (M II A) (a point score of 5 to 7),
Medication
was of very mild intensity; the avoidance of more
severe symptoms was an operational requirement. The astronauts in Skylab 2 and Skylab 3 carried
An observer in collaboration with the subject with them antimotion sickness capsules containing
estimated the severity of each predesignated symp- 1-scopolamin e 0.35 milligrams + d-amphetamine
tom and recorded any "other symptom" not men- 5.0 milligrams; in addition to this drug the Sky-
tioned in table ll.l-III. There was always lab 4 crew took along the drug combination
adequate time after execution of each set of head promethazine hydrochloride 25 milligrams +

TABLE 11.1-III.---Diagnostic Categorization of Different Levels of Severity of Acute Motion Sickness

Pathognomonic Major Minor Minimal A QS 1

Category
16 points 8 points $ points 2 points 1 point

Nausea syndrome Nausea III, 2 retching Nausea II Nausea Epigastrlc Epigastric awareness
or vomiting discomfort
Skin Pallor III Pallor II Pallor I Flushing/Subjective warmth >_ II
Cold sweating III II I
Increased salivation tII II I
Drowsiness III II I
Pain Headache (persistent) __ II
Central nervous Dizziness (persistent)
system
Eyes closed >__II
Eyes open III

Levels of severity identified by total points scored

Frank sickness Severe malaise Moderate malaise A Moderate malaise B Slight malaise

(FS) (M III) (M II A) (M II B) (M I)

_> 16 points 8-15 points 5-7 points 3--4 points 1-2 points

1 AQS, Additional qualifying symptoms.


III, Severe or marked; II, moderate; I, slight.
8O BIOMEDICAL RESULTS FROM SKYLAB

ephedrine sulfate 50 milligrams, drugs which had to transitioning to weightlessness, my appetite


proven to be effective under experimental (ref. was a little bit less, neglecting day 1 when it was
23) and operational conditions (ref. 24). This completely normal, and that it was a little less for
drug combination acts by raising the stimulus somewhere like the first week. I don't know why
thresholds for eliciting motion sickness responses this is. As I said, I had no particular symptoms. I
and is effective in any motion environment. In- felt fine during those first 7 days, but I thought I
deed, preflight drug evaluation tests were carried felt even better after that."
out on all nine astronauts; endpoints were not It is also noteworthy that both the Commander
reached even at angular velocities of 20 r/min for and Scientist Pilot reported that while engaged
the _' ..... '" 2 crewmen and o,_ar/min
_yl_, _,. the _..j_t-,,- _._,_sp_--_-_,, rapidly about their .... lon_ axes or "run-
lab 3 and Skylab 4 crewmen. ning" around the inside of the workshop, they
experienced immediate reflex vestibular side ef-
Results
fects, mainly "false sensations" of rotation. Based
It is convenient to present the findings dealing on past experience, both astronauts expected that
with motion sickness first under "operational con- motion sickness would follow the reflex effects and
ditions" then under "experimental conditions." were surprised by their immunity.
Operational Conditions.--Attention will be The Skylab 2 Pilot did not take an antimotion
mainly centered on motion sickness during the sickness drug aloft and remained symptom free.
orbital phase of the mission and will be discussed Unlike his comrades, however, although he was
with the aid of figure 11.1-4. The horizontal lines aware of illusory phenomena their intensities
reflect two things. First, the periods during which made little impression on him.
the astronauts were based in the Command Mod- During entry the Skylab 2 astronauts did not
ule, and in the workshop during the first week in perceive the oculogravic illusion. The Scientist
orbit. Second, the thickness and continuity of the Pilot stated afterward, "I never picked it up at
lines indicate the onset and probable disappear- all. I think it just had to do with the fact that you
ance of symptoms of motion sickness. The onset have so many visual cues and you're so well
of symptoms is indicated fairly accurately. The lighted and also your attention is so riveted on the
disappearance of symptoms, however, involves instruments that you have no such illusion ....
first a loss of susceptibility to the eliciting stimu- The first time we were conscious of any vestibular
lus, then spontaneous restoration through homeo- inputs was after we were on the water and un-
static mechanisms and finally something termed strapped and moved from the couch. There was
convalescence, hence "disappearance" of motion nothing at all during the entry." The Skylab 2
sickness symptoms is difficult to determine. The Commander stated, "My first head movement
vertical lines indicate when an antimotion sickness was when I was unstrapped and on the water,
drug was taken and its composition. The adminis- when I rolled up on my right and moved around ....
tration of drugs increases the difficulty of diagnos- It was exactly what I would expect had I been rid-
ing motion sickness, hence accuracy in diagnosis is ing the centrifuge and done the same thing." The
greater in the absence of drug effects. Pilot stated, "And I did move. ! got up from the
Skylab 2.--As indicated earlier, the Commander couch and looked out the window for the ship
was, in all likelihood the least susceptible to mo- while we were still on the chutes, and that didn't
tion sickness among the nine Skylab astronauts. bother me."
He didn't take any antimotion sickness drugs and At splashdown the sea state was 5, and the Com-
was symptom free under all conditions. mand Module landed and remained upright. The
The Scientist Pilot, in a debriefing, stated, "I astronauts were quite confident that they would
took the one 'scop/dex' (antimotion sickness not experience motion sickness on return and ac-
drug) right after insertion (into orbit) that I cordingly did not take antimotion sickness drugs
had preprogramed myself to take, whether I prior to entry. Seasickness was not experienced
needed it or not." He further stated, "I felt that, by the Commander but severe symptoms were
although we had no overt symptoms of motion manifested by the Scientist Pilot and mild symp-
sickness or any other specific syndrome related toms by the Pilot.
EXPERIMENT M 131. HUMAN VESTIBULAR FUNCTION 81

Command module, hours


Sky- Workshop, mission day
lab
Predock (12) Postdock (30) 1 2 3 4 5
i I i I j I I I I j I6 I 7I

CDR

SPT

PLT

SS
CDR
II
DD
SS

SPT n

I't
DD
S S S SSS
PLT I 1 I11
1 I I II I
D D D DDD
S P S S P S SP .S
CDR
I I I IIIIII ...... J
D E D D E DDE D
S P S S P SSP S
4 SPT

D E
II I III I
D D E DDE D
P P P P P P P P P

PLT '_ I I I !
I I
! It
I
E E E E E E E E E

Key:

Symptoms of motion sickness: S = Scopolamine, 0.35 mg


None I
D = Dexedrine (dextroamphetamine), 5.0 mg
................ Data uncertain
Slight P = Promethazine, 25 mg
Moderate I
Severe E = Ephedrine, 50 mg

FIGURE ll.l-4.--Motion sickness under operational conditions.

Skylab 3.--The Skylab 3 astronauts were quite gravity. Shortly after transition he removed his
confident before their mission that they would not helmet and soon thereafter his space suit. It was
become motion sick in weightlessness and did not in close relation to taking off the suit that the first
take antimotion sickness drugs as a preventive symptoms of motion sickness were experienced.
measure. He took an antimotion sickness capsule that re-
The Pilot experienced mild symptoms of motion lieved his symptoms for a few hours. Later, symp-
sickness within an hour after insertion into orbit. toms returned and he restricted his activities; he
During launch he wore a space suit and helmet deliberately avoided, however, taking another
(as did the other crewmen). He was not aware of antimotion sickness capsule while based in the
any illusory phenomena on transition into zero Command Module.
82 BIOMEDICAL RESULTS FROM SKYLAB

During the activation of the workshop, about 11 On both days at sea aboard the carrier, the Pilot
hours into the flight, the Commander and Scientist took an antimotion sickness capsule, implying
Pilot also reported the onset of motion sickness. some susceptibility to sea sickness.
Shortly thereafter the Skylab 3 Scientist Pilot Skylab 4.--In the light of Skylab 2 and Skylab
vomited. For three days the astronauts experi- 3 findings, the Skylab 4 crew was scheduled to take
enced symptoms of motion sickness which were antimotion sickness drugs through mission day 3
intensified by movement and alleviated after tak- and, thereafter, as required. The drugs actually
ing the drug or restricting their movements. Dur- administered are shown in table ll.I-IV. The
ing this period their workload was lightened. drugs were referred to as "uppers" (A) and
On mission day 2 the Scientist Pilot executed "downers" (B) and on mission day 8 the Scientist
standardized head movements for 30 minutes with Pilot took the drug combination B as a soporific
the object of increasing his rate of adaptation. rather than for its antimotion sickness properties.
With eyes closed he had "no difficulty," but with Prior to entering the workshop the Pilot experi-
eyes open he experienced "developing malaise." enced nausea and vomiting and was not free of
On mission day 4 regular working hours were symptoms during the first 3 days. The Com-
resumed, although some degree of susceptibility mander reported "epigastric awareness" prior to
to motion sickness remained in all three astro- meals which may have represented susceptibility
nauts Recovery was complete by the seventh mis- to motion sickness, and the Scientist Pilot was
sion day. symptom free. It is interesting that all crewemen
Prior to splashdown the antimotion sickness took antimotion sickness drugs during recovery
drugs were taken, and symptoms were prevented at sea and were symptom free.
even though the sea state was twice as severe as Experimental Conditions.--Skylab 2.--The find-
that to which the Skylab 2 crew had been exposed. ings in figure 11.1-5 demonstrate that the Scien-

TABLE 11.l-IV.--Skylab 4 Antimotion Sickness Medication

Approx. time Scientist


Mission event (Hours c.s.t.) Commander Pilot Pilot

Launch day (MD 1)


After insertion 0900 A B
After NC-1 _ 1100 h
After docking 1700 B B B
2300 B

MD 2 and MD 3 0600 A A B
On arising 1000 A A
1400 B B B

MD 4 0600 A A B
On arising 1400 B

MD 8 Bedtime B

MD 33 Bedtime B

MD 82 Bedtime B

MD 84 A A A
About 2 hours prior
to splash (entry)

z FirstPhasing Maneuvers.
A Scovolamine/Dexedrine (0.35/5.0 rag).
B Promethazine/Ephedrine {25/50rag).
EXPERIMENT M 131. HUMAN VESTIBULAR FUNCTION 83

Skylab 2 astronaut

• Commander
• Scientist Pilot
• Pilot
Mill 8

6 --

MIIA

co 4 --

MIIB

2 --

MI

0 --
o Lfl O [D O q_qqqqq
r/rain 03 03

Head movements _ _ 03o _ _ mo _ =o _ o mo mo o mo o


P

Direction _J o _ (J o (J o (j _ (j (j (j (j

P 03 CO CO (D
Days + + + P tO
E + +
1 I

Preflight Mission day Postflight

FIGURE l].l-5.---Motion sickness symptomatology on Skylab 2 astronauts quantitatively


expressed in terms of malaise level, as evoked by the test parameters (rotational ve-
locity, number of head movements, and direction of rotation) used before, during,
and after the Skylab 2 mission.

tist Pilot and Pilot (the Commander did not mission day 20 was a slight increase in subjective
participate) were less susceptible to motion sick- body warmth, and on mission day 24, a mild cold
ness when they executed head movements during sweating. The temporary manifestations reported
rotation aloft than when they did so on the by the Pilot on mission day 6 when the rotating
ground. Preflight, on three widely separated occa- litter chair was stationary were epigastric aware-
sions, the M II A endpoint was consistently ness and increased body warmth; and, on mission
elicited after 30 to 60 head movements while those day 24, slight dizziness and cold sweating.
astronauts were being rotated at 12.5 r/rain (Sci- Postflight there was no significant change in
entist Pilot) or 15 r/min (Pilot). When rotation the susceptibility of the Scientist Pilot to motion
tests were carried out in the workship, both of sickness compared with preflight, and, for the
these astronauts were virtually symptom free; Pilot, no significant change on the third day post-
their minimal responses, which were transient, flight. The decrease in susceptibility manifested
did not even qualify for a score of one point. This by the Pilot on day 8 postflight does not, in all
was true even when the angular velocities were in- likelihood, reflect more than a temporary change
creased (in two steps) to 30 r/min. The ephemeral in his susceptibility.
manifestation reported by the Scientist Pilot on Skylab 3.--The findings in the three astronauts
84 BIOMEDICAL RESULTS FROM SKYLAB

are summarized in figure 11.1-6. It can be seen for both the appearance and nature of this symp-
that they were virtually immune to experimental tom, which is not typical of acute motion sickness,
motion sickness aloft and that their susceptibility or whether the astronaut was not quite adapted
was lower, at least temporarily, after the mission to counterclockwise rotation. Postflight, the Com-
than before. mander was symptom free on the day after re-
The Commander was tested in the rotating litter covery when he executed head movements with
chair on two widely separated occasions preflight the rotating litter chair stationary and on the
and demonstrated similar susceptibility levels second day postflight when it was rotating clock-
each time. On mission days 26 and 41 he was wise at 15 r/min. On the fifth day postflight an
__ _1- I _

_,L_p_on-, free --_ ^- zu_L_cl c_u_wi_u, respec- endpoint was reached that approximated ,u_:-pre-
tively, at 20 and 30 r/min. On mission day 52 he flight susceptibility level.
was rotated counterclockwise at 30 r/min and ex- The Scientist Pilot was tested on four widely
perienced what he described as a slight vague separated occasions preflight, and the M II A end-
"malaise" that persisted for approximately 30 point was always reached with approximately the
minutes following the test. The question arises same stressor stimulus. Aloft the Scientist Pilot
whether secondary etiological factors accounted was tested on six occasions, the first on mission day

Skylab 3 astronaut

O Commander
[] Scientist Pilot
/% Pilot

A
Mill 8

m
AOAO

A
6

MIIA
I

MIIB

MI 2 i

0
o
I I I I
o oo I I

o. oq q q o q q q q q q o o.o.q q o. q o.o oo. o. o


r/min _ _ o _ _ _ _ _

Head movements

Direction 888o_8_o8o "888_88_8

Days
_, 5 V ,, _r" -I- + "t-

Preflight Mission day Postflight

FIGURE ll.l-6.--Motion sickness symptomatology of Skylab 3 astronauts quantitatively


expressed in terms of malaise level as evoked by the test parameters (rotational ve-
locity, number of head movements, and direction of rotation) used before, during
and after the Skylab 3 mission.
EXPERIMENT M 131. HUMAN VESTIBULAR FUNCTION 85

5 with the rotating litter chair stationary. There- sions. Aloft he was tested on six occasions. On
after, the angular velocities of the chair, beginning mission day 5 he experienced slight but persistent
at 20 r/min, were increased to 25 r/min, then to "dizziness" when the rotating litter chair was
30 r/min for the last three tests; symptoms of stationary. (It will be recalled that on mission day
motion sickness were never elicited. Postflight he 5 the Pilot was just getting over his susceptibility
was symptom free on the day after recovery when to motion sickness in the workshop and that he had
the rotating litter chair was stationary and again taken an antimotion sickness drug on mission day
on day 2 postflight when the rotating litter chair 3.) Thereafter, he was symptom free when rotated
was rotating counterclockwise at 20 r/min. On clockwise at 20, 25, and 30 r/min and on mission
day 5 postflight the Scientist Pilot experienced days 8, 18, and 29, respectively. On mission day 43
very mild symptoms (dizziness II, drowsiness I), he experienced "some body warmth" that did not
but an endpoint was not reached when the rotat- rate a one-point score (moderate intensity re-
ing litter chair was rotating clockwise at 25 quired) while rotating clockwise at 30 r/min,
r/min. The M II A endpoint was reached on day but he was symptom free 10 days later while
17 postflight with the rotating litter chair rotating rotating counterclockwise at 30 r/min.
counterclockwise. The Skylab 3 Pilot was tested Skylab 4.--The findings are summarized in fig-
on four widely separated occasions preflight and ure 11.1-7. Preflight the ceiling on the test was
demonstrated similar test scores on all four occa- closely approached in the case of the Commander

Skytab 4 astronaut

(_) Commander
r:] Scientist Pilot
Mill 8 m Pilot

MIIA

m 4 _

"__
MIIB E) OB E)

2 u

MI

0 m

r/min

Head movements

Direction

Days

Fi6v_t_ ll.l-7.--Motion sickness symptomatology of Skylab 4 astronatus quantitatively


expressed in terms of malaise level as evoked by the test parameters (rotational ve-
Ioeity, number of bead movements, and direction of rotation) used before, during,
and after the Skylab 4 mission.
86 BIOMEDICAL RESULTS FROM SKYLAB

and Pilot and nearly reached in the case of the grams) in 8 hours, which may have complicated
Scientist Pilot. In the workshop the ceiling of the the symptomatology, hence, the attention here will
test was quickly reached without eliciting any center on the Skylab 3 Pilot.
symptoms of motion sickness. In view of this im- Shortly after transition into orbit the Skylab 3
munity a change in the procedure was instituted. Pilot experienced mild symptoms characteristic of
This change was essential to determine whether motion sickness. The close temporal relation be-
the absence of responses was the result of complete tween the astronaut's activities and the onset or
insusceptibility or, in part, the consequence of alleviation of symptoms and the relief following
adaptation to the stressful accelerations during the administration of the antimotion sickness capsule
..... .*^ ._
p_rmu of exposure to rotation. The latter was confi,_r, cd the diagnosis, the earliest confirmation
tested by reversing the direction of rotation im- among space crewmen on record.
mediately after 150 head movements had been ex- On entry into weightlessness few of the internal
ecuted in the initial direction of rotation. The adjustments that were initiated during the tran-
basis for this approach rested on the finding that sition were complete. Alterations such as in hemo-
although bidirectional adaptation effects are ac- dynamic adjustments, redistribution of body fluids,
quired with either clockwise or counterclockwise and-changes in electrolyte balance that might af-
rotation, the level of adaptation is greater in the fect susceptibility to motion sickness, either via
direction of turn than in the opposite direction. the vestibular system or more indirectly, were at
Therefore, by reversing the direction, the elicita- various stages along their time course (refs. 25,
tion or nonelicitation of symptoms of motion sick- 26, 27, 28, 29). Even though the stimulus to the
ness served to indicate, respectively, whether the macular receptors due to gravity was lost, the
absence of symptoms during the initial direction question had arisen as to whether the physiological
of turn was or was not due in part to the acquisi- deafferentation process had stabilized.
tion of adaptation. On mission day 73, the Com- Loss of the g-load would affect the "modulat-
mander and Pilot, and on mission day 75, the ing influence" of the otolithic system. If the
Scientist Pilot remained symptomless during the otolithic influence was inhibitory the responses
bidirectional test procedure. Consequently, they elicited by stimulation of the canals are said to
were not adapting during the test. be "exaggerated" (ref. 30). The observations
Tests conducted postflight on days 1, 2 and 5 bearing on this point in parabolic flight, how-
revealed either very mild symptoms or immunity ; ever, indicated reduced responses to canalicular
the motion sickness endpoint was not reached. On stimulation (refs. 31, 32, 33) during the weight-
day 17 postflight the Pilot reached the motion less phase.
sickness endpoint. On day 31 postflight both the Fortunately, in the case of the Skylab 3 Pilot,
Pilot and Scientist Pilot reached endpoints and it was possible to follow his course which demon-
the Commander scored 3 points. On day 68 post- strated that there was little or no support for the
flight the revolutions per minute were reduced to notion that nonvestibular predisposing factors in
25 r/min and none reached the motion sickness addition to the immediate eliciting factors were
endpoints. involved; he remained motion sick or susceptible
to motion sickness at least through mission day 3
Discussion
and probably 2 days longer. Moreover, the fact
There were clear-cut findings under operational that the remaining seven astronauts did not have
and experimental stimulus conditions that will motion sickness while based in the Command
serve as points of departure in the following Module argues against a common unique etiologi-
discussion. cal factor.
Operational Conditions.--Command Module.- Workshop.--Under operational conditions three
Two astronauts were motion sick when based in astronauts were motion sick for the first time
the Command Module, the Skylab 3 Pilot and the aloft after making the transition from the Com-
Skylab 4 Pilot. The latter had taken two doses of mand Module into the workshop, implying that
an antimotion sickness drug (Promethazine HC1 stimulus conditions were more stressful then
25 milligrams and ephedrine sulfate 50 milli- than at any time in the Command Module and
EXPERIMENT M 131. HUMAN VESTIBULAR FUNCTION 87

that the adaptation acquired in the Command mechanisms, upon which were superimposed the
Module offered inadequate protection in the work- nonspecific general effects of a period of ill health.
shop. It is especially noteworthy that recovery was not
The spaciousness of the workshop provided the complete until mission day 7.
greatest opportunity up to the present time to The Skylab 4 Commander despite the adminis-
reveal the great potentialities in weightlessness tration of antimotion sickness drugs 3 times daily
for limiting natural movements and encouraging on mission days 2 and 3 became mildly motion
highly unnatural movements that often resembled sick, and the Pilot continued, despite medication,
acrobatic feats. Movies of the astronauts carry- to demonstrate, on occasion, symptoms of motion
ing out their tasks in the workshop, often involv- sickness.
ing transitions from one place to another, best There is much resemblance between the time
display the relatively large component of passive course of the symptomatology of motion sickness
movement associated with active movements, elicited in the workshop and in a slow rotation
with the opportunities for generating unusual room. This resemblance is due in large part to the
patterns of vestibular stimulation and unusual or etiological relation between "activities" and elicit-
abnormal visual inputs. ing stimuli. The two environments have, in com-
The Skylab 3 Commander and Scientist Pilot mon, the generation of stressful stimuli when a
began to have symptoms shortly after entering person is engaged in various activities and abo-
the workshop, and soon thereafter the Pilot lition of the stressful stimuli when the head and
vomited. The question has been raised whether body are fixed. In both environments there are:
the motion sickness experienced by the Pilot in-
A delay in appearance of symptoms after the
fluenced unfavorably the elicitation of symptoms
in the other two crew members. This seems un- onset of the stressful stimuli;
likely for two reasons, namely, the Pilot had been A gradual or rapid increase in severity of
motion sick (or highly susceptible to motion sick- symptoms ;
Modulation by secondary influences ;
ness) since the first hour in flight, and symptoms
Perseveration for a time after sudden cessation
appeared in the Scientist Pilot and Commander
before the Pilot vomited. Among these three of stimuli ; and
A response decline, indicating that restoration
astronauts under workshop conditions, the Pilot
is taking place spontaneously through homeo-
was not only most susceptible but also susceptible
for the longest period while the Commander was static events and processes.
least susceptible with the shortest time course. If the intensity of the stimuli is high, the laten-
It was on mission day 2 that the Scientist Pilot cies associated with the appearance and disap-
executed standardized head movements for a pearance of symptoms will be brief. With the
short period and did not have any symptoms with acquisition of adaptation effects and concomitant
eyes closed, but, continuing the head movements reduction in the intensity of the stimuli, the laten-
with eyes open, he did experience symptoms. cies are increased, and, characteristically, restora-
Whether symptoms would have been elicited if tion may not only be prolonged but also
the head movements had been continued with eyes complicated by the appearance of symptoms not
closed is not known, but the visual inputs con- typical of acute motion sickness. Thus, in a slow
tributed to the interacting sensory stimuli and rotation room it has been demonstrated that
probably were of etiological significance. This drowsiness may be elicited in the virtual absence
brief "experiment" represented an attempt at of other symptoms (ref. 35) and that after the
programing the acquisition of adaptation effects nausea syndrome has disappeared, drowsiness,
and underscores the possible advantage of "eyes lethargy, and fatigue remained (ref. 36).
closed" in the early stage of adaptation, some- An analysis of the foregoing and similar mani-
thing that has been demonstrated under labora- festations has led to the definition of a unique
tory conditions (ref. 34). After the third or syndrome. For clarity, it is termed the Sopite syn-
fourth day it is difficult to sort out the counter- drome (from the Latin Sopor, meaning drooping
vailing influences of eliciting and restoring or drowsy) (Graybiel, A. and J. C. Knepton, "The
88 BIOMEDICAL RESULTS FROM SKYLAB

Sopite syndrome: a component or even sole ex- otolithic system on the canalicular system but also
pression of motion sickness symptomatology," in its opportunity to interact directly with this sys-
preparation). This syndrome may be part of the tem.
clinical symptomatology or, if the eliciting stimuli The important question arises whether the prior
are at a critical level of intensity, it may be the adaptation to weightlessness "transferred" to the
sole manifestation. In addition to drowsiness and rotating environment or whether it played a sec-
lethargy, there is a reduced interest in ongoing ondary role ; namely, simply ensuring the absence
events and a performance decrement, especially of overt as well as any covert symptoms of motion
when attempting to carry out tasks involving high- sickness. In this connection, the findings in para-
level mental activity. Lastly, just as in recovering bolic flight are pertinent, inasmuch as the periods
from any illness, there is a period termed "con- of exposure to near-weightlessness are brief. The
valescence." It is possible that the Skylab 2 Scien- alternating periods of supragravity and subgravity
tist Pilot experienced something in the nature of states in parabolic flight create a bias in favor of
the Sopite syndrome in the workshop. increased susceptibility to motion sickness in the
Under experimental conditions in the workshop rotating litter chair. Motion sickness susceptibility
the virtual failure to elicit symptoms of motion has been compared in 74 healthy subjects who ex-
sickness in any of the five astronauts who were ecuted standardized head movements while they
exposed to a stressful type of accelerative stimuli rotated at constant velocity during sequential
in a rotating chair (on or after mission day 8) weightless phases of parabolic flights and during
implies that, under the stimulus conditions, suscep- periods of exposures under laboratory conditions
tibility was lower aloft than on the ground, where (ref. 12). Most subjects demonstrated either a
symptoms were elicited preflight and postflight. substantial increase or decrease in susceptibility,
The amount of this decrease in susceptibility could while a few experienced little change in suscepti-
not be measured because the "ceiling" on the test bility.
(30 r/min) was so quickly reached.
Conclusions and Recommendations
The difference in susceptibility between work-
shop and terrestrial conditions is readily traced Skylab findings indicate three ways or means
to gravireceptors (mainly in the otolith organs; that permit weightlessness, a static state, to
touch, pressure, and kinesthetic receptor systems qualify as a unique motion environment: first, its
possibly contributing) for the reason that stimula- quasidynamic potentialities for inducing changes
tion of the canals was the same aloft as on the in nonrigid parts of the body; second, its unique
ground, and visual inputs were always excluded. potentialities at once limiting a person's natural
If it is assumed that the otolith system is respon- movements and encouraging unnatural movements
sible, then the absence of stimulation to the oto- that may result in unusual vestibular and visual
lithic receptors due to gravity must have a greater sensory inputs; third, the demonstration under
influence (tending to reduce the vestibular dis- specific experimental conditions that susceptibility
turbance) than the disturbing influences of the is lower aloft than on the ground.
transient centrifugal linear and Coriolis accelera- The lower susceptibility to vestibular stimula-
tions generated when head and trunk movements tion aloft, compared with that on the ground under
were executed in the rotating litter chair. Al- experimental conditions, was "traced" to the re-
though these transient accelerative forces, as duction in g-load but had to meet a precondition,
pointed out in the section on Procedure, are sub- namely, either there was no need to adapt, or, as
stantial their effectiveness as stimuli are virtually exemplified by the Skylab 3 Pilot, adaptation to
unknown. The otolithic zonal membrane has con- weightlessness had been achieved. The inference
siderable mass, and transient accelerations lasting is that from the standpoint of the vestibular or-
fractions of a second might have little or no effect. gans, the "basic" susceptibility to motion sickness
The absence of gravity, causing what has been is lower in weightlessness than under terrestrial
termed "physiological deafferentation" of the oto- conditions; how much lower remains to be meas-
lith receptor system, would be expected to reduce ured.
not only the indirect modulating influence of the In the case of the Skylab 3 Pilot, the prolonged
EXPERIMENT M 131. HUMAN VESTIBULAR FUNCTION 89

period of susceptibility would seem to rule out operational and experimental conditions, empha-
any short-lived etiological factors associated with sized the distinction between two categories of
entry into orbit. vestibular side effects, namely, immediate reflex
In the workshop three astronauts experienced phenomena (illusions, sensations of turning, et
motion sickness for the first time aloft, thus in- cetera) and delayed epiphenomena that include
ferring at once the more stressful conditions in the constellation of symptoms and syndromes com-
the workshop compared with those in the Com- prising motion sickness. The relationship between
mand Module and the inadequate level of adapta- the two categories deserves further study.
tion previously acquired. The drug combinations 1-scopolamine and d-
None of the Skylab 2 crewmen experienced mo- amphetamine and promethazine hydrochloride
tion sickness in the workshop, implying either and ephedrine sulfate were effective in prevention
there was no need to adapt (a possibility in the and treatment of motion sickness; nonetheless,
case of the Commander) or that prior adaptation they are not the "ideal" antimotion sickness drugs.
in a less stressful environment afforded adequate Although not used as a diagnostic test the anti-
protection. The period during which the "ade- motion sickness drug was helpful in diagnosing
quate" adaptation in the Command Module was motion sickness, notably in the case of the Skylab
acquired by the Skylab 2 crewmen was much 3 Pilot.
shorter than the period during which Skylab 3 Prevention of motion sickness in any stressful
and Skylab 4 crewmen were motion sick, let alone motion environment involves selection, adaptation,
the additional period while recovering from mo- and the use of drugs. Today we lack laboratory
tion sickness. Both of these findings have implica- tests that accurately predict susceptibility to mo-
tions that argue for programing the acquisition of tion sickness in weightlessness; susceptibility to
adaptative effects. motion sickness in the weightless phase of para-
Findings in some of the astronauts, under both bolic flight is promising but has not been validated.

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2. THRESHOLDS FOR PERCEPTION OF ANGU- observed during rotation in the laboratory and in
LAR ACCELERATION AS REVEALED BY the Mercury spacecraft during the course of his
THE OCULOGYRAL ILLUSION (PRELIM- orbital flight. In Glenn's opinion, the illusory ef-
INARY RESULTS) fects as the result of very similar angular accel-
erations were "essentially the same."
Both the oculogyral illusion and ocular nystag- Roman, et al. (ref. 9), used the oculogyral il-
mus are used as indicators of semicircular canal lusion to measure "the sensitivity of the semi-
function and behavior. Nystagmography, gen- circular canals to stimulation" during periods of
erally regarded as the most useful of all indicators weightlessness averaging 46 seconds in parabolic
of vestibular function, was not available. In con- flight. This was accomplished by rolling the air-
sequence, we made use of the oculogyral illusion craft during periods of subgravity as well as
(ref. 1) which, whatever its drawbacks, is a more during one-g control maneuvers and by timing
sensitive indicator than nystagmus (ref. 2). The the duration of apparent rotation of a visual tar-
relation between the oculogyral illusion and nys- get. It was concluded that there was no significant
tagmus has long been an object of interest (refs. difference between the duration of the illusion
3, 4, 5), and, while it seems that the illusion can under the two stimulus conditions.
be a consequence of nystagmoid movement, the
behavior of the two responses may not only differ Procedure
but even may simultaneously occur in the opposite Sub]ects.--Eight of the nine Skylab astronauts
sense. (the Skylab 2 Commander did not participate)
Although complete agreement regarding the acted as test subjects. Each had demonstrated nor-
effect of g-loading on nystagmus may be lacking, mal otolithic and semicircular canal function, as
the weight of the evidence indicates that the in- indicated, respectively, by ocular counterrolling,
tensity of the nystagmic responses increases and and by caloric as well as oculogyral illusion re-
decreases, respectively, with increases and de- sponses. The oculogyral illusion perception thresh-
creases in g-load (refs. 6, 7). It is also to be noted old of each participant measured initially by a
that these effects are quickly manifested and are method (ref. 10) different from the one used in
ascribed to otolithic excitatory or inhibitory in- this study fell within the lower half of the distri-
fluences. bution of 300 similarly tested normal healthy
John Glenn conducted the first experiment in males as shown in figure 11.2-1.
space flight that involved the oculogyral illusion Apparatus.--Vestibular Test Goggle.--The ves-
(ref. 8). He compared the oculogyral illusion tibular test goggle, described in detail elsewhere
92 BIOMEDICAL RESULTS FROM SKYLAB

Key:
45--
= N=300
= Skylab astronauts 1-9
40-- OGI = Oculogyral illusion

35--

30--

25--

z m

20m

15 D

5--

10-- i

0_

c5 d d c5 d d ¢5 d c5 c5 d d d ¢5 c5 ¢5 ¢5 " " " _ H c6


OGi threshold, degrees/s2

FIGURE ll.2-1.--Performance of the astronauts compared with that of 300 normal


subjects using a variation of the Skylab procedure.

(ref. 10), is a self-contained device worn over the


subject's eyes (fig. 11.2-2). The collimated line-
of-light target, the only thing visible to the sub-
ject, is self-illuminated by a radioactive source
and arbitrarily placed for viewing by the right
eye only. The device is held on the face by its at-
tachment to a biteboard assembly which, in turn, ::!_iiiiii::_ Apparent target motion

is secured by an adjustable support connected to


the rotating litter chair. The distance between the
ocular and occlusal planes is adjusted so that the
subject's visual axis in its primary postion is Self.illuminated target ___ _ _

essentially in the "horizontal" plane containing


the optic axis of the target system.
Roll control
Acceleration Profile.--The rotating litter chair, Pitch control
described in part 1, was programed to rotate a
FIGURE l l.2-2.--Sketch of goggle device with slight right-
seated subject (clockwise or counterclockwise) at
ward apparent displacement of line target as viewed by
any one of 24 progressive logarithmic steps in the astronaut. Some apparent displacement is commonly
velocity versus constant time (90 seconds) profiles associated with apparent movement.
EXPERIMENT M 13 I. HUMAN VESTIBULAR FUNCTION 93

within extremely narrow limits of precision. The no movement was perceived. The subject was in-
man-supporting superstructure and motor of the structed to close his eyes immediately after each
rotating litter chair are directly coupled to elimi- response.
nate gear slack and perceptible vibration and The down ramp of the profile required the sub-
therefore meet the physiological requirement of ject, as in positive acceleration, to open his eyes
eliminating small performance errors that are at 2 seconds and to respond between the 5th and
normally within the sensitivity range of the deli- 20th second after deceleration had begun. After
cate vestibular organs. reaching zero revolutions per minute, the rotat-
Plan.--The subject was secured in a seated ing litter chair remained stationary for at least
position within the rotating litter chair, and his 25 seconds.
biteboard and the vestibular test goggles were af-
fixed to the support mechanism of the chair. He Results
engaged the biteboard with his teeth and donned All data collected before, during, and after the
the vestibular test goggle by tilting his head for- Skylab missions 2, 3, and 4 are presented in table
ward 20 ° . The target viewed by his right eye 11.2-I. The table lists the number of a) correct,
was adjusted so that it appeared vertical and b) incorrect with respect to the apparent direc-
straight ahead. The purpose of the fixed head tilt tion of movement, and c) no movement responses
was to place the "plane" of the lateral canals divided by the total number of expected right and
closer to the plane of rotation. The rotating litter left responses at each level of acceleration tested
chair device had the capability of generating any in each session, preflight, in-flight (mission day)
one of 24 progressive logarithmic steps of con- and postflight. A summary of these results is
stant acceleration ranging from 0.02°/s 2 (step 1) portrayed in figure 11.2-3 as average "frequency
to 3.00°/s 2 (step 23) ; two log units of acceleration of seeing" curves with percentage of correct
separated steps 23 and 24. However, in order to responses among eight trials for each of the accel-
reduce in-flight experimental time, the test selec- eration tests steps under the three major test
tion was limited among steps 1, 4, 8, 10, 14, and conditions: preflight, in-flight, postflight. Com-
18. In the first two missions, steps 1, 4, 8, 10, and parison_ of the tabulated preflight data indicate
18 were used; in the third mission, step 14 was similar individual response patterns with a tend-
introduced as a test option when appropriate to ency for each subject to improve with repetition
determine performance within the large interval of the test.
between acceleration log steps 10 and 18. When A relatively wide range of accelerations was
step 14 was used, step 1 or 18 was omitted, the employed to increase the probability that each
choice depending upon the pattern of prior test participant's subthreshold to suprathreshold range
performance by the subject. Testing was always of response would, in the event of even gross
done in the ascending order to acceleration rates. changes, be captured during each test session
After one of the acceleration rates was selected aloft. It was found that the pronounced changes
on the basis of the predetermined test schedule occurred principally at acceleration levels that
and prior subject performance, the program start produced near threshold levels of the oculogyral
switch of the rotating litter chair was pressed. illusion perception.
After 2 seconds of constant positive acceleration, Although each astronaut was instructed to al-
the subject was signaled to open his eyes; after 5 ways report any nonmovement of target, he knew
seconds' accumulative time, he was signaled again as the result of his dual role as subject and exam-
to judge whether the target appeared to move iner that only right or left responses were appro-
rightward or leftward, or to remain stationary. If priate. If he failed to ignore or was influenced by
the subject did not respond after 15 seconds' ac- his knowledge of the procedure, the test became a
cumulative time, a third signal was given. If no forced-choice situation and the chance factor was
response was received within 20 seconds' accumu- 50 percent; if he chose among the three responses
lative time, the end of the constant acceleration the chance factor was 33_ percent. An illustration
period and the beginning of the 25-second constant that a given set could influence perception of the
velocity phase, it was assumed and recorded that oculogyral illusion is given in the comments of the
94 BIOMEDICAL RESULTS FROM SKYLAB

TABLE ll.2-I.--Oculogyral Illusion Response For Eight Astronauts


[Number of correct and incorrect responses divided by the total number of expected correct responses reported by eight
Skylab astronauts (Skylab 2 Commander did not participate). When exposed to constant angular acceleration at indicated
log step increases, preflight, in-flight, and postflight.]

Response Response Response Response


Incorrect Incorrect Incorrect
COT- Cor-
rect c_- _ _
Ace rect _ ._ ._ feet I _ Incorrect
._
Level
I

L-53 _ L--23
1 2 0 1 5 3 1 0 4
4 2 1 0 5 2 0 1 5
8 3 0 1 4 3 0 0 5
10 7 0 1 0 8 0 0 0
14
18 8 0 0 0 6 0 0 0
MD 6 _ MD 12 MD 20 MD 24
1 4 1 1 2 5 0 1 2 4 2 2 0 1 0 2 5
4 3 0 0 5 6 0 0 2 1 1 2 4 4 0 0 4
8 3 1 0 3 2 2 2 2 4 2 0 2 4 1 1 2
10 3 1 2 2 6 1 0 1 7 0 0 1 7 0 1 0
14
18 6 0 1 1 7 0 0 1 8 0 0 0 6 2 0 0
R+3 3
1 3 0 0 5
4 1 1 0 6
8 4 1 1 2
10 7 1 0 0
14
18 8 0 0 0
L-53 L--22
1 1 0 6 2 1 0 5
4 7 0 0 1 0 1 0 7
8 6 1 1 0 4 2 2 0

/ 110
8 0 0 0 7 0 0 1
14
18 8 0 0 0 8 0 0 0

!L1I
MD 6 MD 16 MD 20 MD 24
2 2 1 3 1 0 0 7 1 0 0 7 4 1 2
4 4 0 0 4 3 0 0 5 2 0 0 6 4 1 0
8 2 0 0 6 1 1 2 4 1 0 1 6 3 0 1

i /1°_ 14
18
6

8
0

0
1

0
1

0
6

8
0

0
0

0
2

0
6

8 0
0 1

0
1

0
6

8
0

0
1

1 3 1 0 4
, 84 47 01 2 02
_[ R+3 0
10 7 1 0 0

_I 14
18 8 0 0 0

See footnotes at end of table.


EXPERIMENT M 13 I. HUMAN VESTIBULAR FUNCTION 95

TABLE ll.2-I.--Oculogyral Illusion Response For Eight Astronauts--Continued

Response [ Response Response I Response I Response Response


Incorrect
_- l_cor_Ct- I i_rect _ h,_or"eet_] Cot- i _.incorrect I Cor- ln_orreot Cor-
Acc Cor- I _ --I Cor- I_ Cor- _ _ _ _ _ ._
Level rect _, _
rect .r_. % _ feet .r-. % _ rect ,3 _ _ ,'eet
+ L-119 "
1 5 2 1 -0

4 5
4
1
3
1
1
1
0
10
14
8 5 0 2 1

18 8 0 0 0
MD 41 _ MD 52
1 _2 3 1 2 5 I 2 0
4 4 2 0 2 4 I 1 2
8 6 0 0 2 5 2 0 1
10 5 2 1 0 5 0 1 2
14
18 6 2 0 0 8 0 0 0

R+4* R+9
1 ---4 4 0 0 5 3 0 0
4 4 4 0 0 4 2 I I
8 5 2 i 0 6 1 1 0
10 4 4 0 0 4 2 1 1
14
18 6 0 2 0 7 1 0 0
L--119 L--.33 L-12
2 4 2 0 6 2 0 0 3 1 0 4
4 3 i 2 2 3 1 I 3 5 1 i 1
8 7 1 0 0 6 1 1 0 7 0 0 1
10 5 0 2 1 5 2 1 0 6 0 i 1
i 141
7 0 0 1 7 0 0 1 8 0 0 0
MD5 MDi2 - MD18 -MD29 MD 43 MD 53
1 3 3 2 - 0 4 1 1 2 ..... 5_1_ 0 4 2 2 0 .... 4 1 1 2 6 1 1 0
7 1 0 0 4 0 3 1 3 1 3 1 5 1 2 0 5 0 1 2 3 1 3 1
•_ 8 5 0 2 1 3 1 2 2 3 3 2 0 2 1 4 1 4 1 2 1 4 1 2 1
_ 10 7 1 0 0 4 1 2 1 8 0 0 0 6 1 0 1 6 0 1 1 4 2 1 1
"® _ 14
8 0 0 0 8 0 0 0 8 0 0 0 8 0 0 0 7 0 1 0 7 0 0 1

R+4 R+9
r_
1
._ 5 1 1 1 6 2 "_b
._ 4 4 1 2 1 4 2 2 0
8
_-_ 6 I 1 0 8 0 0 0
lo 7 0 1 0 6 0 1 1
14
18 8 0 0 0 8 0 0 0

-- T- 7 - 17L-1-- .... _-_ _-_o_ _} 17


1 0 3 1 4 4 1 2 1 3 2 2 1
4 2 2 2 2 3 0 1 4 2 1 1 4
___ 8 2 3 3 0 3 0 1 4 5 0 1 2

_ 110 5 0 0 3 6 0 1 1 6 0 1 1

I 18 8 o o o 8 o o o 8 o o o
_1_ -- - MD5 .... MD--8 ....... MDi8 MD32 MD43 MD 52,
_[ [ 1 6-- 0 1 i 3-- i --3 1- --- 2 0 3 3 6 i 1 0 4 2 1 1 2 2 3 1
_. 4 a 0 2 3 6 1 1 0 2 1 1 4 4 1 2 1 5 1 0 2 4 1 2 1
_1_,1 8 s 0 0 _ 4 0 2 2 s 0 2 _ s 2 2 t _ _ 0 0 6 1 0 1
_['_l 10 5 0 0 3 4 1 2 1 5 0 1 2 7 0 0 1 6 1 0 1 5 1 0 2

6 1 1 0
_]_ 18 8 O_ 0 0 __ 8 0 ._L_ 0 7 0 0 1 8 0 0 0 . 8 0 0 0

.... _+.,: :("-


/_q 8 s e 2 x _ 2 x o
t_l lo 6 1 1 o 5 1 2 o
|I x8 8 o o o 8 o o o
See footnotes at end of table.
96 BIOMEDICAL RESULTS FROM SKYLAB

TABLE ll.2-I--Oculogy_al IUusion Response For Eight Astronauts--Continued

Response
Response ] Response Response
Incorrect Incorrect
I Incorrect I Incorrect Incorrect
Res_nse-_- I _ Response l-
Cor-I Incorrect
Cor- " " : _ I Cot-I--_ Cor-
Cor- _ Cor- _
Ace
Level rect_ _ rect _

L-24 L-2o L-IO

1 4 2 1 1 6 1 1 0
_: 4 6 0 1 1 5 0 1 2 7 0 1 0 7 1 0 0
8 7 0 1 0 6 1 1 0 7 0 0 1 7 0 1 0

10 6 L_219_
0 1 I 8 0 0 0 8 0 0 0 8 0 0 0

14 8 0 0 0 7 0 1 0

t.I [ 18 8 0 0 0 8 0 0 0 8 0 0 0 +
MD 47 MD 60
"_ MDs" MD 11 MD 19 3 3 2 0 2 3 3 0 5 1 2 0

4 2 2 0 5 1 1 0
__ 1 5120
7 0 1 0 7 0 1 0
___ 8 6 1 1 0 7 0 1 0 6 0 20 7 0 1 0
6 1 1 0 8 0 0 0
.._ _ 10 7 0 1 0 6 1 1 0 8 0 0 0 8 0 0 0
._/_1 14 8 0 0 0 8 0 0 0 7 1 0 0 8 0 0 0 6 0 2 0 8 0 0 0

"_m[ I 18 8000 8000 8000

.... R+55 _ R + 11

1 8 O 0 O 5 1 2 0

"_ 4 5 1 2 0 8 0 0 0

8 7 1 0 0 7 0 1 0
/"_1 lO 8 o o o 7 o o o
/_.1 14 8 o o o 8 o o o
_ll 18
L-219 L-130 L-67 L-20
1i 0
1 2 _ 2 6 1
4 3 1 0 4 5 0 1
1 2 7 0 1 0 7 1 0 0

8 5 0 1 2 6 1 11 0 7 0 0 1 7 0 1 0

_- 10 7 1 0 0 8 0 00 0 8 0 0 0 8 0 0 0

]_'] 14 8 0 0 0 7 0 1 0
"_ I 18 6 1 1 0 8 0 0 0 8 0 0 0

"_ " - MI) d MD 12 MD 26 MD 47 MD 62 MD 81

1 7 1 i 1 2 3 3 0 3 2 3 0 1 4 3 0
"_ 4 5 2 2 1 8 0 0 0 5 2 1 0 5 1 2 0 5 1 1 1 4 1 3 0

7 0 1 0 8 0 0 0 7 0 1 0 5 1 2 0 6 0 2 0 4 2 2 0

10 4 1 2 1 7 0 0 1 4 2 2 0 5 0 1 2 8 0 0 0 5 2 1 0

"_ 14 8 0 0 0 8 1 1 0 8 0 0 0 8 0 0 0 7 0 1 0 8 0 0 0

_ 18 8 0 0 0 8 0 0 0

R+5 R+11

1 8 0 0 0 5 1 2 0

4 5 1 2 0 8 0 0 0

8 7 1 0 0 7 0 1 0
10 8 0 0 0 7 0 0 0

14 8 0 0 0 8 0 0 0

18

L-219 L-I._O L-67 L-20

4 5 1 1 1 4 0 0 4 5 2 1 0 6 0 1 1

8 7 0 0 1 4 2 0 2 7 0 0 1 7 1 0 0
i 101 27 00 20 41 63 20 30 02 7 0 0 1
4 1 0 3

14 7 0 0 1 8 0 0 0 8 0 0 0

18 7 0 0 1 5 1 0 2 8 0 0 0
MD 62 MD 81

1 _ - 2 3 f .... 2 5 1 2 0 6 1 1 0 8 0 0 0
4 4 1 1 4 7 1 0 0 1 0 1 6 4 1 3 0
3 3 2 0 6 0 2 0
i MD 8 MD 12 MD 28 MD 49
4 0 0 4 8 0 0 0
108 76 01 11 00 35 00 10 63 23 01 00 64 46 31 11 00
4 0 0 2 1 1 0 6
14 6 0 0 2 7 0 0 1 4 2 0 2 6 1 0 1 7 0 0 1 1 0 1 5
18 5 0 0 3 8 0 0 0

1 6 1 1 0
_" 4 3 2 3 0 7 1 0 0 3 3 2 0

8 7 0 0 1 6 2 0 0 7 I 0 0
i .... R+5_ .... R+ll R+47 __
I0 3 0 0 5 7 1 0 0 6 1 0 1

14 5 1 0 2 6 1 0 1 6 1 0 1

18 2 0 0 6 7 0 0 0

Launch minus "n" number of days.


• Mismlon Day '+n.*'
I Recovery plus "n" number of days.
EXPERIMENT M 13 1. HUMAN VESTIBULAR FUNCTION 97

CDR = Commander In the first mission the Scientist Pilot and Pilot
SPT = Scientist Pilot
PLT = Pilot
demonstrated higher thresholds under weightless
....... _= Preflight conditions than on the ground; moreover, they
_x" = In-flight showed a greater intersessional range in this re-
_'_ _ = Postflight sponse to angular acceleration compared to their
preflight and postflight thresholds of response
Skylab 2 Skylab 2 Skylab 3 Skylab 3 which were similar. These subjects' data reflect
SPT PLT CDR SPT
their subjective comments that the illusion was in
100

8O "" 'c'.i general more difficult for them to perceive in-flight


and in particular in the midrange
tion steps. Both subjects reported
of the accelera-
that at steps 4
6O
through 10 the target often spontaneously ap-

!,o peared to oscillate principally


ward at a frequency
rightward
of 1 to 2 seconds.
and left-
These
o 20
V oscillations were regularly perceived by the Scien-
tist Pilot and sometimes perceived by the Pilot. It
0
is important to note that these oscillations were
o Skylab 3 Skylab 4 Skylab 4 Skylab 4 never observed during ground-based testing pre-
PLT CD R SPT PLT
100 flight or postflight.
In the third mission, the Commander (tested
only twice aloft) and Pilot revealed average re-
sponses that were similar to their preflight and
postflight levels. The Scientist Pilot's performance
<
40 aloft was slightly but not significantly below that
b • ° •
on the ground. All three subjects reported some
20, oscillatory movement aloft but were more aware
of drowsiness during the test aloft than on the
ground.
ll' I II I I1 II I II I I I I1 i II I II II I II I II

0 10 20 0 10 20 0 10 20 0 10 20 The Skylab 4 Scientist Pilot and Pilot of the


Acceleration level, log step third and longest mission showed a tendency to
perceive the illusion less frequently as the mission
FICVnE l l.2-3--A summary of the data in table l l.2-I progressed, whereas the Commander revealed no
shown as "frequency of seeing" curves.
consistent change during or after the mission. The
Scientist Pilot demonstrated recovery to baseline
Skylab 4 Commander when he said, "I close my levels in the first and second postflight trials, 5
eyes and I can . . . and it took me about three and 11 days after recovery, respectively. The
times as long to figure out that I was really rotat- Pilot revealed a reversal in his performance on
ing to the left. I think that had I been rotating to mission day 81, i.e., his performance for the most
the right and been prejudiced I would have prob- part declined as the stimulus increased. This un-
ably seen it very quickly. But it was rather inter- usual response mode persisted in the first test
esting to see that I could prejudice myself and postflight (5 days after recovery) but 6 days
that it made it very difficult for me to figure out thereafter his performance equaled or excelled
the real rotation. It is really best not to think at his preflight scores.
all of rotation in either direction. I might also add
Discussion
that I saw quite a few white flashes--about seven
--while I had the vestibular test goggle on." It was The results show that none of the subjects aloft
interesting to note that prior to unusual perform- consistently improved in their ability to perceive
ance of the SL 4 PLT on mission day 81, ground the oculogyral illusion, whereas four revealed some
control provided feedback information and ques- decrement and the remaining four no consistent
tioned his poor performance. change in this perceptual task. In this discussion
98 BIOMEDICAL RESULTS FROM SKYLAB

we will consider possible reasons for the perform- It is interesting to note that the Skylab 2 Scientist
ance decrements including decreases in canalic- Pilot also reported a type of oscillatory movement
ular sensitivity. of the reticle during observations through the on-
The potential nonvestibular influential factors board telescope. Although acceleration at the step
that were reported by the crewmembers in the 18 level tended to increase target stability, the
first two missions were a spontaneous oscillatory registration of this relatively high stimulus level
illusion and the soporific effect of the test condi- as well as the lesser levels was not as marked in-
tions. During the first mission, the target line of flight. The Skylab 2 Scientist Pilot describes his
the vestibular test goggle when viewed under cer- change in oculogyral illusion perception as: "Even
tain conditions began to oscillate spontaneous!y, in step 18 I felt that the OGI responses were not
principally in the horizontal but sometimes in the marked, that they were being reinforced by seat
vertical direction. Movement occurred mainly of the pants which is pretty definite in step 18,
when the subject was accelerated at midrange and my general feeling is that the OGI response
levels (table 11.2-I). The Skylab 2 Scientist Pilot, is not as clean cut as it is on the ground."
for example, reported: "Remember the left-right, The genesis of the oscillatory movement may be
1-second to 2-second cycling--it was not present related to the drowsiness that was experienced by
in step 1. I noticed it in step 4 and in most of the the astronauts; pendular-type eye movements
responses through step 10 ; and in step 18 I didn't may be a prominent feature of drowsiness just
notice it .... For me, it was always of equal am- short o_ falling asleep. The exclusion of useful
plitude and approximately equal frequency. It was visual cues and normal otolithic and other gravi-
really only noticeable at the lower levels of OGI, receptor inputs, the restriction of active head or
although I don't remember seeing it at level I. You bodily movements, the relatively constant audi-
might consider something in the way of an optical tory inputs and the gentle rotational movements
fatigue or a progressive illusion. Also, it wasn't of the chair evidently constituted a high effective
noticeable at higher levels 10 and 18 when you inducement to sleep and its attendant eye move-
were seeing a genuine OGI." ments.
The Skylab 2 Pilot observed, "I think predomi- The level of inducement, furthermore, seemed
nantly, when I saw this illusion, it was at level 4. I dependent upon the adequacy in terms of quality
think the frequency was essentially unvarying. as well as quantity of an individual's sleep in
However, I had the impression at times and I sur- space. The first mission crew maintained that
mise it's strictly an impression, that instead of their sleep was quite adequate; however, the Sci-
oscillating either side of the datum, it would go entist Pilot who perceived the oscillatory move-
all to one side, to the left, to my left." Although ment of the target more frequently than the Pilot
both astronauts felt that this oscillatory illusion commented, "going through the OGI test, it was
did not interfere with their perception of the very hard to stay awake. If you make your body
oculogyral illusion, the data would indicate other- motionless you just really power down." During
wise. This space flight illusion of movement can- the second mission, drowsiness became a more
not be explained by any physical movement of the prevalent factor with only the occasional appear-
subject or apparatus. Even when the astronauts ance of the oscillatory type of spontaneous illusory
attempted to produce this illusion in space by movement as reported by the Scientist Pilot and
active head movement, they were unsuccessful as Pilot who were tested six times in-flight (the Com-
reported by the Skylab 2 Pilot in a conversation mander was tested only twice during the final 15
with mission control : "And the test you wanted us days of the mission) and showed no appreciable
to run, yes, you can excite a movement of the line changes. Drowsiness often led to sleep for brief
by gradually very gently rocking your face back periods. The reduction in scores of the Scientist
and forth. However, that's not what's causing it. Pilot and Pilot at times could be attributed to
I feel very confident because it just looks different. nonperformance due to sleepiness. For example,
I did not experience the back and forth, left-right the Scientist Pilot observed that, "The PLT noted
oscillations today at any level except 4 and I got it this time and I noted on my run a couple days ago
on--I'd estimate a little more than half of step 4." that you get awful sleepy underneath that set of
EXPERIMENT M 13 1. HUMAN VESTIBULAR FUNCTION 99

goggles and you really tend to doze off. The PLT reversal in slope of his resultant curve on the last
had to give a 'no' response to a couple of questions mission test day and on the first test postflight.
simply because he had forgotten that a response In the second test postflight his perception of the
was due_He didn't know that I had tapped him. I oculogyral illusion was excellent, comparable to
remember having done the same thing on my run." his best performance preflight and far exceeding
The Pilot suggested: "It would be a good idea to his scores made after mission day 12.
schedule OGI in the morning because it's awful
easy to go to sleep with that experiment, difficult Tentative Conclusions
to concentrate especially in the afternoon. You
could even go to sleep real easy in the morning. It's The fact that the performance of all the Skylab
a good sleep-inducing experiment, and it should 3 crewmen and the Skylab 4 Commander was
be done when you're fresh." His suggestion was about the same aloft as on the ground demon-
followed and after mission day 32 testing was strated that they experienced no inhibitory influ-
carried out in the morning rather than the after- ences reducing the effective "sensitivity" of the
noon but no real changes were noted. It is signifi- semicircular canals. In consequence, the small dec-
cant that drowsiness was never experienced by rements in performance manifested by the re-
any of the subjects during either preflight or maining four participants cannot be regarded as
postflight testing. Curiously, although the Skylab "the rule."
3 Scientist Pilot aloft noticed a greater sensitivity The differences in performance between the
to rotation at step 18, his general ability to per- two groups might be explained on the basis of less
ceive the illusion was less. favorable testing conditions aloft or simply rep-
The results obtained in the Skylab 4 mission are resent individual differences.
at once the most important (because of the dura- In any event, the behavior of the oculogyral
tion) and most difficult to explain. The Com- illusion in weightlessness is different from that
mander's performance was much the same aloft as reported for nystagmus measured during para-
on the ground, but the Scientist Pilot's perform- bolic flight. This is of theoretical interest, at least,
ance aloft was lower than on the ground. For as contributing to the evidence that these two re-
yet unexplained reasons, the Pilot showed a curious sponses have different underlying mechanisms.

References
1. GRAYBIEL,A., and D. I. HUPP. The oculogyral illusion. A form of apparent motion
which may be observed following stimulation of the semicircular canals. J. aviat.
Med., 17:3-27, 1946.
2. CLARK, B., and J. D. STEWART. Effects of angular acceleration on man: Thresholds
for the perception of rotation and the oculogyral illusion. Aerospace Med., 40:952-
956, 1969.
3. VAN DISHOECK, H. A. E., A. SPOOR, and P. NIJHOFF. The optogyral illusion and its
relation to the nystagmus of the eyes. Acta Otolaryng., 44:597-607. Stockholm,
1954.
4. VOGELSANG, C. J. The perception of a visual object during stimulation of the vestib-
ular system. Acta Otolaryng., 53:461-469. Stockholm, 1961.
5. WHITESIDE, W. C. D., A. GRAYBIEL, and J. I. NIVEN. Visual illusions of movement.
Brain, 88:193-210, 1965.
6. YUGANOV, YE. M., I. A. SIDEL'NIKOV, A. I. GORSHKOV, and I. I. KAS'YAN. Sensitivity
of the vestibular analyzor and sensory reactions of man during short-term weight-
lessness. Izvestiya AN SSSR, 3:369-375, 1964.
7. YUGANOV, YE. M., and A. I. GORSHKOV. Characteristics of the Functional State of
the Otolithic Apparatus Under Conditions of Variable Weight, pp. 85-89. NASA
TT F-616, 1970.
8. GLENN, J. H. Pilot's flight report. In Results of the First United States Manned
Orbital Space Flight, pp. 119-136. NASA Manned Spacecraft Center, 1962.
100 BIOMEDICAL RESULTS FROM SKYLAB

9. ROMAN,J . A., B. H. WARREN,and A. GRAYBIEL. The function of the semi-circular


canals during weightlessness. Aerospace Med., 34 :1085-1089, 1963.
10. MILLER, E. F., 11, and A. GRAYBIEL. Goggle device for measuring the visually per-
. ceived direction of space. Minerva Otorinolaringol., 22 :177-180, 1972.

3. THE PERCEIVED DIRECTION OF so that it may be pressed firmly against the sub-
INTERNAL AND EXTERNAL SPACE ject’s face without discomfort. The mask section
In Gemini flights V and VI1 an experiment was of the goggle forms the rigid base for:
conducted in which the astronaut‘s task was to Attachment of the target and optical system ;
set a dim line of light (in an otherwise dark Gear mechanisms and scales for adjustment and
field) to a n external horizontal reference. Aloft reading out the positions of the target in the
this reference was a panel horizontal with refer- roll and pitch planes ;
ence to the astronaut’s seat, while on the ground Stabilization of the coupling to the biteboard
the test was conducted with the astronaut secured assembly ; and
in the gravitational upright position. Except for The external cover.
a systematic error in the case of one astronaut the
settings made aloft were as accurate as on the The slit target consists of a single 0.1 mm X
ground. The inference drawn was that relatively 0.55 mm sealed vial of tritium gas (U.S.Radium
meager touch, pressure, and kinesthetic receptor Corporation-Atomic Energy Commission license
cues served as well as the more plentiful non- 09-06979-03) which requires licensing for han-
vestibular and otolithic cues on the ground. It was
these findings that generated the interest to re-
peat the experiment under f a r more favorable
conditions in Skylab missions (ref. 1 ) .
Astronauts
In the Skylab 2 mission it was decided that the
Commander would not participate in the oculo-
gyral illusion or motion sickness susceptibility
tests. It was left t o the Commander to determine
whether and to what extent he would act as a
subject in the space perception tests.
Apparatus
Goggle Device.-Devices for studying the visu-
ally perceived direction of space in the absence
of visual cues have long been in use, but the prin-
ciple underlying such devices is so simple that its
elegance is seldom appreciated. The basic device
is a visual target, usually a line pattern of light
on a dark background, that can be manipulated
to indicate the direction of space yet afford no
clue to its direction.
The so-called vestibular test goggle used in the
Gemini V and VI1 experiment was modified for
the specific purpose of the Skylab mission.
The overall appearance of the goggle is shown
in figure 11.3-1. The inner surface of the goggle FIGURE
11.3-l.---Goggle device showing behavior of the
forms the soft-cushion carrier portion structured target in the pitch and roll planes.
ORIGINAL PAGE IS
OF W R QUALIm

EXPERIMENT M 13 1. HUMAN VESTIBULAR FUNCTION 101


dling. The self-luminous light source has a rela- of a flexible arm that contains readouts for indi-
tively constant level of illumination over a half-life cating the pointer's pitch and roll position with
of 12 years without bulbs, batteries, and wiring reference to the sphere, but not translational
which would require periodic servicing and re- movements. This arrangement allows considerable
placement. High reliability and essentially com- freedom of movement of the device without refer-
plete safety of this light source are assured by ence cues to the rotating litter chair.
a rugged housing qualified to withstand space- I n using the rod-and-sphere device it is not
craft launch forces. The target light is collimated possible to set the rod, say, to the upright in the
by a triplet located near the subject's eye. The frontal plane first, then make the setting in the
position of this triplet can be adjusted toward or saggital plane. Instead, the final setting must be
away from the target with a fine threaded screw reached incrementally, i.e., usually two or three
adjustment to correct for a wide range of spheri- steps. The astronauts did not regard t'nis con-
cal refractive errors of the subject, thereby ensur- straint a significant handicap.
ing a sharp image of the test target for each sub- On the ground the weak magnetic field made it
ject. necessary for the subject to exert pressure to keep
The pitch of the target is adjusted (throughout the rod on the sphere unless the rod was near the
a range of ~ 2 degrees
0 relative to a reference gravitational upright ; the rod-and-sphere device
plane normally at eye level when the subject is was easier to use in weightlessness than on the
upright) by means of a knurled knob (fig, 11.3-1) ground.
that activates a mechanical link to a rack and Chair Device.-The rotating litter chair could
pinion gear. The target's roll position can be be perfectly positioned with regard to the visual
changed by rotating a second knurled knob (fig. upright of the workshop. When tilted forward
11.3-1) linked to a helical gear arrangement 11.01O from the upright there was an inescapable
(36: 1 ratio) ;fine rotary adjustment can be made leftward roll of 4.5O. In the litter mode when the
without limit in the clockwise or countwlockwise rotating litter chair was horizontal there was a
direction. The line pattern target was designed roll of 0 . 9 O leftward; when tilted head upward
with a break at its center, serving as a visual ref- 12.1O the leftward roll was 4.95O.
erence point and a break near one of its ends to Water Immersion Tank.-A small facility was
indicate polarity. The entire target and optical constructed to carry out the space perception tests
system is arbitrarily placed in the right half of underwater. The object was to simulate weightless
the goggle for viewing by the right eye only.
The device weighs less than 1pound and is eas-
ily supported and held firmly against the subject's
face solely by his teeth interfacing with the bite-
board assembly. Dental impression material soft-
ened by heat or more permanent material
fashioned by a molding process is deposited on the
biteboard for custom fitting. One model of the
goggle is provided with scales for direct readouts,
another with potentiometers for continuous write-
outs.
Rod-and-Sphere Device.-Most devices for in-
dicating the upright are confined t o movement in
one plane. The rod-and-sphere device shown in
figure 11.3-2 was fabricated specifically for the
Skylab experiment. The reference sphere is a
15.24 ern (6-in.) diameter, lightweight [336 g
(12 oz)] hollow, metallic sphere that is used in
conjunction with the magnetic pointer. The pointer FIGURE11.3-2.-Rod-and-sphere device with subject ma-
is attached to the rotating litter chair by means nipulating the rod in two typical positions.
102 BIOMEDICAL RESULTS FROM SKYLAB

conditions with regard to touch, pressure, and offsetting it) are obtained both in the upright and
kinesthetic receptor systems but preserve otolith tilted chair positions. The rotating litter chair is
function. finally converted to its litter mode and the same
procedure for measuring the nonvisual perception
Plan of space with the rod/sphere device is conducted
In using the goggle device the subject grasps with the litter horizontal as well as tilted.
the bite piece with his teeth, which causes his
Results
face to come in firm contact (in a repeatable fixed
position) with the goggle surface. He then closes All of the findings (none for water immersion)
his eyes for 60 seconds, opens his eyes, and sets have been plotted in terms of the astronaut's actual
the target in the roll and pitch planes to internal settings. In general, the settings using the goggle
references (the target alined with his longitudi- show a strong tendency to cluster, the settings
nal body axis and its broken tip pointed toward made on the ground overlapping those aloft. Oc-
his head and its center in the "straight-ahead" casionally there is a systematic deviation from the
position). The subject closes his eyes and signals "perfect" score. The plots not only are difficult to
the observer when he has completed this task. The envision in terms of the position of the subject
observer then reads and records (in the onboard but also in terms of the measurements of the er-
log book) the settings, after which he offsets the rors. In consequence, the data is being replotted in
target in some random fashion. This procedure is terms of actual positions the subject indicates
repeated for a total of five times. The subject next with reference to the workshop, and small line
relaxes his bite and moves backward from the drawings will allow the reader immediatel.v to
goggle to observe his position relative to the Sky- grasp the stimulus situation.
lab for a 10-second period. He then reassumes the The plots using the rod-and-sphere device show
test position and sets the target in relationship to considerable scatter except when the chair is up-
the external reference (target alined with the right in the ground-based workshop. Settings
longitudinal axis of the Skylab and its broken tip made aloft show a tendency toward deviations of
pointing "upward," and its center at eye level with a similar nature.
reference to the Skylab floor). The subject then
Acknowledgments
closes his eyes and signals the observer to record
and offset the target. This cycle is repeated until We grasp this first opportunity to name the
five pitch and roll settings have been recorded. men who not only acted as subjects and observers
This entire procedure of internal and external but whose quick minds contributed much informa-
spatial localization is repeated with the chair in tion greatly extending the value of data points:
its tilt positions. Skylab 2: Charles Conrad, Joseph P. Kerwin and
The chair is returned to upright, and the ob- Paul J. Weitz; Skylab 3: Alan L. Bean, Owen K.
server next attaches the magnetic pointer and Garriott and Jack R. Lousma; Skylab 4: Gerald
readout device to the chair. The vestibular test P. Carr, Edward G. Gibson and William R. Pogue.
goggle is removed, and the subject's eyes are In large organizations quick response to change
covered with the blindfold. The subject grasps the in conditions is "against the rule," yet manage-
sphere in his left hand, the magnetic pointer in his ment (notably Richard S. Johnston and Lawrence
right, and attempts to aline the pointer in a man- F. Dietlein) recommended what amounted to
ner analogous to the visual judgments. For the doubling the number of subjects in studying the
internal reference judgments, the pointer is placed susceptibility to motion sickness.
parallel to the apparent long axis of his body with None of the equipment in the workshop failed;
its free end pointing in the direction of his head; even a loss of pressure in the nitrogen blanket
for the external judgments, the pointer is alined around the rotating litter chair motor, for ex-
with the perceived direction of the Skylab longi- ample, would have cancelled the tests described in
tudinal axis and pointed upward. Five internal the first two parts of this report. For elegance in
and external reference settings (each separated workmanship in fabricating the chair and other
by the subject releasing the rod and the observer equipment, we wish to acknowledge the profes-
EXPERIMENT M1 3 1. HUMAN VESTIBULAR FUNCTION 103

sional skill and judgment of Charles M. Blackburn We do wish to mention, however, the critical roles
and his associates at the Johns Hopkins Applied played by the crew surgeons, Charles E. Ross and
Physics Laboratory. Paul Buchanan; the engineers in the Project En-
Our indebtedness also extends to many other gineering Branch, James S. Evans and William J.
persons of good will at the Johnson Space Center Huffstetler; and our chief assistant, Charles H.
and elsewhere, many of whom cannot be named. Diamond, Jr.

Reference
1. GRAYBIEL, A., E. F. MILL_, II, J. BILLINGtIAM, R. WAITE, C. BERRY, and L,. DIETLEIN.
Vestibular experiments in Gemini flights V and VII. Aerospace Med., 38:360-370,
1967.
N77-33792

CHAPTER 12

The Effects of Prolonged Exposure to


Weightlessness on Postural Equilibrium

JERRYL. HOMICK," MILLARD F. RESCHKE, a AND EARL F. MILLER II b

from kinesthetic, pressure, and touch receptors,


Nman
HIS NORMAL
has GRAVITATIONAL
four sources of sensory ENVIRONMENT
information as well as visual and vestibular inputs (refs. 13,
which can be used to maintain postural equilib- 14).
rium: vision, vestibular inputs, kinesthesia, and That exposure to the dramatically altered en-
touch. Of these senses the superiority of vision as vironment encountered during weightless space
a basis of postural stability has been demonstrated flight may affect postural stability has been under
by a number of investigators (refs. 1, 2, 3, 4, 5, investigation by our laboratories beginning with
6, 7, 8). Even when other systems are nonopera- the Apollo 16 mission. Although complete data are
tive, vision can be employed to maintain upright not available from Apollo 17, preflight and post-
posture. On the other hand, provided that the flight testing of the Apollo 16 crewmen indicated
mechanoreceptors are intact, vision is not essen- some decrement in postural equilibrium 3 days
tial as evidenced by the observation that blind following recovery when the crewmen were tested
people have little difficulty in maintaining postural with their eyes closed (ref. 15). Using a meas-
equilibrium (ref. 3). urement procedure referred to as stabilography,
There is also little doubt that functional disturb- investigators in the Soviet Union have reported
ances in the vestibular, kinesthetic, and tactile that the crewmen of the 18-day Soyuz 9 mission
sensory modalities can affect postural stability. manifested difficulty in maintaining a stable ver-
People who have experienced unilateral labyrin- tical posture which did not normalize until 10 days
thine or cerebellar damage will often fall to the after the flight. The greatest disturbances were
side of the lesion (ref. 9). Patients with bilateral measured during an eyes closed test condition
labyrinthine disturbances, on the other hand, fre- (ref. 16).
quently appear to exhibit little disability in main- On the basis of these observations it was hy-
taining a steady posture when standing with feet pothesized that, with prolonged exposure to a
together and eyes closed in the Romberg position weightless environment, those sensory systems,
(ref. 10). When the testing procedure is improved, with the possible exception of vision, necessary
however, and a sharpened Romberg is employed for the maintenance of postural stability, will
(ref. 11), bilateral labyrinthine defects as well as undergo some changes. Further, these changes are
other less dramatic vestibular disturbances do re- most likely originally peripheral, and involve the
sult in postural difficulties that are evident when modification of inputs from the receptors serving
the eyes are closed (ref. 12). These observations kinesthesia, touch, pressure, and otolith function.
suggest that, in a closed loop system, the sensory As exposure is prolonged, habituation responses
basis of postural stability must include inputs occur at a central level in the nervous system which
constitute learning in a ne_v environment. When
• Neuroscience and Behavior Laboratory, NASA John-
son Space Center, Houston, Texas. the environment is again changed from weight-
b Deceased. lessness to one-g reference, ataxia and postural

104
EFFECTS OF EXPOSURE TO WEIGHTLESSNESS ON POSTURAL EQUILIBRIUM 105

instability will be manifested as the result of the for the three trials were summed to obtain the
neural reorganization that has occurred in weight- final score. The choice of the second rail width
lessness. depended upon the crewman’s performance on
The specific objective of this investigation was the initial support width. If his score was greater
to assess the postural equilibrium of the Skylab than or equal to 80 seconds, the next smaller sup-
astronauts following their return to a one-g en- port width was used ; if his score was less than 80
vironment and to suggest possible mechanisms seconds, the next larger support width was used.
involved in any measured changes. Testing on a third rail size was required when both
of the two previous support width scores fell either
Method above or below the 80-second performance level.
Postural equilibrium was tested by a modified Testing with eyes closed followed the same pro-
and shortened version of a standard laboratory cedure except that a larger rail support, 5.72 centi-
method developed by Graybiel and Fregly (ref. meters (2.25 inches) was typically used initially.
11). Metal rails of four widths, 1.90, 3.17, 4.45, Eyes closed testing always followed testing with
and 5.72 centimeters (0.75, 1.25, 1.75, and 2.25 eyes open. The time required to perform the entire
inches), provided the foot support for the crew- test was approximately 18 minutes. All tests were
man during the preflight and postflight tests. In conducted with normal laboratory illumination.
addition, rail widths of 1.27 and 2.54 centimeters Three preflight baseline tests were performed on
(0.5 and 1.0 inches) were available for preflight each of the Skylab 2, 3, and 4 crewmen approxi-
testing only. A tape approximately 10.16 centime- mately 6 months prior to their space flights. These
ters (4.0 inches) wide and 68.5 centimeters (27.0 postural equilibrium tests were part of a com-
inches) long served as a foot-guide alignment when prehensive battery of vestibular tests completed
the crewman was required to stand on the floor. by each of the crewmen at the Naval Aerospace
Each crewman was fitted with military-type shoes Medical Research Laboratory.
for this test, both preflight and postflight to rule Tests following the 28-day Skylab 2 mission
out differences in footwear as a variable in intra- were limited to balancing with eyes open and eyes
subject and intersubject comparisons. closed while standing on the floor only. These tests
The test rails and required body posture are were conducted during the first and second day
illustrated in figure 12-1. Time, which was the
performance measure of balance, began when the
crewman, while standing on the prescribed sup-
port with his feet in a tandem heel-to-toe arrange-
ment, folded his arms. His eyes remained open in
the first test series. In the second series the time
measurement was initiated after the crewman
attained a balanced position and closed his eyes.
During initial preflight testing several practice
trials were allowed on representative rails until
the crewman demonstrated full knowledge of the
test procedure and reasonable confidence in his ap-
proach to this balancing task.
During a test session the initial rail width for
testing with eyes open was typically 3.17 centi-
meters (1.25 inches). Three test trials with a max-
imum required duration of 50 seconds each were
given. If the time limit was reacb.ed in the first
two trials, a third was not performed, and a per-
fect score of 100 seconds was recorded for the
initial support width. If the crewman failed to FIGURE12-1.-Illustration of postural equilibrium test
rails and a subject demonstrating the required test
obtain a perfect score, the two largest time values posture.
106 BIOMEDICAL RESULTS FROM SKYLAB

following splashdown. Postflight tests on the Sky- rium performance typically exhibited by young,
lab 3 Scientist Pilot and Pilot were conducted on healthy aviator-type subjects.
the 2nd, 9th, and 29th day following termina- The limited postflight data collected on the Sky-
tion of their 59-day mission. The Skylab 3 Com- lab 2 crewmen indicated that they all experienced
mander was excluded from postflight testing considerable difficulty with standing on the floor
because of an acute back muscle strain acquired during the eyes closed test condition. They had
on the first day postflight which might have been no trouble, however, in meeting the performance
aggravated by the test procedure and which, in criterion when permitted the use of visual cues.
any event, would have affected his performance In considering the significance of these data, it
on the rails. Postfiight tests on each of the Sky!ab must be remembered that the tests were performed
4 crewmen were conducted on the second, the on a moving ship.
4th, the llth, and the 31st day postflight. The Data obtained preflight and postflight on the
Skylab 4 flight was 84 days in duration. With Skylab 3 Scientist Pilot and Pilot and the Skylab
both of the latter two crews the tests on the second 4 Commander, Scientist Pilot, and Pilot are pre-
day following splashdown were conducted onboard sented in figures 12-2 to 12-6, respectively. In
the recovery ship which was tied to a dock and, these figures eyes open and eyes closed pos-
therefore, provided a stable platform. All sub- tural equilibrium performance on each of the rail
sequent postflight tests were conducted at the sizes used, plus the floor, is plotted as a function
Johnson Space Center. of test day. The baseline data point shown against
which the postflight data are compared is the
Results mean of the preflight data for that condition. The
Postural Equilibrium Tests.--Preflight data standard error of the mean was selected as a de-
obtained on these crewmen indicated that they scriptor of the variance observed in the baseline
were all well within the range of postural equilib- data and is represented by dashed lines. Approxi-

1.90 cm 3.17 cm
0.75 in. 1.25 in. Subject - Skylab 3 Scientist Pi_ot

oo 40 f
0 '
BL
R+I
R+9
R+29
BL
R+I
R+9

R+29
0

BL
R
Eyes open
Eyes closed
Baseline
Recovery

Standard
error of
the mean

4.45 cm 5.72 cm
1.75 in. 2.25 in. Floor

"_

l°°r
8or
60
40
20

0

BL
-
i |

R+I
a

R+9
R+29
| J

R+I
R+9
i J

R+29
BL
R+I
R+9
i

R+29

Test day

FIGURE 12-2.--Postural equilibrium test performance scores for the Skylab 3 Scientist
Pilot. The abscissa for each rail size shown indicates the days on which testing oc-
curred, including a mean baseline (BL) value. The ordinates show total time on the
rails where total time is the sum of the best two of three trials. Data obtained
with eyes open and eyes closed are indicated by closed circles, squares and tri-
anglcs respectively. The dashed lines represent values for the standard error of tile
baseline mean.
EFFECTS OF EXPOSURE TO WEIGHTLESSNESS ON POSTURAL EQUILIBRIUM 107

mately 50 percent of those cases where no variance splashdown. However, a more pronounced decre-
is indicated are the result of having only a single ment in ability to maintain an upright posture was
data point on the rail size in question; otherwise, observed in the eyes closed test condition. This
the standard error of the mean is less than one. change was more evident in the Pilot and is clearly
Visual inspection of figures 12-2 and 12-3 in- demonstrated by the 5.72 centimeter (2.25 inches)
dicates that the Skylab 3 Scientist Pilot and Pilot rail size data seen in figure 12-3. Indeed, without
showed a decrease of approximately the same mag- the aid of vision on the second day after recovery,
nitude in eyes open postural equilibrium perform- the Pilot experienced considerable difficulty even
ance when tested on the second day after when attempting to stand on the floor, a condition

1.90 cm 3.17 cm
Subject - Skylab 3 Pilot
0.75 in. 1.25 in.
& Eyes open
• Eyes closed
6o BL Baseline

N
"80I 40
loor
20
0 _,-Y_Y.."_
....
I
=, , , &,
.....
R Recovery

Standard
error of
BL R+9 BL R+9 ..... the mean
R+I R+29 R+I R+29

4.45 cm 5.72 cm
Floor
1.75 in. 2.25 in.

/
A A

k- 20
40 f
0 i i| i
31L i i
R+9 i BL R+9 i
BL I I
R+9 i
R+I R+29 R+I R+29 R+I R+29

Test day

F[cunE 12-3.--Postural equilibrium test performance scores for the Skylab 3 Pilot. The
parameters are the same as those described in figure 12-2.

1.90 cm 3.17 cm
0.75 in. 1.25 in. Subject - Skylab 4 Commander
100

=. 80
• Eyes closed
E 60

-_ 40
0 Eyes open
20 ......... _ BL
R Recovery
Baseline
b-
0 ...... Standard
BL R+4 R+31 BL R+4 R+31
error of
R+I R+I 1 R+I R+I 1
...... the mean

4.45 cm 5.72 cm
1.75 in. 2.25 in. Floor

m 40 -- ----
100I!
806020 -- ----_--_ I_ _
b- " ' ' I l
0 BL R+4 R+31 BL R+4 R+31 BL R+4 R+31
R+I R+I I R+I R+I I R+I R+I I

Test day

F[CUnE 12-4.--Postural equilibrium test performance scores for the Skylab 4 Com-
mander. The parameters are the same as those described for figure 12-2.
108 BIOMEDICAL RESULTS FROM SKYLAB

he was never confronted with preflight because In contrast to the Skylab 3 crewmen, the Skylab
of his excellent balance on the 4.45 centimeter 4 Commander and Pilot demonstrated no decrease
(1.75 inches) and 5.72 centimeter (2.25 inches) in their postflight eyes open postural equilibrium
rail sizes. Complete recovery to preflight levels of as measured by this procedure (figures 12-4 and
performance did occur in both the eyes open and 12-5)• The did, however, show a very large deficit
eyes closed conditions for both of these crewmen• in ability to balance with eyes closed. In the case
However, the rate of recovery for the Pilot was of the Commander, this postflight change is clearly
apparently slower as evidenced by his relatively indicated on the first day after recovery with the
poor score on the 5.72 centimeter (2.25 inches) 5.72 centimeter 2.25 inches) wide rail. Also, it
_a,,-_:'
v_,--"_^_,,_
ninth day a_vr recovery. can be seen *_-*_,,a_ u_,
_- the first day ,,_ "_*_
_=, recovery

1.90 cm 3.17 cm
0.75 in. 1.25 in. Subject - Skylab 4 Pilot
100
& Eyes open
80
• Eyes closed
_= 60
BL Baseline
'_ 40
20 LI I I I I
R Recovery
0 ...... Standard
BL R+4 R+31 BL R+4 R+31 error of
R+I R+I 1 R+I R+I 1
...... the mean

4.45 cm 5.72 cm
1.75 in. 2.25 in. Floor

• 80
_" 60
",=
4O
o 20 ...........
0 r -_'-'--_-" ' '
BL R+4 R+31 BL R+4 R+31 BL R+4 R+31
R+I R+11 R+I R+11 R+I R+11

Test day

FIGUnE 12-5.--Postural equilibrium test performance scores for the Skylab 4 Pilot. The
parameters are the same as those described for figure ]2-2.

1.90 cm 3.17 cm Subject - Skylab 4 Scientist Pilot


0.75 in. 1.25 in. B Eyes open

_. 80 ............. • Eves closed

60 I'q BE uaselme
-_ 40 ............
20 ...... Standard
I- O/' _ , I B'"Z" "": T--------Z
'B= -- --_ error of
BL R+4 R+31 BL R+4 R+31 ...... the mean
R+I R+I 1 R+I R+I 1
4.45 cm 5.72 cm
1.75 in. 2.25 in. Floor

= 80 •

0 I i I I
BL R+4 R+31 BL R+4 R+31 BL R+4 R+31
R+I R+I 1 R+I R+I 1 R+I . R+I 1

Test day

FIGUnE 12-6._Postural equilibrium test performance scores for the Skylab 4 Scientist
Pilot. The parameters are the same as those described for figure 12-2.
EFFECTS OF EXPOSURE TO WEIGHTLESSNESS ON POSTURAL EQUILIBRIUM 109

he was almost unable to maintain the required stability was the report by all of the crewmen
vertical posture while standing on the floor with that rapid head movements produced a sensation
his eyes closed. Improvement was evident on the of mild vertigo. This sensation could be effectively
4th day after recovery, and the data obtained on controlled by holding the head steady. Several of
the 1 lth day indicates that both of these crewmen the crewmen, including the Skylab 4 Commander
had regained their preflight level of ability on the and Pilot, indicated a particular need to hold their
eyes closed portion of this task. head steady while attempting to balance on the
Data obtained on the Skylab 4 Scientist Pilot are test rails. Any slight head movement, especially
presented in figure 12-6. It can be seen that, like during the eyes closed test condition, would induce
the Skylab 3 crewmen, the Skylab 4 Scientist Pilot the vertigo sensation and cause them to lose bal-
experienced a postflight decrease in ability to ance. The movement-induced vertigo diminished
maintain postural equilibrium in both the eyes gradually and in most cases was gone within 3 to
open and eyes closed test conditions. The magni- 4 days following splashdown; however, the Sky-
tude of change was much greater without vision. lab 4 Pilot reported that he occasionally experi-
On the 4th day after recovery this change was enced mild vertigo with rapid head turns as late
still very evident, but by the llth day this crew- as 11 days after recovery. It is also of interest to
man's ability to balance on the test rails had re- note that on the second and fourth days after re-
turned to baseline proficiency. covery, the Skylab 4 Pilot reported experiencing
Subjective Reports and Observations.--The a "wide dead-band" when attempting to balance
postflight decrease in postural stability demon- on the test rails with his eyes closed. In other
strated by the rail tests are supported by observa- words, he was unable to accurately sense small
tions of and subjective reports by the crewmen. displacements of his head and body.
Although all of the Skylab crewmen were able Because the postflight test intervals were infre-
to walk with minimal or no assistance immediately quent and not at the same times for each crew, the
after exiting the Command Module, they did so time course to complete recovery cannot be clearly
with noticeable difficulty. During this initial post- specified. However, on the basis of observations
flight period on the recovery ship, they tended to and data obtained, it appears that the Skylab
use a wide-stanced shuffling gait with the upper crewmen required up to 10 days to regain their
torso bent slightly forward. With each passing normal postural stability. These results are in
hour back in the one-g environment, they gained close agreement with the Soyuz-9 postflight pos-
confidence and proficiency in their ability to walk tural stability findings reported from the Soviet
about unaided. By the end of the first recovery day Union.
all of the crewmen showed considerably improved
ambulatory performance and by the time they were Discussion
ready to disembark the recovery ship on the sec-
ond day after recovery, they manifested few The results from the present study provide evi-
noticeable signs of ataxia or postural instability. dence that postural stability can be affected by
During the first several days following splash- prolonged periods of exposure to weightlessness.
down, and especially on the first recovery day, all Support for the hypothesis that central neural re-
of the crewmen reported that the simple act of organization occurs in response to environmental
walking required a conscious effort. The Skylab 3 change is obtained when the postflight decrease in
Commander, for example, reported that, when he stability on the rails and the time course for re-
stepped forward, he had a feeling that he was covery is compared with preflight performance.
moving sideways. Also, nearly all of the crewmen That adaptive changes may occur and contribute
reported that they had to be especially careful to disturbances of equilibrium following exposure
when walking around corners because they had a to a weightless environment is reasonable from a
tendency to fall to the outside. This problem was physiological point of view. As one basis of pos-
described by a few of the crewmen as a sensation tural stability, vision can expect to undergo little
of forced lateral movement. change. However, the vestibular apparatus (par-
Related to these subtle disturbances in postural ticularly otolith input), kinesthesia, and touch
110 BIOMEDICAL RESULTS FROM SKYLAB

will be those sensory systems most affected by nesthetic, and touch receptors. These altered out-
exposure to zero-g. puts would then be sent to their corresponding
Subgravity levels can be experienced in para- centers and these in turn relayed to the pattern
bolic flight, free fall, and short jumps. Water im- center, where a copy of the appropriate movement
mersion and sensory deprivation procedures was stored progressively over time. Once an ade-
minimize stimulation of kinesthetic and touch quate memory of the pattern is built up, the pat-
receptor systems without lifting the gravitational tern center would take over movement and
load on the otolith receptors. It is only in space automatic balance control. Further, under control
flight that prolonged periods of weightlessness of peripheral inputs from the otolith, kinesthetic,
ca. oe ac.iewu. During these pe,tlvu_,, _oucn receptors
and ................. rela yi rig" the ac_ua_A-_"-' move-
......
and touch stimulation is reduced and otolith input ment, the center would permit anticipation of the
is considerably modified. Static otolith output can- coming movement. Return to a one-g environ-
not in this latter situation provide information for ment would result in a recurrence of difficulty,
spatial orientation (spacecraft vertical) nor can both in locomotion and postural equilibrium. Ha-
kinesthesia or touch provide reliable sensations bituation to a gravity reference would begin almost
unless the crewman is in contact with a rigid sur- immediately and a new effective pattern in the
face to provide some reference point. pattern center would be established possibly in a
That these sensory systems can habituate to the time proportional to the previous duration of
weightless environment is suggested by the weightless exposure.
increased ability with time for the crewmen to A second mechanism could possibly be responsi-
maneuver with decreasing difficulty. In this regard ble for the changes noted in postural stability. Bio-
physiological evidence has been obtained that sug- stereometrie analysis of body form indicated that
gests adaptation toward the norm in the frog's the crewmen experienced a measurable postflight
otolith system following 4 to 5 days exposure to reduction in body tissue volume, part of which
weightlessness (ref. 17). It is also possible that was muscle tissue (ch. 22). A significant percent-
habituation in weightlessness of the sensory sys- age of the total volume loss noted was in the thighs
tem, basic for postural stability, is similar to the and calves. A postflight decrease in leg strength
changes experienced in other unusual force en- was also measured (ch. 21). In the ease of the
vironments such as prolonged exposure to slowly Skylab 3 crew the average leg strength loss was
rotating rooms and movements encountered on approximately 20 percent. As the present task
ships. required standing on the rails in a sharpened Rom-
If this is the case, then several mechanisms berg position, it is possible that the crewmen
could be proposed to account for the changes oc- were physically incapable of completing the task
curring as a result of exposure to weightlessness. due to disuse atrophy of the major weight bearing
First, a central nervous system "pattern center" muscles.
concept (ref. 18) could be postulated to help un- A third alternative is also possible. Both a
derstand the possible mechanism encountered in hyper Achilles tendon refex and an increased
the habituation process. For example, following gastrocnemis muscle potential were observed
insertion into orbit the crewmen may experience postflight in the Skylab 3 and Skylab 4 crewmen
difficulty in maneuvering and find orientation to be (ch. 15). This hyperactivity could have resulted
a problem. After 4 to 5 days, movement from one in overreaction and overcompensation on the part
area of the vehicle to another would become some- of the crewman, thus making rail performance
what easier. Fine motor control to determine dis- difficult.
placement would be established. Adaptation in the The fourth mechanism that could be responsible
postural mechanicomotor system would have for the degradation of postural stability observed
occurred. postflight in the Skylab crewmen is one which
On the basis of the postulated pattern center, would include as contributing factors all of the
the radical environmental change encountered in possibilities mentioned. Once the pattern center
transitioning from one-g to zero-g would result serving the postural, mechanomotor system has
in vastly different outputs from the otolith, ki- been established in weightlessness and must begin
EFFECTS OF EXPOSURE TO WEIGHTLESSNESS ON POSTURAL EQUILIBRIUM 111

habituation to a one-g reference, increased reflex tion generated in the mechanism responsible for
sensitivity may be only a single aspect of the programing the position center as a result of
process. modified otolith input and a mechanically under-
A second aspect may be that the loss of tissue damped system.
volume would contribute to a reduction in mechan- Our results tend to support this fourth hypoth-
ical damping of leg movements. For example, if esized mechanism. Decreased postural stability
we look at the pattern center serving the postural, was observed in all crewmen when tested post-
mechanomotor system as one in which control flight. Although the larger deficits were obtained
depends on negative feedback (as the muscle when visual cues were not available, there were
spindle control system does), then it is possible for greater changes in postflight equilibrium in the
instability to occur both in locomotion and pos- Skylab 3 crew with vision than there were in the
tural equilibrium. The instability results because Skylab 4 crew. Correspondingly, the Skylab 3
the error signal takes time to generate a correc- crew did not exercise to the same degree in-flight
tive response. This means that, if no compensation as the Skylab 4 crew and, as a result, exhibited
for the error is programed, the corrective signal a greater loss in leg muscle strength and muscle
would arrive at such a time that the leg, in this tissue. This suggests that vision compensated less
case, has already moved on to a new position. A with increasing muscle mass loss.
second correction would be necessary which would These overall findings argue for an environ-
also result in overshooting. To stop this oscillation ment dependent memory store (pattern center)
around the desired point, the limb movement must of frequently repeated sensory inputs that is un-
be damped. Pure mechanical damping is provided der the guidance of a combined otolith, kines-
by the in-series elastic elements in the muscles as thetic, and touch system which registers the ac-
well as the viscosity of muscle tissue and joints tual movement and allows for anticipation and
(ref. 19). More tissue in the leg adds increased compensation of each movement as it occurs.
mechanical damping while less tissue would tend Being environmentally dependent, such a mecha-
to permit underdamped movements. nism could account for the buildup of postural
An alternate way of viewing damping is to sug- responses (such as hyperreflex activity) in zero-g
gest that the reflex control system depends on an that would be inappropriate upon return to a
output determining both position error and the one-g reference. A mechanism of this type could
rate-of-change of muscle length. When the sys- be applied to account for sensory physiological
tem has rate-of-change information available, an- habituation in a variety of situations. In par-
ticipation of the new limb position is predictable ticular, such a mechanism could provide an ade-
and a corrective signal can be initiated to begin quate basis for change when the acquired response
corrective adjustment (ref. 20). The hyperreflex patterns are no longer congruent with the en-
activity observed could be a compensatory reac- vironment.

References

1. CANTRELL, _R. P. Body balance activity and perception. Percept. Mot. Skills., 17:431-
437, 1963.
2. CLARK, B., and A. GRAYBIEL. Perception of the postural vertical following pro-
longed body tilt in normals and subjects with labyrinthine defects. Acta Oto-
laryngol., 58:143-148, 1964.
3. EDWARDS, A. S. Body sway and vision. J. Exp. Psychol., 36:526-535, 1946.
4. EDWARDS, A. S. Factors tending to decrease the steadiness of the body at rest.
Amer. J. Psychol., 56:599-602, 1943.
5. PASSEY, G. E. The perception of the vertical: IV. Adjustment to the vertical with
normal and tilted frames of reference. J. Exp. Psychol., 40:738-745, 1950.
6. WAPNF_, S., and H. A. WITKIN. The role of visual factors in the maintenance of
body-balance. Amer. J. Psychol., 63:385-408, 1950.
112 BIOMEDICAL RESULTS FROM SKYLAB

7. WEISSMAN, S., and E. DZENDOLET. Effects of visual cues on the standing body sway
of males and females. Pe_'cept. Mot. Skills., 34:951-959, 1972.
8. WITKIN, H. A., and S. WAPNER. Visual factors in the maintenance of upright pos-
ture. Amer. J. Psychol., 63:31-50, 1950.
9. HALPERN, L. Biological significance of head posture in unilateral disequilibrium.
Arch. Neurol. Psychiat., 72:160-168. Chicago, 1954.
10. BIRREN, J'. E. Static equilibrium and vestibular function. J. Exp. Psychol., 35:127-
133, 1945.
11. GRAYBIEL, A., and A. R. FREGLY. A new quantitative ataxia test battery. Acta
Otolaryngol., 61:292-312, 1966.
12. FREGLY, A. R., and A. GRAYBIEL. Labyrinthine defects as shown by ataxia and
caloric tes_. Acta Oto!a_jngo!., 69:216-222, 1970.
13. GRAYBIEL, A. Otolith function and human performance. Adv. Oto-Rhino-Laryngol.,
20:485-519, 1973.
14. HOWARD, I. P., and W. B. TEMPLETON. Human Spatial Orientation. WILEY and
SONS, New York, 1966.
15. HOMICK, J. L., and E. F. MILLF_. Apollo flight crew vestibular assessment. In Bio-
medical Results of Apollo. NASA SP-368, 1975.
16. KAKURIN, L. I. Medical Research Performed on the Flight Program of the Soyuz-
type Spacecraft. Academy of Sciences of the USSR and Ministry of Health of
the USSR, Moscow, 1971. (Unpublished manuscript).
17. GUALTIERATTI, T. Orbiting Frog Otolith Experiment: Final Report, 353 pp. NASA
CR-62084, 1972.
18. GROEN, J. J. Problems of the semicircular canal from a mechanicophysiological point
of view. Acta Otolaryngol., Suppl. 163, pp. 59-67, 1961.
19. ROBERTS, T. D. M. Rhythmic excitation of a stretch reflex, revealing (a) hysteresis
and (b) a difference between the responses to pulling and to stretching. Quart. J.
Exp. Physiol., 48:328-345, 1963.
20. PARTRIDGE, L. D., and G. H. GLASER. Adaptation in regulation of movement and
posture. A study of stretch responses in spastic animals. J. Neurophysiol., 23:257-
268, 1960.
N77-33793
CHAPTER 13

Experiment M133. Sleep Monitoring on Skylab

JAMES D. FROST, JR., a WILLIAM H. SI-IUMATE, b JOSEPH G. SALAMY, e AND


CLETIS R. BOOHER b

T HAS LONG BEEN RECOGNIZED that sleep de- hardware, onboard analysis components, and a
privation is associated with degradation of capability for real-time telemetry.
performance, the amount or severity of the per- Onboard equipment accomplished automatic
formance decrement generally increasing in pro- analysis of the EEG, electro-oculogram (EOG),
portion to the length of the sleep loss (ref. 1). and head-motion signals. The system's output,
Since crewmembers are expected to perform at consisting of sleep-stage information, was tele-
a high level throughout a mission, their ability metered in near-real time to Mission Control,
to obtain sufficient sleep becomes an important where a profile of sleep state versus time was ac-
variable in terms of overall mission planning and cumulated. The analog signals (EEG, EOG, and
scheduling of daily work-rest periods. head motion) were also preserved by onboard
The United States' first attempt to record the magnetic-tape recorders, thus allowing a more
electroencephalogram (EEG) during space flight detailed postflight analysis. A description of the
was carried out during the Gemini 7 mission in methodology and the hardware for this experi-
1965 (refs. 2, 3, 4, 5). Technical difficulties asso- ment is described in appendix A.I.k and in refer-
ciated with electrode attachment limited record- ences 6 through 10.
ing to slightly under 55 hours. However, two Experimental Design.--One crewmember par-
sleep periods were observed, and, while the first ticipated in the sleep monitoring activities during
was found to be inadequate in terms of duration each Skylab flight. Baseline data were obtained
and quality, the second was considered to be nor- on the participating subjects before flight during
mal. Postflight examination of the recorded EEG three consecutive nights of sleep monitoring, us-
showed no pathological changes or definite altera- ing portable apparatus functionally identical to
tions attributable to weightlessness. The limited the onboard hardware. The astronaut studied
nature of this recording precluded an adequate during the 28-day mission was recorded in his
analysis of sleep characteristics during long-term own home 2 months prior to launch, while the
space flight; consequently, the purpose of the subjects of the 59- and 84-day missions were
Skylab M133 sleep monitoring experiment was monitored in the preflight quarantine facility 2
to obtain the first truly objective evaluation of weeks before their respective launches. In addi-
man's ability to sleep during extended space travel. tion, a standard clinical electroencephalogram
was performed on each subiect prior to the flight
Methods to permit precise electroencephalographic ampli-
The complete sleep-analysis system designed tude determinations for calibration of the flight
for this experiment included data-acquisition hardware.
Monitoring during flight was accomplished
during 12 selected nights of the 28-day mission
• Baylor College of Medicine, Houston, Texas.
(nights 5, 6, 7, 10, 11, 15, 17, 19, 21, 24, 25, and
b NASA Lyndon B. Johnson Space Center, Houston,
Texas.
26), during 20 nights of the 59-day mission
Technology Inc., Houston, Texas. (nights 7, 8, 9. 12, 15, 18, 21, 24, 27, 29, 33, 36, 39,

113
114 BIOMEDICAL RESULTS FROM SKYLAB

42, 45, 48, 52, 55, 56, and 57), and during 18 nights, the results of onboard automatic analysis
nights of the 84-day flight (nights 3, 4, 10, 14, 19, have been utilized after application of certain cor-
24, 29, 34, 40, 45, 50, 55, 60, 72, 77, 80, 81, and 82). rective factors based upon past performance of
Operational factors associated with the activa- the system (analysis type MA) and, in the case
tion and function of various spacecraft systems of the 59-day mission, upon correlation of the re-
prevented recordings during the initial period of sults during flight with those of visual analysis
each flight. for the nights on which both types of information
Crew bedtime was typically at 2200 hours c.s.t., were available (analysis type MCA).
and the scheduled sleep period terminated at 0600 Sleep Latency.---The amount of elapsed time
hours c.s.t., although occasional deviations from from the actual onset of the rest period until the
this schedule were necessitated by work require- first appearance of stage 2 sleep is defined as sleep
ments not associated with the sleep monitoring latency. Sleep-latency characteristics observed
experiment. During the last week of the 28- and during the three Skylab missions are summarized
59-day missions, sleep schedules were adjusted in tables 13-I, 13-II, and 13-III. Average in-flight,
forward by a total of 4 hours; i.e., typical bed- preflight, and postflight figures for this para-
time became 1800 hours c.s.t. An adjustment of meter are indicated in the tables. Sleep latency
2 hours was made on days 20 and 22 of the 28-day varied considerably during the 28-day mission
mission, and there was a similar change of 2 (table 13-I), ranging from a low value of 3.6
hours on days 51 and 53 of the 59-day mission. minutes on day 21 to a maximum of 45 minutes
During the 84-day mission, schedule alterations on day 10. Day 19 was, however, the only in-
were made during the last 3 days only, and con- stance in which the latency exceeded the preflight
sequently only 1 day (day 82) of sleep monitor- values, and the average value of 18 minutes, in
ing was affected. On this day, the bedtime was the flight phase, actually represents a decrease of
advanced approximately 2 hours (to approxi- 20 minutes as compared to the preflight average
mately 2000 hours c.s.t.), and the subject was of 37.8 minutes. Postflight values were all rela-
permitted a 10-hour total rest time, i.e., the time tively low but well within the in-flight range.
of awakening remained approximately 0600 Statistically, the in-flight and postflight latencies
hours c.s.t. These scheduled alterations were ne- were less than the preflight values (P<0.01).
cessitated by the activities associated with splash- No statistically significant changes in sleep
down and recovery operations, which required latency were noted during the 59-day mission
early awakening on the final day of the mission. (table 13-II) although on several days the values
Upon return to Earth, postflight baseline stud- were somewhat above the preflight average of 12
ies were performed on each sleep-monitoring par- minutes. This parameter ranged from a low of
ticipant. After the 28-day mission, recordings 4 minutes on day 21 to a maximum of 24 minutes
were done on nights 4, 6, 8, and in the case of the on day 45. A cyclic fluctuation of sleep latency
59-day mission, on the second, fourth, and sixth was suggested, with maxima near days 10, 29, 45,
nights following splashdown. Following the 84- and 52. The average value (12.6 minutes) for the
day flight, recordings were made on the first, sec- flight phase, however, was almost exactly the
ond, and fifth nights. same as the preflight value. The postflight la-
Results.--The final results, presented in tables tencies, averaging 9.6 minutes, were only slightly
13-I, 13-II, and 13-III, and discussed below, rep- less than either the preflight or in-flight measure-
resent the best available estimates of the various ments.
sleep parameters. The results are, when possible, Sleep latency during the 84-day mission aver-
those obtained by visual analysis (analysis type aged almost the same in-flight (15.6 minutes)
V) of the tape-recorded EEG, EOG and head- as preflight (16.2 minutes) but dropped to an
motion signals, since this method is considered average of 7.8 minutes postflight (table 13-III).
the most reliable and the least influenced by var- Although the averages do not reflect a significant
ious artifactual components that may have been change, a preponderance of longer latencies oc-
present. In the instances where this was not pos- curred in the first half of the mission with a de-
sible due to loss of recorded data on several cline as the flight progressed. The average value
EXPERIMENT M133. SLEEP MONITORING ON SKYLAB 115

TABLE 13-I.--Data From All-Night Steep Profiles: 28-Day Mission

Preflight Avg. In-flight Avg. Postflight Avg.

Mission Day -60 -59 -58 5 6 10 15 17 19 21 24 26 +3 +5 +7


Analysis Type V 1 V V V V MA u MA MA MA MA MA MA V V V
Total Rest Time (h) 7.3 7.3 8.7 7.8 6.6 6.3 7.7 7.4 5.6 7.7 6.5 8.0 6.0 6.86 9.3 9.0 8.5 8.9
Total Sleep Time (h) 6.5 6.5 7.7 6.9 6.1 6.4 5.3 7.0 5.2 6.6 6.2 7.2 5.4 6.04 9.0 8.5 8.0 8.5
Total Awake Time (h) 0.74 0.81 0.96 0.34 9.31 0.85 2.43 0.45 0,47 0.81 0.25 0.67 0.26 0.72 0.26 0.45 0.44 0.38
Sleep Latency (min) 0.46 0,70 0.73 0.63 0.35 0.33 0.28 0.35 0.18 0.76 0.06 0.10 0.30 0.30 0.17 0.2'4 0.16 0.19
Stage 1 (percent) 7.4 4.3 4.2 5.3 6,3 9,5 9.8 8.3 7.7 1.1 5.4 4.4 0.6 5.95 4.0 6.5 4.8 5.1
Stage 2 (percent) 60.3 49.6 54.5 54.8 60.2 56,4 43.4 56.4 26.7 50.9 43.8 28.9 24.0 43.4 58.5 53.8 57.4 56.6
Stage 3 (percent) 12.8 17.9 13.8 14.8 18.3 14.6 1O.0 12.6 8.8 13.1 11.2 28.0 27.8 16.0 11.8 11.1 13.7 12.2
Stage 4 (percent) 2.9 3.4 2.4 2.9 4.6 0.8 12.6 17.1 14.9 14.5 16.5 27.7 41.6 16.7 1.0 1.0 1.3 1.1
Stage Rent (percent) 16.6 24.8 25.1 22.2 10,1 18.6 24.1 5.5 41.9 20.4 23.2 11.0 5.9 17.9 24.7 27.5 22.8 25.0
Rein Latency 1.24 1.24 1.91 1.46 2.31 1.66 1.98 0.93 1.18 1.11 1.07
No. of Awakenings 19 16 24 19.7 10 14 12 20 20 26 22

1 V, Visual analysis of return tape data.


s MA, Modified automatic analysis.

TABLE 13-II.--Data From Al_Night Sleep Profiles: 59-Day Mission

Preflight Avg. In-flight

Mission Day -15 -14 -13 7 8 9 12 15 18 21 24 27 29 33


Analysis Type V 1 V V V V V V V V V V V V V V
Total Rest Time (h) 7.7 8.4 6.5 7.5 6.90 6.59 8.23 7.14 7.32 7.05 6.95 7.27 7.87 8.90 7.19
Total Sleep Time (h) 6.4 7.6 5.2 6.4 5.95 6.08 6.94 6.24 6.86 5.75 5.47 6.50 7.03 6.96 6.46
Total Awake Time (h) 1.3 0.8 1.3 1.1 0.95 0.51 1.28 0.90 0.46 1.30 1.49 0.77 0.87 1.94 0.73
Sleep Latency (min) 0.3 0.09 0.2 0.2 0.21 0.24 0.32 0.32 0.13 0.15 0.06 0.15 0.26 0.36 0.19
Stage 1 (percent) 8.3 7.6 10.6 8.8 7.5 5.9 11.2 10.6 8.7 11.9 11.6 9.5 11.3 13.5 4.3
Stage 2 (percent) 57.3 58.3 53.3 56.3 59.5 57.4 63.2 60.4 60.7 57.8 49.2 62.4 63.6 56.6 60.8
Stage 3 (percent) 18.0 16.4 17.7 17.4 19.1 13.5 13.8 17.2 18.6 15.8 24.6 13.9 15.1 20.0 19.1
Stage 4 (percent) 3.1 4.9 0.3 2.8 1.8 1.9 0.8 1.6 1.5 1.0 3.1 1.3 0.8 1.3 1.1
Stage Rem (percent) 13.2 12.7 18.2 14.7 12.1 21.3 11.0 10.2 10.7 13.4 11.5 13.0 9.2 8.6 14.7
Rein Latency 1.6 2.2 1.8 1.87 1.5 1.8 2.3 2.6 2.2 2.1 1.6 2.2 2.3 2.9 1.6
No. of Awakenings 37 51 34 40.7 39 32 70 52 62 43 21 51 44 25 8

In-flight Avg. Postflight Avg.

Mission Day 36 39 42 45 48 52 55 56 57 +i +3 +5
M M M M M M M M
Analysis Type V Cs C C C C C C C V V V
A A A A A A A A
Total Rest Time (h) 7.38 7.21 7.23 7.55 7.68 6.82 6.78 7.32 6.61 7.32 7.09 8.44 7.77
Total Sleep Time (h) 6.99 6.16 6.47 6.14 5.04 6.48 6.44 6.31 5.77 7.36 6.58
Total Awake Time (h) 0.38 1.07 1.08 1.54 1.78 0.84 0.17 1.00 1.32 1.06 1.19
Sleep Latency (min) 0.12 0.14 0.37 0.12 0.36 0.10 0.16 0.17 0.21 0.08 0.15 0.24 0.16
Stage 1 (percent) 5.0 7.5 9.4 10.5 7.3 6.4 8.8 8.9 10.4 9.9 10.2
Stage 2 (percent) 59.1 61.0 60.5 59.6 60.9 61.0 60.1 59.7 57.1 58.4 57.8
Stage 3 (percent) 19.4 15.4 17.9 16.2 16.6 17.4 21.1 17.5 12.0 8.2 10.1
Stage 4 (percent) 1.4 1.3 1.3 1.3 1.3 1.3 1.3 1.4 0.4 0.4 0.4
Stage Rem (percent) 15.1 11.8 13.2 10.8 8.5 10.1 12.1 20.1 23.0 21.6
Rem Latency 1.6 2.0 2.05 0.8 1.1 0.7 0.87
No. of Awakenings 25 39.3 26 31 28.5

1 V, visual analysis of return tape data.


MCA, Modified automatic analysis further enhanced by correlation and regression analysis.
116 BIOMEDICAL RESULTS FROM SKYLAB

TABLE 13-III.--Data From All-Night Sleep Profiles: 84-Day Mission

Preflight Avg. In-flight

Mission Day -13 -12 -11 3 4 10 14 19 24 29 34 40 45


Analysis Type V 1 V V V V V V V V V V V V
Total Rest Time (h) 7.43 8.11 8.64 8.06 6.51 6.82 6.40 7.30 7.28 9.78 6.92 8.33 7.67 6.49
Total Sleep Time (h) 6.59 7.43 7.85 7.29 5.90 4.88 6.00 6.65 5.93 9.37 6.26 6.83 7.49 6.16
Total Awake Time (h) 0.84 0.68 0.78 0.77 0.61 1.94 0.39 0.65 1.35 0.40 0.66 1.50 0.18 0.33
Sleep Latency (rain) 0.16 0.55 0.10 0.27 0.26 0.82 0.33 0.53 0.26 0.18 0.59 0.20 0.04 0.24
Stage 1 (percent) 10.6 7.8 8.2 8.9 4.9 13.3 5.7 8.6 6.4 6.8 10.4 8.8 4.0 4.9
Stage 2 (percent) 59.5 54.1 62.0 58.5 57.3 50.2 58.4 61.4 50.8 56.1 54.3 50.9 65.5 65.0
Stage 3 (percent) 3.7 11.7 5.9 7.1 13.0 10.6 6.4 10.3 12.2 5.4 12.2 13.5 4.6 7.6
Stage 4 (percent) 0.0 0.4 0.1 0.2 1.2 0.5 0.2 0.6 1.3 0.1 1.6 1.5 0.1 0.4
Stage Rein (percent) 26.2 26.0 23.3 25.3 23.6 25.4 29.3 19.2 29.4 31.6 21.4 25.2 25.7 22.1
Rem Latency 0.96 2.45 1.01 1.47 1.24 0.12 0.79 0.95 1.15 1.03 1.19 2.22 1.11 1.08
No. of Awakenings 20 21 21 20.7 10 8 15 15 13 20 12 16 14 6

In-flight Avg. Postflight Avg.

Mission Day 50 55 60 72 77 80 81 82 +0 +1 +5
Analysis Type V V V V V V V V V V V
Total Rest Time (h) 8.65 6.73 6.69 8.60 7.32 7.21 9.82 7.56 8.67 6.25 8.09 7.67
Total Sleep Time (h) 8.39 6.43 6.29 7.38 5.43 5.58 8.80 6.69 7.69 4.50 7.40 6.53
Total Awake Time (h) 0.26 0.31 0.39 1.22 1.90 1.64 1.01 0.87 0.98 0.78 0.69 0.82
Sleep Latency (rain) 0.08 0.14 0.19 0.09 0.27 0.11 0.22 0.12 0.26 0.04 0.13 0.23 0.13
Stage 1 (percent) 5.3 4.6 5.0 3.4 6.9 7.8 6.2 6.76 14.2 7.0 7.0 9.4
Stage 2 (percent) 53.8 61.6 66.8 61.8 60.7 58.0 62.5 58.5 71.5 71.1 55.8 66.1
Stage 3 (percent) 9.2 9.5 3.6 3.3 11.0 7.3 10.0 8.8 2.2 3.3 2.5 2.7
Stage 4 (percent) 0.2 0.5 0.04 0.0 0.5 0.1 0.3 0.5 0.0 0.1 0.04 0.05
Stage Rein (percent) 31.6 23.8 24.5 29.5 20.9 26.8 20.9 25.3 12.1 18.6 3.46 2.18
Rem Latency 1.49 0.84 2.55 1.23 1.13 1.17 1.01 3.34 1.31 2.68 0.79 0.90 1.46
No. of Awakenings 22 6 6 8 12 11 10 12 21 11 24 18.7

1V, Visual analysis of return tape data.

for the first half (days 3 through 40) was 21.4 cated in table 13-I, the in-flight average of 6.0
minutes, while that for the latter half (days 45 hours is almost 1 hour less than the preflight
through 82) was 9.7 minutes, a statistically sig- value of 6.9 hours and more than 2 hours less
nificant difference (P<0.05). than the postflight average (8.5 hours). This de-
In general, then, there was no evidence of dif- crease in sleep time, however, was due not to an
ficulty in falling asleep in either the 28- or 59-day unusual amount of time spent in the awake state
mission, while in the 84-day mission, values some- but instead to a reduction in the total rest-period
what above baseline were seen in the first half of time itself. The subject thus slept quite well on
the mission but declined to normal or below nor- most nights while he was in bed; however, he did
mal in the final portion. not spend as much time in bed as he did during
Total Sleep Time.--A commonly used measure studies either before or after the mission.
of sleep adequacy is the total sleep time obtained The postflight average value for total rest-
in a given sleep period, i.e., total rest-period time period time (8.9 hours) was significantly higher
minus total time spent awake. It is apparent that than the in-flight average (P<0.01) but did not
in the 28-day mission, there was a reduction in differ significantly from the preflight value.
total sleep time throughout the flight phase pe- No significant changes in the total sleep/total
riod as compared to the preflight and postflight rest characteristics were obtained during the 59-
studies. Postflight, total sleep time was signifi- day mission. The total rest time, which averaged
cantly greater than the preflight and in-flight 7.3 hours in-flight (table 13-II), was only slightly
values (P_0.05 and 0.01, respectively). As indi- lower than either the preflight average of 7.5
EXPERIMENT M133. SLEEP MONITORING ON SKYLAB 117

hours or the postflight values of 7.8 hours. In recording night. Average percent figures for the
terms of total sleep time, although there was con- various stages in the preflight, in-flight, and post-
siderable fluctuation, only 1 day (52) was below flight periods are listed in tables 13-I, 13-II, and
the range established during the preflight series, 13-III.
and the subject obtained in excess of 5 hours' If the average values are considered, stages 1,
sleep on all other nights. The in-flight average 2, 3, and REM were not significantly altered dur-
value of 6.3 hours (table 13-II) is nearly the ing the in-flight period of the 28-day mission.
same as the preflight average (6.4 hours) and Stage 1 occupied 5.3 percent of the total sleep
slightly lower than the postflight results (aver- time preflight and averaged 6.0 percent in-flight
age, 6.6 hours). and 5.1 percent postflight. The day-to-day in-
A wide range of variation in the total rest and flight characteristics show a considerable fluctua-
total sleep times was seen during the 84-day mis- tion in stage 1 percent, with a tendency toward
sion. Total rest time ranged from a minimum of slightly decreased values in the latter portions
6.4 hours on day 10 to a maximum of 9.8 hours of the flight (days 19 through 26).
on days 24 and 82. This parameter averaged 8.06 Stage 3, averaging 14.8 percent in the preflight
hours preflight, dropped by 30 minutes to 7.56 period, rose slightly to an average of 16.0 percent
hours in-flight, and then rose to 7.67 hours post- in-flight and dropped to 12.2 percent postflight.
flight; but these variations were not statistically The small increase in the stage 3 percent average
significant. Although most of the in-flight period was largely a result of moderate increases in this
was marked by considerable variation from one stage on days 24 and 26 at the end of the mission.
recording session to the next, there was a con- Stage REM decreased only slightly from a 22.2
sistently lowered total rest time during the obser- percent preflight average to 17.9 percent in-flight,
vations of the first 19 days. The five values of although again there was considerable variation
this period averaged 6.86 hours, or 1.2 hours throughout the flight, with some tendency toward
below the preflight average. a more marked decrease near the end of the mis-
Total sleep time tended to parallel total rest sion. The postflight stage REM average (25.0
time, and thus long periods of time spent awake percent) was somewhat higher than either the
during the night were, in this mission as in the preflight or in-flight values, but it did not attain
others, rare. Sleep time ranged from a low of 4.88 statistical significance.
hours on day 4 to a high of 9.37 hours on day 24. Fairly clear-cut changes were seen in stage 2
The in-flight average value of 6.69 hours is about and stage 4 percentages. In both cases, the most
36 minutes below the preflight average of 7.29 obvious alterations were seen in the last days of
hours, but it is approximately 10 minutes higher the flight. Stage 2 dropped from an average of
than the postflight result of 6.53 hours. As in the 54.8 percent preflight to 43.4 percent in-flight,
case of total rest time, although the overall aver- returning to 56.6 percent postflight. These dif-
ages were not significantly altered, total sleep ferences, however, were not statistically signifi-
time was considerably lower during the first 19- cant. Similarly, stage 4 rose from 2.9 percent
day period. During this time, the average value preflight to 16.7 percent in-flight, then dropped
was 5.87 hours, or 1.42 hours below the preflight significantly (P_0.05) postflight to 1.1 percent.
average. Thus, the 28-day mission was characterized by
It is of interest that, while the initial 19-day increased percentages of stages 3 and 4 and cor-
period was characterized by a reduced time in bed responding decreases of stages REM, 1, and 2,
and correspondingly reduced total rest time, it with the alterations confined primarily to the last
was also marked by a higher value for total few days of the flight.
awake time (0.99 hours average) compared to Average values of sleep-stage features for the
either the preflight average (0.77 hours) or the 59-day mission are tabulated in table 13-II. Stage
overall in-flight average (0.87 hours). 1, averaging 8.8 percent preflight, showed con-
Sleep-Stage Characteristics.--Sleep-stage char- siderable variation in-flight but averaged almost
acteristics for the three missions are expressed the same (8.9 percent). The postflight average
as percentages of the total sleep time for each value of 10.2 percent was only slightly above the
118 BIOMEDICAL RESULTS FROM SKYLAB

in-flight result. Stage 2 remained fairly consistent percent. Stage REM percent averaged 25.3 per-
throughout (preflight, 56.3 percent; in-flight, 59.7 cent preflight, and the in-flight average remained
percent; postflight, 57.8 percent), although there at 25.3 percent. There was considerable varia-
was a decrease during the final days of the flight tion in this parameter over the course of the mis-
(days 56 and 57). Thus, neither stage 1 nor stage sion, however, but no definite trends were ob-
2 changed significantly. Stage 3 was similar in- served. Although the postflight average of 21.8
flight (17.5 percent) and preflight (17.4 percent) percent was slightly lower than either the pre-
and also exhibited a change near the termination flight or in-flight average value, it is obvious that
of the flight, tending to increase slightly. The this parameter was not stable in the postflight
...... _.,_ average of 10 1 ...... _ however, •.... •_-_ The value _ 1_ 1 n_r,_n_ on the first host-
significantly lower (P<0.01) than either the pre- flight night is substantially lower than any of the
flight or in-flight values. This subject showed preflight or in-flight values for this characteris-
very little stage 4 sleep in his preflight study (2.8 tic. On the other hand, the value of 34.6 percent
percent), and this parameter decreased signifi- seen on the sixth postflight night is considerably
cantly (P<0.05) in-flight (1.4 percent) and higher than any of the values seen preflight or
postflight (0.4 percent) (P<0.05). Stage REM in-flight.
showed the greatest alteration, dropping from REM Latency.--REM latency is defined as the
14.7 percent during the preflight baseline series elapsed time from sleep onset, i.e., the first ap-
to 12.1 percent in-flight and then rising signifi- pearance of stage 2 sleep until the onset of the
cantly (P<0.01) to 21.6 percent postflight. This first stage REM period of the night. Because of
postflight increase in REM was also significantly the relative unreliability of this measurement
greater than the preflight value (P<0.05). The when derived from the results of _utomatic analy-
REM decrease seen in-flight was most prominent sis, only the values obtained from visual analysis
in the final phase of the study (days 52, 56, and have been reported below. Compared to preflight
57). values, this measure was shortened during the
Average values of sleep-stage characteristics postflight period of the 28- and 59-day missions.
for the 84-day flight are tabulated in table 13- During the 28-day mission, the REM latency
III. Stage 1, averaging 8.9 percent preflight, averaged 1.5 hours preflight and 1.1 hours post-
dropped in-flight to 6.8 percent, then rose post- flight, or a decrease of 24 minutes. Although sub-
flight to 9.4 percent, a value slightly higher than stantial, this decrease was not statistically
the preflight average. There were no clear-cut significant. The phenomenon was more apparent
trends discernible over the in-flight course of the during the 59-day mission. In the preflight base-
mission. The stage 2 values were relatively con- line period, the values ranged from 1.6 to 2.2
sistent during the in-flight period, and the aver- hours, with an average latency of 1.9 hours. The
age value of 58.5 percent was identical to the in-flight values showed considerable fluctuation,
preflight average. Postflight stage 2 showed a but the average of 2.1 hours was not significantly
small increase, averaging 66.1 percent for the different compared to the preflight results. In the
3 days. The first two postflight days were sig- postflight period, however, the latency dropped
nificantly higher than any of the preflight or in- to 0.9 hours, which represented a decrease of 1
flight values. Stage 3 was not significantly hour below the preflight findings. This postflight
different in-flight (8.8 percent) as compared to REM latency was significantly (P<0.01) less
the preflight value (7.1 percent). Postflight, how- than both preflight and in-flight values.
ever, this parameter fell to an average of 2.7 REM latencies during the 84-day mission
percent with all three values falling well below showed little change in the in-flight period com-
the preflight and in-flight averages (P<0.01). pared to either preflight or postflight studies.
This subject showed very little stage 4 preflight, The in-flight average value of 1.31 hours is not
averaging only 0.2 percent, and maintained a low significantly different from the 1.47 hours figure
level throughout the flight, with the in-flight aver- seen preflight, while the value of 1.46 hours seen
age at 0.5 percent. There was a further reduction postflight is almost identical to the preflight re-
postflight, with the average value less than 0.1 sult. It is worthy of note that the first postflight
EXPERIMENT
M133.SLEEPMONITORING
ONSKYLAB 119
night exhibited a relatively long REiK latency, held after each mission. During the 59- and 84-
while the secondandthird postflightnights were day missions, sleep logs were kept by all three
markedby muchshorter periods. crewmen, in which they recorded their estimates
Number of Awakenings.--The number of awak- of the quantity and quality of each night of sleep.
enings per night was calculated for the data based Data gathered from these sources are summar-
upon human visual analysis only. ized below for each mission. Although the M133
The 28-day flight was characterized in the pre- Sleep Monitoring experiment was performed by
flight period by an average of 19.7 awakenings the Scientist Pilot only, subjective observations
per night, with a range of 16 to 24. Postflight, made by all three crewmen are included.
the average was 22, with a range of 20 to 26. Al- 28-Day Mission.--Subjective sleep logs were
though only 2 in-flight nights are available for not maintained during this mission as they were
comparison, in both instances the number of during the 59- and 84-day flights. In general, the
awakenings was below the preflight and postflight crewmembers felt that sleep was adequate, and
levels. no particular problems of a long-term nature
The number of awakenings during the preflight were reported. All three astronauts felt that they
baseline series for the 59-day mission ranged slept less in-flight than they had been accustomed
from 34 to 51, with an average of 40.7. In-flight, to on the ground, but they did not feel that the
a greater range was seen, extending from a low reduction in time was detrimental. In fact, they
of 8 on day 33 to a high of 70 on day 9, with did not feel that they required more sleep than
an average of 39.3. Postflight, the average num- they actually obtained. The extra time was uti-
ber of awakenings dropped to 28.5, with a range lized for reading or other personal recreation,
of 26 to 31. The number of arousals seen during and the 8-hour total rest period was felt to be
the in-flight portion of this mission peaked at beneficial even though not always used for sleep.
day 9 and showed a tendency to decline toward The function of the sleep-restraint system was
baseline or subbaseline levels as the flight pro- considered to be satisfactory, and according to
gressed. the Commander it was a significant improvement
In the 84-day mission, the number of awaken- over the methods utilized in prior spacecraft.
ings declined from a preflight average of 20.7 The occasional periods of elevated temperature
(20 to 21) to an in-flight average value of 12, present in Skylab were considered to have inter-
with a range of 6 to 22 (P<0.01). Postflight, fered with sleep to some extent, and the sporadic
the level rose to an average of 18.7, with a range noise generated by certain equipment on board
of 11 to 24 (P_0.05). Although the in-flight occasionally resulted in brief arousals from sleep.
period was characterized by a good deal of varia- The M133 system caused no particular prob-
tion in this measure, there was no consistent lems, although the Scientist Pilot felt that the re-
trend noticeable. cording cap resulted in some mild discomfort,
and this may have occasionally influenced sleep
Subjective Reports characteristics.
Although subjective reports of sleep character- 59-Day Mission.--The crewmen were satisfied
istics are often not quantitatively correct when with the functioning of the sleep-restraint sys-
compared to the results of objective sleep moni- tem and felt that it, in some respects, simulated
toring studies utilizing EEG and EOG, in many the pressure sensations of one-g. In general, they
instances they do reflect an accurate estimate of felt that sleep was better when the Skylab tem-
the overall quality. During Skylab, there were perature was cooler. There were complaints about
numerous references to sleep made by the crew- the lack of soundproofing and lightproofing in
members in their conversations with Mission the individual sleep compartments: sleep was
Control, and these are preserved in the tran- difficult if one crewman was active while the
scripts of spacecraft-to-ground communications. others attempted to sleep.
In addition, comments concerning sleep were The Scientist Pilot commented on how pleasant
made spontaneously and in response to specific it was to sleep in space, and he felt that he was
questions during the postflight debriefing sessions receiving approximately the same amount of sleep
120 BIOMEDICAL RESULTS FROM SKYLAB

as he was accustomed to on the ground. He also Scientist Pilot commented that he almost en-
commented that on the few nights when he did joyed waking up because he then had the pleasure
not sleep well, or long enough, the lack of sleep of returning to sleep. The Skylab equipment
seemed to affect him more the next day than a noises were somewhat bothersome during the
comparable sleep loss would have on the ground. first few nights in space.
A similar comment was made by the Commander, It was noted that the M133 cap was more
who noted that on the ground he might miss con- bothersome in the postflight period due to the
siderable sleep during the week and yet make it pressure on the head. The Scientist Pilot felt that
up on the weekends without its affecting his per- he lost perhaps an hour of sleep during the first
formance, but in space it seemed to affect him postflight study due to the discomfort.
immediately the next day. The Scientist Pilot commented that he rarely
All crewmen, in general, felt that they slept felt as tired at the end of a day in space as he
well. Falling asleep was not a problem, and the might have after a comparable day on Earth. He

SD Scientist Pilot, 59-Day Mission


M AF SEC
12- SEC '

10-

I
l
I
S-
I

, I I

t # t I I llc
t_ ''"i_",, _'_'' HD
2: t!
tl
_5

2-

I1|11! I ' ' = i , = i j ; ! !


5 10 15 20 25 30 35 40 45 50 55

Mission night

_= Subjective estimate of sleep AF = Afrin _)


I SD = Scopolamine/dextroamphetamine sulfate
II = Awake time SEC = Seconal _)
M = Mylanta ®
I = Sleep time

FICUnE 13-1.--Subjective estimates of total sleep and recorded values for the Scientist
Pilot of the 59-day mission.
EXPERIMENT M133. SLEEP MONITORING ON SKYLAB 121

went to bed because he felt that he needed the experienced the most pronounced difficulty, pri-
sleep, but he usually had the impression that he marily during the first 28 days; then he began
could easily have stayed awake longer. The Com- to sleep fairly well, with only sporadic problems
mander, however, stated that he did feel tired at for the remainder of the flight. However, he felt
the end of the day, and he had not noticed a strongly that the problems encountered were
difference in this aspect peculiar to spaceflight. A "man made," i.e., due to overscheduling prob-
comparison of the objective (M133) data with the lems, and he did not feel that the zero-g en-
Scientist Pilot's estimates is illustrated graphic- vironment per se was a factor. Dalmane and
ally in figure 13-1. promethazine/ephedrine were occasionally uti-
84-Day Mission.--The three crewmembers lized to promote sleep, with the promethazine/
were unanimous in their opinions that sleep qual- ephedrine providing the best subjective response.
ity was greatly enhanced by the sleeping bag re- A comparison of the Scientist Pilot's subjective
straint systems. Attempts were made by at least estimates of sleep and the recorded data is pre-
two of the astronauts (Scientist Pilot and Com- sented in figure 13-2. Also shown is the Scientist
mander) to sleep without restraints on several Pilot's subjective estimate of the amount of
occasions while drifting freely. Although they "heavy sleep" during each sleep period. It is ap-
felt that they did sleep to some extent under this parent that in almost every instance, on days
condition, sleep was intermittent and was not when M133 data were available, the subject's
considered to be sound. The restraints apparently estimates of total sleep time corresponded closely
produced a sensation somewhat similar to grav- to the subjective measure of total time in bed. In
ity, and this contributed to the ability to fall a few instances, e.g., days 72, 77, 80, et cetera.,
asleep and remain asleep. In addition, when drift- estimate of "heavy sleep" coincided with the ob-
ing freely there was intermittent contact with jective measure of total sleep time, but in most
various objects which apparently served as cases there was no correlation.
arousal stimuli.
The Scientist Discussion
Pilot reported no difficulty in
operation of the M133 system and expressed the Overview.--Sleep Latency. The three Skylab
opinion that the recording cap did not interfere flights differed with respect to sleep-latency char-
with his sleep. He found the cap more comforta- acteristics. No significant changes in this param-
ble in zero-g than he had under one-g conditions. eter were noted during the 59-day mission. In
The only significant problem noted with respect the 28-day mission, the in-flight and postflight
to the M133 experiment was the necessity to latencies were significantly lower than the pre-
clean excess electrolyte gel out of his hair each flight values. The 84-day flight was characterized
morning following use of the cap, a job requiring by relatively long sleep latencies in the early por-
approximately 5 minutes. He experienced some tion, with the return to values typical of the pre-
difficulty in plugging the cap umbilical cable back flight and postflight periods in the latter half of
into the control unit when it was necessary to the mission.
get up during the night. The alterations seen during the 28-day mission
Occasional and intermittent bouts of insomnia are apparently explainable, at least in part, by a
were reported by all three astronauts, especially difference in the subject's routine rather than by
during the first 28 days of the mission. The crew- a direct influence of the environment. This indi-
members attributed this, in part, to unusually vidual typically spent a few minutes reading in
long working hours (several 18-hour workdays) bed prior to falling asleep during preflight studies
in the early days of the mission, with insufficient in his own home. However, he did not continue
time in the presleep period to relax and "wind this practice either during the flight or in the
down." No specific problems were delineated, and postflight period.
they experienced at various times difficulty in In only the initial portion of the 84-day mis-
falling asleep, arousals from sleep, with a pro- sion was a degradation in sleep latency seen.
longed time necessary to return to sleep, and Even in this case the magnitude of the altera-
early awakenings. The Scientist Pilot apparently tions seen was not great, and on only two nights
122 BIOMEDICAL RESULTS FROM SKYLAB

SD Scientist Pilot, 84-Day Mission


PE SD AF
SDIS[ SU D D D
12 _ PE IPI PE ASA PE D D
°,° _

10

[] r';3

l
8
_ /' []
i[
i I _, ' r i* I
6-- /=*, ''_" _( '_-x ,_ _',,'
I I L tl i

II

2*

0
,'i'11,
......
,......
5 10 15 20
i ,,,r |,,, f | .... la,
45
1ill|°,,,
50
25 30 35 40 55 60 65 70 75 80

Mission night

,_= Subjective estimate of sleep AF = Afrin _)


x = Recorded date ASA _-- Aspirin
I D = Dalmane
I = Awake time PE = Promethazine/ephedrine
I SD = Scopolamine/dextroamphetamine sulfate
SU Sudafed ®
I = Sleep time

FIGURE 13-2.--Subjective estimates of total sleep and recorded values for the Scientist
Pilot of the 84-day mission.

were the values outside the range seen during the not complain of sleep loss and apparently was
preflight studies. In addition, it is significant sleeping as much as he actually required. No
that these alterations occurred in the early por- significant changes in sleep time were noted dur-
tion of the study and thus cannot be attributed ing the 59- or 84-day missions. If the initial
to the longer duration of this mission. Conse- portion of the 84-day flight is considered sepa-
quently, it appears reasonable to conclude that rately, however, it is evident that the subject
space flight and the associated weightless condi- experienced some difficulty in sleeping during
tion do not significantly interfere with the process this time. Sleep was also more of a problem sub-
of falling asleep, although in some individuals jectively to this individual, and he indicated on
there may be an adaptive period during which several occasions that his sleep was not adequate.
some difficulty is experienced. Sleeping medication was occasionally used by the
Sleep Time.--The greatest overall change in subject, although not on the nights which were
total sleep time occurred during the 28-day mis- monitored.
sion, when a decrease of approximately 1 hour Of the three subjects, then, only the one studied
was seen in-flight compared to preflight. As indi- during the 84-day flight experienced real diffi-
cated previously, this was voluntary reduction in culty in terms of sleep time. In this case, the
sleep time by the subject himself and thus can- problem diminished with time, although sleeping
not be considered as insomnia. The subject did medication was used sporadically throughout the
EXPERIMENT M 13 3. SLEEP MONITORING ON SKYLAB 123

flight. In terms of any possible adverse effect that of the 84-day flight, was it even a temporary
upon performance capability, it seems that only difficulty. Furthermore, there was no evidence
during the initial period of the 84-day mission of consistently increased amounts of time spent
would this have been likely to be caused by sleep awake during the night; in fact, the number of
loss. This cannot be precisely assessed because of awakenings tended to decrease in the flight phase.
the long sample interval; however, even general- The results indicate that during space flights of
izing the worst case (4.0 hours on day 4), a se- long duration, it is possible to obtain adequate
vere influence upon performance would not be amounts of sleep during regularly scheduled
expected. 8-hour rest periods.
Sleep-Stage Characteristics.--Several changes The most consistent and most significant
in sleep-stage characteristics were common to all changes were actually observed in the postflight
three flights. Stage 3, which was significantly ele- period of all flights and pertained to sleep-stage
vated during the in-flight portion of the 28-day characteristics. Thus, stages 3 and 4 tended to
mission, also rose in-flight in the 59- and 84-day be decreased in the postflight period as compared
missions. Postflight, the stage 3 and stage 4 val- to both preflight and in-flight data, while stage
ues were below the preflight average in all three REM was elevated in the late postflight period
flights. A consistent elevation of stage REM was (after day 3 following recovery) and was accom-
seen in the late postflight period of all flights and panied by a shortening of REM latency.
was accompanied by a shortening of REM latency. The postflight changes in stage REM are
Number of Awakenings.--Although this meas- worthy of further consideration. Since such find-
ure was highly variable, in general the in-flight ings are typical of the rebound effect seen fol-
period of all missions was characterized by no lowing periods of relative deprivation of stage
overall increase in number of arousals, and in REM (ref. 18), the question of a significant
the case of the 84-day mission, there were signifi- deprivation in the flight phase arises. This ques-
cantly fewer awakenings. tion is, however, somewhat difficult to assess
Significance of Results.raThe results obtained accurately. When the overall averages are consid-
during the three Skylab missions suggest that ered, there appears to be no significant decrease
prolonged space flight, with its accompanying in REM in the flight phase. However, when the
weightless state, is not directly associated with individual data points are considered, there is a
major adverse changes in sleep characteristics. suggestion that perhaps REM percent did de-
The alterations in sleep patterns that were ob- cline in the terminal portion of the flights. This
served were not of sufficient magnitude to result tendency is most prominent in the case of the
in significant degradation of performance capa- 28-day mission, where a relatively steady decline
bility. These conclusions were somewhat unsus- in stage REM percent is evident after day 17.
pected, since previous studies of confinement, Such a trend is less obvious in the case of the
social isolation, and unusual environments involv- 59-day mission, although the last 2 days are be-
ing polar explorers (refs. 11, 12, 13, 14), under- low the preflight average value. In the case of
water habitats (ref. 15), long-duration flight the 84-day flight, the latter portion of the mission
operations (ref. 16), and astronauts (ref. 17) shows only a slight indication of a decrease in
have all reported sleep loss and/or disturbances stage REM. Even though the results appear to
of sleep. argue against a prior period of REM deprivation
Mechanisms.--It had been suspected that the in-flight as a contributing factor, it must be em-
altered sensory input to the central nervous sys- phasized that recordings were not made during
tem associated with weightlessness might inter- the last two nights of each mission, and conse-
fere with sleep onset and result in prolongation quently this situation cannot be fully assessed.
of sleep latency and lead to long periods of wake- A shortening of REM latency was observed in
fulness following arousals from sleep. The Skylab the late postflight period of all missions and ac-
results, however, show that in none of the mis- companied the increase in REM percent noted
sions was sleep latency a significant problem during that time. This phenomenon has also been
over the course of the flight, and in only one case, reported as a manifestation of a prior period of
124 BIOMEDICAL RESULTS FROM SKYLAB

REM deprivation. Arguing against REM depriva- 21, 22, 23). According to this view, REM may be
tion as a causative agent of this change is that involved in consolidation or reprograming of
no lessening of the effect was evident even on short-term memory into a more permanent or
the sixth night following recovery of the 59- and long-term form. If this hypothesis is correct, then
84-day missions nor after the eighth night fol- it might be predicted that tasks associated with
lowing the 28-day mission. Similarly, it seems acquisition of new motor skills and coordinated
unlikely that the changes in stage REM can motor activity might be associated with an in-
be attributed to alterations in the astronauts' creased need for stage REM sleep.
sleep schedules, i.e., the advances in bedtime near In support of this hypothesis, it has been found
the termination of each mission. It has been that during the period of adaptation to an in-
reported that delaying sleep periods by 4 hours verted visual field, REM time was increased (refs.
results in a shortening of REM latency, but such 24, 25). After declining to relatively normal lev-
findings have not been reported with comparable els after adaptation, reverting the visual field to
advances in sleep onset. Furthermore, while de- normal was again accompanied by an increase in
laying sleep periods has been found to increase REM-sleep amount. The situation in space flight
REM percent, advancing sleep periods resulted may be analogous, since the withdrawal of gravi-
in a decrease in REM percent (ref. 19). tational cues and the decrease in proprioceptive
Postflight data from the 84-day mission further input and altered vestibular input place a consid-
suggest that the increase in REM percent seen erable burden upon the visual system as the sole
late postflight is actually a delayed phenomenon means of maintaining" spatial orientation. Follow-
and follows a period of relative REM suppres- ing the mission, the return to Earth similarly
sion in the immediate recovery period. In fact, requires a period of adaptation to the one-g con-
the REM percent value of 12.1 percent on the dition. It might be speculated, then, that the in-
first night following recovery is well below any crease in REM time seen postflight was a
REM percent value seen either preflight or in manifestation of this hypothesized mechanism.
the flight phase. The value seen on day 5 after There is no evidence in the Skylab data that
recovery, in the late postflight period, is corre- adaptation to zero-g is accompanied by an increase
spondingly well above any value seen either pre- in REM time; in fact, the values in the flight
flight or in-flight. Delayed REM rebound is not phase were either the same or lower than pre-
a typical finding in experimental situations in- flight values. The hypothesis cannot, however, be
volving REM deprivation. It has been reported adequately evaluated, since no sleep data was ob-
following periods of total sleep deprivation, in tained prior to day 3 in any of the flights; thus,
which case there is an elevation of stages 3 and 4 pertinent changes could conceivably have been
in the first recovery night and a later elevation missed. If such in-flight changes were present,
of stage REM (ref. 20). However, in none of the however, they evidently were shorter duration
three Skylab flights was a postflight elevation of than those seen postflight where changes were
stages 3 and 4 noted, and in fact these param- seen until the eighth day after recovery.
eters tended to decline. Consequently, in these
Conclusions
cases a delayed REM rebound appears to argue
against prior sleep deprivation as the cause of The objective results of these sleep monitoring
the postflight REM changes. experiments indicate that man is able to obtain
In view of these findings, it seems plausible at least adequate sleep over prolonged periods of
that the decreased REM latency and increased time in space and during regularly scheduled
REM percent represent a true influence of the 8-hour sleep periods. The alterations in sleep
reinstated one-g condition and that this signified patterns which were observed during these mis-
a basic alteration in the sleep/wakefulness mech- sions were not of the type, nor of sufficient mag-
anism of the central nervous system. nitude (with the possible exception of the initial
It has been postulated that sleep, and in partic- portion of the 84-day mission), to result in sig-
ular the REM stage, may be of importance in the nificant degradation of performance capability.
organization and maintenance of memory (refs. The most notable changes seen actually occurred
EXPERIMENT M 133. SLEEP MONITORING ON SKYLAB 125

in the postflight period, and this suggests that dition, Skylab allowed the establishment of a
perhaps the readaptation to one-g is somewhat daily routine which was, in most respects, directly
more disruptive to sleep than the adaptation to comparable to ground-based, everyday activity.
zero-g. Yet, even in this case, the alterations seen The crewmen maintained their Houston-based
were those of sleep quality and not quantity. It time reference throughout the fights and, for the
is also worthy of emphasis particularly with re- most part, worked during conventional hours.
spect to the results seen during prior space The individual sleeping compartments were a
flights, that none of the Skylab crewmen com- definite improvement over the prior spacecraft
plained excessively of sleeping difficulties. In fact, systems, and this undoubtedly greatly minimized
most reported no problems with respect to sleep, or eliminated interference with sleep caused by
and some expressed the opinion that sleep was activity of other crewmen. In general, the ele-
perhaps better in space. Viewed overall, these re- ment of risk or danger present in all space flight
sults are somewhat surprising because of the fre- seemed to be minimized in Skylab by the presence
quent complaints of insomnia during pre-Skylab of an established daily routine, and this also may
missions. Apparently, the problems encountered have contributed to the improvement in sleeping
during earlier space flights were not simply due conditions.
to the imposed zero-g environment. The Skylab The results also suggest areas for future study
orbiting laboratory differed considerably from with respect to the acquisition of scientific data
spacecraft of the Apollo and Gemini types, al- and in terms of man's overall adaptation to life
though the gravitational and atmospheric fac- in space. As indicated previously, the changes in
tors were the same in all cases. The working sleep-stage characteristics seen postflight possi-
volume of the spacecraft is most likely the in- bly do represent a direct influence of the altered
fluential factor in terms of sleep. Skylab provided gravitational factors upon the sleep/wakefulness
adequate room for separate eating, exercising, mechanisms. Future experiments, if properly de-
working, and sleeping areas within 12 763 cubic signed, could provide information of basic im-
feet of living area. The Apollo spacecraft meas- portance to our understanding of sleep. In terms
ured only approximately 3 percent of this vol- of human capabilities, we feel confident that
ume, while the Gemini craft contained less than 1 flights of 2 to 3 months will not be jeopardized
percent. In these smaller spacecraft all daily tasks by sleeping difficulties, but beyond this point we
were more difficult, and the astronauts undoubt- must continue to carefully evaluate sleep and in-
edly had a greater sense of confinement. In ad- sure proper work-rest scheduling.

References

i. N_ITOH, P. Sleep loss and Its Effect Upon Performance. U.S. Navy Neuropsychi-
atric Research Unit Report 68-3, Department of the Navy, Washington, D.C.,
1969.
2. MAULSBY, R. L. Electroencephalogram during orbital flight. Aerosp. Med., 37:1022-
1026, 1966.
3. MAULSSY, R. L., and P. KELLAWAY. Electroencephalogram during orbital flight: eval-
uation of depth of sleep. In Proceedings o] the Second Annual Biomedical Research
Conference, pp. 77-92. NASA Manned Spacecraft Center, Houston, 1966.
4. ADEY, W. R., R. T. KADO, and D. O. WALTER. Computer analysis of EEG data from
Gemini flight GT-7. Aerosp. Med., 38:345-359, 1967.
5. BURCH, N. R., R. G. DOSSETT, A. L. VORDERMAN, and K. L. BOYD. Period analysis of
an electroencephalogram from an orbiting command pilot. In Biomedical Research
and Computer Application in Manned Space Flight, pp. 117-140, J. F. Lindsay
and J. C. Townsend, Eds. NASA SP-5078, Washington, D.C., 1971.
6. FROST, J. D., JR., and J. G. SALAMY. Sleep-monitoring---experiment M133. In Skylab
Medical Experiments Altitude Test (SMEAT), pp. 12.1-12.21. NASA TM
X-58115, Johnson Space Center, Houston, Texas, 1973.
126 BIOMEDICAL RESULTS FROM SKYLAB

7. FROST, J. D., JR., WILLIAM H. SHUMATE, JOSEPH G. SALAMY, and CLETIS R. BOOHER.
Skylab sleep monitoring experiment M133. In The Proceedings of the Skylab Life
Sciences Symposium, pp. 239-285. TM X-58154, Houston, Texas, November 1974.
8. FROST, J. D., JR., W. H. SHUMATE, C. R. BOOHER, and M. R. DELUCCHI. The Skylab
sleep-monitoring experiment: methodology and initial results. Astronautiea Acta,
1974. (In Press.)
9. FROST, J. D., JR., W. H. SHUMATE, J. G. SALAMY, and C. R. BOOHER. Sleep character-
istics during the 28 and 59 day skylab missions. In Behavior and Brain Electrical
Activity, N. R. Butch, Ed. Plenum Press, New York, 1974. (In press.)
10. RECHTSCHAFFEN, A., and A. KALES, Eds. A Manual of Standardized Terminology,
Techniques and Scoring System for Sleep Stages of Human Subjects. Public
Health Service, U.S. Government Printing Office, Washington, D.C., 1968.
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1970.
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the sleep-wakefulness cycle. Electroencephalogr. Clin. Neurophysiol., 35:613-619,
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/

N77-33794

CHAPTER 14

Visual Light Flash Observations on Skylab 4

RUDOLF A. HOFFMAN, a LAWRENCE S. PINSKY, b W. ZACH OSBORNE, b AND


J. VERNON BAILEY a

HE OBSERVATION OF LIGHT FLASHES was first acter of visual light flashes in near Earth orbit
reported by the Apollo 11 Lunar Module as the Skylab trajectory passes from northern to
Pilot, Edwin Aldrin, with subsequent observa- southern latitudes. Because the trajectory peri-
tions made on all Apollo missions (refs. 1, 2). odically passed through the South Atlantic Anom-
Professor C. A. Tobias predicted as early as 1952 aly, another study objective was the investigation
(ref. 3) that this type of visual phenomenon of possible visual flashes during passage through
would be experienced by humans when exposed this region.
to heavily ionizing cosmic particles. Although it
Procedure
has been quite generally accepted that the light
flashes observed were caused by passage of cos- Two periods of observation by the Pilot were
mic particles through the visual apparatus, the planned. These observation sessions were accom-
exact mechanism of particle interaction is still plished on orbits selected to provide data on both
uncertain. Some investigations (refs. 1, 4, 5, 6, latitude and South Atlantic Anomaly effects. Un-
7, 10) support the premise that the visual flashes fortunately, no single orbit possessed ideal geo-
are caused by direct particle/retina interaction magnetic latitude and anomaly conditions. Hence
while others (refs. 8, 9) tend to favor Cherenkov the first session provided the best latitude condi-
radiation from relatavistic particles as their eti- tions but passed only through the edge of the
ology. While both mechanisms probably contrib- South Atlantic Anomaly region. The second ses-
ute, the current consensus seems to be that most sion passed through the center of the South At-
of the flashes result from direct ionization energy lantic Anomaly but did not achieve as high
loss as the particle traverses retinal cells. In geomagnetic latitudes. The first observation ses-
either case, if cosmic particles are the cause, a sion occurred on mission day 74 and was 70 min-
strong latitude effect of the light flash rate would utes in duration, while the second occurred on
exist for an observer in Earth orbit. This effect is mission day 81 and was 55 minutes long. The
a consequence of the geomagnetic cutoff and the second period was shorter because of very critical
steep energy spectrum of cosmic ray fluxes. In time limitations during the last few days of the
other words, near the equator only cosmic par- mission.
ticles with very high energy can reach orbital At the start of each session the Pilot got into
altitudes, while near the magnetic poles particles his sleep restraint, set a timer for the prescribed
of much lower energies can reach comparable period (either 70 or 55 minutes), donned a blind-
altitudes. fold, and began observing for light flashes. Ap-
The primary objective of the study reported proximately the first 10 minutes of each session
here was to investigate the frequency and char- was allocated for dark adaptation by the subject.
During the first session no particular position in
the sleep restraint was specified. The Orbital
"NASA Lyndon B. Johnson Space Center, Houston,
Texas. Workshop was in a Solar Inertial Mode during
b University of Houston, Houston, Texas. both periods and local noon occurred very close

127
128 BIOMEDICAL RESULTS FROM SKYLAB

to equator passage in both cases. For the second number one, event marks insteacl of numbers were
session, directions were given for head position- used.
ing which placed the anterior-posterior axis of It is almost impossible, because of the rela-
head parallel to the Earth's magnetic field lines tively few flashes observed and because of vary-
in the anomaly. ing lengths of time spent at different latitudes,
The occurrence of each light flash event along to show in a simple way the relationship between
with its description was voice recorded on the on- flash occurrence and geomagnetic latitude or
board tape recorder and a transcript of the re- HZE flux. However, figures 14-2 and 14-3 at-
cording for each of the two periods was obtained tempt to demonstrate this for the two observa-
for analysis. tion sessions. As can be seen by referring to figure
14-1, time from equator passage is directly re-
Results lated to latitude. The calculated cosmic ray flux
A total of 168 flashes was reported: 24 during for latitude positions of the spacecraft corre-
the first session and 144 during the second. Fig- sponding to the times from equator passage is
ure 14-1 shows a plot of the trajectory ground shown on both figures 14-2 and 14-3. Although
tracks for both observation sessions with each there is evidence for correlation of flash occur-
light flash occurrence marked. The numbers rence with cosmic ray flux (or geomagnetic lati-
shown in the South Atlantic Anomaly on the tude) in figure 14-2, figure 14-3 more clearly
ground track for session number two indicate the demonstrates this relationship. The Van Allen
number of flashes observed during 1 minute in- Belt Dosimeter data for the observation periods
tervals. Because the frequency of flashes in the are also shown on figures 14-2 and 14-3. The
South Atlantic Anomaly was much less in session units shown on the ordinate of figures 14-2 and

....- -i f"

(day r rev. 3740) adaption I !_ J

FIGUnE 14.-l.--Event occurrences along ground tracks for the two Skylab 4 light flash
sessions (Pilot-observer).
VISUAL LIGHT FLASH OBSERVATIONS ON SKYLAB 4 129

Key: Key:
_" = One light flash outside SAA
P"/J = One light flash outside SAA
= One light flash in SAA 0 = One light flash in SAA
35
SAA = South Atlantic anomaly 35 SAA = South Atlantic anomaly
VABD = Van Allen belt dosimeter / I _
30.
30 I _ VABD
I I response
VABD =
Calculated Van Allen belt dosimeter
7_ 25- I I inSAA
11-- cosmic ray flux
\ (z>2) I Calculated I ]
20- . p' _ cosmic ray flux I I
"_ 20, (Z>2)
IE
15--
15-

£ 1o-
£ 10-
5_

5-
. . _
0
; I' I' I ' I' I ' I' I ' I ' I' I ' i
-40-32-24-16 -8 0 8 16 24 32 40 48

Time from equator passage, min o i I i i i !


-40 -32 -24 -16 -8 0 8 16 24

FIGURE 14-2.--Skylab 4 light flash observation. Session Time from equator passage, min
No. 1. (Mission Day 71; Rev. 3740)
FIGURE 14-3.---Skylab 4 light observation. Session No. 2.
(Mission Day 84; Rev. 3841)

14-3 do not apply to those curves; instead only


relative units need to be visualized. It is apparent
observing these events their occurrence will be
that the flash rate in the South Atlantic Anomaly
noted whenever proper conditions exist.
coincides remarkably well with the increased ra-
The following conclusions cgn be drawn from
diation levels detected by the Van Allen Belt
Dosimeter. the data presented:

Dark adaptation of at least 10 minutes dura-


Comments And Conclusions
tion is required to begin observing the flashes.
Although a few light flashes were reported as There is a strong correlation of very high flash
casual observations by the crews of Skylab 2 and rates with passage through the South Atlan-
Skylab 3, the events reported here represent the tic Anomaly, and, from physical arguments
first observations made in Earth orbit. No flashes and event descriptions, it appears certain
were observed during previous Mercury or Gem- that these flashes are due to the trapped
ini flights or during Apollo missions prior to radiation.
Apollo 11. Why no flashes were observed prior There is evidence for the predicted latitude ef-
to Apollo 11 has been considered before (ref. 1) fect, although existing data are insufficient
and even now no clear explanation exists. The for a thorough statistical evaluation.
most logical explanation appears to be that the A greater particle flux in the trajectory through
eye must be dark adapted and the observer must the South Atlantic Anomaly during the sec-
be reasonably relaxed and free from most dis- ond observation period probably explains the
tracting activities to observe light flashes. This increased number of flashes observed at that
was not the case on earlier flights. Also without time, but there were also more flashes ob-
a precedent for their observation, there would served outside the anomaly during this sec-
probably be the tendency to discount minor flashes ond period where the cosmic particle
as nothing unusual and simply an innocous event environment should have been comparable.
in a milieu of more important observations. It This variation remains unexplained at this
seems obvious now that with eyes trained for time.
130 BIOMEDICAL RESULTS FROM SKYLAB

There is an additional suggestion from the gram mission. Although there is a basic interest
event rates and descriptions of flashes during the in studying the visual flashes per se, the real im-
South Atlantic Anomaly passes, that there may portance to manned space flight is the question of
be particles heavier than protons in the inner their significance. Are they mere flashes similar
belt of trapped radiation. The current knowledge to other visual observations we make continually
of the inner belt includes an upper limit of only and represent no danger? Does each flash signify
approximately one heavy nucleus per 1000 pro- the destruction of one or more retinal cells ? Are
tons. The Skylab 4 light flash data are compatible the flashes observed and the resultant damage,
with this limit, but still suggest the existence of a although potentially serious in itself, indicative
significant flux of Z_2 particles. This provides of even more damaging interaction of HZE par-
strong motivation for making detailed and accu- ticles with other tissues, e.g., the brain ? The need
rate measurements of the South Atlantic Anomaly for extensive ground investigations using accel-
(inner belt) heavy component. erator-produced radiation is apparent. Space ob-
The observation of flashes during space flight servations as reported here must serve as
reported here and those reported previously rep- guidelines for ground studies currently underway
resent very few events from a statistical stand- and others yet to be conducted.
point. More such observations need to be made 1 Experiment MA106: Principal Investigator--Dr. T. F.
and are planned 1 for the Apollo-Soyuz Test Pro- Budinger.

References

1. CHAPMAN, P. L., L. S. PINSKY, R. E. BENSON, and T. F. BUDINGER. Observations


of Cosmic Ray Induced Phosphenes on Apollo 14. Proc. Nat. Symp. Natural
and Manmade Radiation in Space, p. 1002. NASA TM X-2440, 1972.
2. PINSKY, L. S., W. Z. OSBORNE, J. V. BAILEY, R. E. BENSON, and L. F. THOMPSON.
Light flashes observed by astronauts on Apollo 11 through Apollo 17. Science,
183:957-959, March 8, 1974.
3. TOBIAS, C. A. J. Aviation Medicine, 23:345, 1952.
4. BUDINGER, T. F., HANS BICHSEL, and C. A. TOBIAS. Visual phenomena noted by
human subjects on exposure to neutrons of energies less than 25 MEV. Science,
172:868-870, May 21, 1971.
5. BUDINGER, T. F., JOHN T. LYMAN, and C. A. TOBIAS. Visual perception of accelerated
nitrogen nuclei interacting with the human retina. Nature, 239(5369):209-211,
September 22, 1972.
6. CHARMAN, W.
N., and C. M. ROWLANDS. Visual sensations produced by cosmic ray
muons. Nature, 232:574-575, August 20, 1971.
7. FREMLIN, J. H. Cosmic ray flashes. New Scientist, 47:42, July 2, 1970.
8. FAZI0, G. G., J. V. JELLY, and W. N. CHARMAN. Generation of Cherenkov light
flashes by cosmic radiation within the eyes of the Apollo astronauts. Nature,
228:260, 1970.
9. McNULTY, P. J. Light flashes produced in the human eye by extremely relativistic
muons. Nature, 234:110, November 12, 1971.
10. TOBIAS, C. A., T. F. BUVlNGER, and J. T. LYMAN. Radiation induced light flashes
observed by human subjects in fast neutron, X-ray and positive ion beams.
Nature, 230:596, 1971.
N77-33795

CHAPTER 15

Changes in the Achilles Tendon Reflexes


Following Skylab Missions

JOSEPH T. BAKER, a ARNAULD E. NICOGOSSIAN, b G. WYCKLIFFE HOFFLER, b


ROBERT L. JOHNSON, b AND J. HORDINSKY b

milliseconds. Such wide variation in reflex dura-


A GENERALIZED HYPERREFLEXIA was reported
in the crewmembers o