A Conference Presentation with Accessibility Features
Presenters: Sheyna Gifford (MD, MPH, MBA, MS, MA), Shivani Mehta (BA), Jim Vanderploeg MD, and Eric Viirre (MD, PhD). Conference: Aerospace Medicine Association. Year: 2022. Location: Reno, NV, USA, Planet Earth.
Slide 2: This talk is void of disclosures
Slide 3: This is our talk about medical considerations for parastronautics – a field that increasingly proves that the boundaries are where you set them, or, perhaps, refuse set them.
As we move into the era of commercial and recreational spaceflight, parastronautic is an increasingly relevant lens through which to consider the crew selection process. For 70 years, we’ve been asking crew to prove to us that they can do things. Can meet or exceed some physical challenge. Can perform some task during a high G maneuver while sleep deprived.
The philosophy underpinning that Approach has very much been – what makes you think that you can do this?
The philosophy that underpins parastronautics and casual space travel in general is far closer to, “Is there a reason why you can’t?” What people can and can’t safely do well in space in what we’re all here to find out, and parastronautics is in many ways leading the charge.
But before we go any further, by a show of hands, who has ever heard of a Paralympian?
And what do we think about that – are Paralympians world-class athletes?
For sure. And under certain circumstances, a Paralympian might perform as well as or even better than a non-adapted athlete. Let’s put that in the back of our minds as we talk about the spaceflight equivalent of para-athletes: parastronauts.
Slide 4:
Parastronauts have been called for by ESA and studied as potential flyers by NASA. Why? What is even a parastronaut? A parastronaut is:
A human training for spaceflight whose function, physical abilities, or appearance are off-nominal by classic astronaut standards.
Parastronauts, like Paralympians, are medically disqualified from participating in this class of activities.
This is in the process of changing. ESA has called specifically for astronaut candidates with a limb length difference, a single lower-extremity prosthetic, or stature below 130 cm
NASA also studied this population’s potential to be qualified as astronauts in a report they published in 2021. Those three non-traditional features are very much the tip of adaptable human iceberg
Slide 5:
It is believed that up to 15% of humankind lives with what many people would call a disability.
Some feature of themselves that prevents them from enjoying full participation in society
Because “disability” has a specifical medico-legal meaning in the US and because many of our ambassadors enjoy full participation in society, we will be using the term adapted in our discussion
As in, people who are adapted to life on Earth a differently than the statistically “average” person. So why include adapted flyers or parastronauts?
Representation is certainly one answer to that question, though it’s not representation for the sake of representation.
The space population has been one very distinct, type of human population.
Increasing, the space population has begun to resemble the general human population
the general human population has EVERY BODY. Every type of human form. Every limb assortment and arrangement.
Every kind of capacity and modified capacity.
For the first time in history, Earth’s population and the space population on converging
By studying parastronauts, by flying parastronauts, by developing screening protocols and medical checklists for parastronauts what we’re really doing is generally is
Preparing to send everyone to space someday who may wish to possibly go
What we’re doing specifically is preparing to be the flight surgeons for people who are frequently prevented from going a lot of places. They go anyway, which brings to the next reason to study parastronautics.
Slide 6:
Everyone in this room is well aware of how hard the Space Population fights to adapt to the microgravity environment
Some people in this room will have an intrinsic understanding of how hard the people in this picture fight to adapt to the Earth environment.
Because Para-Astronauts Are people who are on a constant state of adaptation
In doing this work, what we may discover is that parastronauts have certain performance advantages in the space environment
For example, When put into the microgravity environment, every flyer in the front row of that picture will use their upper extremities for propulsion, not their feet
And the the flyers in the back row who function outside of the standard boundaries of hearing and vision may very well have no issues with space adaptation sickness
While this population may have many advantages, There are a lot of very important questions
about functional limitations and safety in the operational spacecraft environment
And that’s what we the medical team at Mission Astroaccess set out to discover.
Slide 7:
What happens when people who are highly adapted to performance on Earth attempt to perform outside of the general Earth environment?
What are the constraints?
The considerations?
The implications of flying astronauts with various types of adaptations?
Simply put, how do we do this?
Slide 8:
For Stephen Hawking’s 2007 Zero G flight: the entire plane was turned into an ICU and there was an entire practice run before hand.
In the second flight, the real flight, the goal was 1 30 second parabola
There were 8 parabolas
Everyone had a great time, no injuries
The flight surgeons for that flight were the same ones as the flight surgeon’s on Mission AstroAccess flight #1: Jim Vanderpleog and Erik Virre
For the Nick Kids Zero G flight with 4 paraplegic 11 and 12 year-olds in 2008
Erik Virre was, again, the flight surgeon
Hayley Arceneaux flew to LEO on with Inspiration 4 – she has a surgically implanted lower extremity prosthesis
And then there’s our mission.
In our mission we were aware of course of ESA’s ongoing parastronaut call (slide change)
Slide 9:
-We did not restrict ourselves to these three adaptations.
-All persons of all types were able to apply.
-Any number of limbs, organic or not
-Visual, auditory, sensory, mobility adaptations welcome
Then the flight surgeons, Erik Virre and Jim Vanderploeg joined by Dr. Sheyna Gifford, a physiatrist who cares for this patient population, did the thing that all flight surgeons do.
Slide 10:
Safety
Screening
Risk Assessment and
Team Leadership
We used the traditional red, yellow, green coding
Slide 11:
In the end MedOps handed a 27 parastronaut candidates in green and yellow for the several dozen flyers that we screened.
And screened. And discussed. And screened again.
We discussed each flyer’s unique medical situation with an OT from the Stamford ability lab and in the end we handed the list to the selection committee.
These were the candidates who were chosen. Some are world-class athletes and performers. One works for NASA. One had previously flown on a ZeroG flight.
Slide 12:
We knew that under nominal operational conditions each had their pain, respiration, bowel and bladder programs well managed.
We know that all the candidates function in their activities of daily living independently or with modified independence.
We provided modifications to the aircraft cabin environment, the boarding process, and the communications pattern.
Basically, How do the flyers:
- Get on to the plane
2. Get around the cabin
3. Get into safety positions
4. Do their research tasks?
For those who haven’t been on a Zero G flight, there are a series of calls during the parabolas. One to tell people that the parabola is starting, one to say that the parabola is starting, that the plane
Is kicking over at the apex or base, and another to say that it’s time to get back into position •There were lights to signal those calls as well as taps on the body for the flyers who needed it
• Each personal had a buddy to assist with those taps, with navigation and research tasks •Whether they would be needed or not we did not know, but the buddies were there and on the plane
•Everyone received a pre-flight dose of Compazine, with one exception •Every flyer had research tasks to do during dome of the parabolas •And everyone had to follow the safety rules and guidelines, no exceptions to that
Slide 13:
After selection the role of the flight surgeons and their advisors became risk mitigation via:
• Planning and running parabola scenarios •Getting people who navigate the world with a non-standard set of senses back into their safety positions on time on the floor of the cabin •writing and executing protocols for •Loading the plane •Unloading the plane • donning and doffing prosthetics, • how to store those now-removed limbs during flight •Communication •Educating the MAA team and ZeroG staff, though the staff are extremely, fantastically versatile and experienced
Slide 14:
And, in the end, showing up. There were two flight surgeons on the flight itself, though none were needed. Protocols were followed as well as can be expected for a first flight with a
Very new crew
New to microgravity, almost all of them, and new to each other
Thanks to the protocols and the pre-screening and the training
There was one very minor abrasion injury
And one incidence of near-air-sickness in a flight surgeon who shall not be named at this time.
Slide 15:
That’s not to say that things were EASY.
This was a call that Dr. Gifford got the morning of the flight:
When the call came in from that flyer the question Dr. Gifford had was: what component did you break?
We had lots of spares but not for everything. Fortunately it was just a rivet.
Rivets and straps are the most commonly broken prosthetic components.
And in-flight there were issues. One spinal cord injury patient found that, though he didn’t have any desire to use his legs
As those who walk do
When the parabola hit, he still had to struggle to control where they went and what their uncontrolled motion
Did to his attitude in microgravity, sometimes.
That was a function that microgravity decreased.
There were many functions that being in microgravity increased in this population
Mary Demonstrated that she could take her leg off, do a cartwheel around it, and put it back on when the call came for “feet down and get down” before the parabola ended
The total elapsed time for that maneuver, by the way, is approximately 20 seconds.
In lunar gravity, a flyer named Eric stood unassisted in his entire life.
Viktoria, who has a lower extremity prosthesis, felt the functional plane was equalized and for the first time everyone was functioning about as well,
regardless of how many limbs they had or what they could or could not do with them.
In general, the flyers felt that Mars gravity was extremely beneficial because it is “slow enough to feel your decisions. To feel yourself falling.
Everyone described “A sense of delight & overpowering joy”
Slide 16:
So what did we learn?
Prescreening was essential. So was experience
Running the candidate list in the traditional fashion worked well
Red, green, yellow
Not good for deuteranopia but great for risk assessment
Having a lot of input from a different specialists who work with this population
Dr. Gifford, Jody Greenough from Stanford OT
And the two flight surgeons who have flown adapted populations before
That was medOps dream team
Pre flight and in flight Protocols were key. Here’s what we didn’t do as well as we could have: bladder management
People needed to pee. A lot. During this flight
People who manage their bladders in the traditional fashion
those who use adaptive equipment
Elimination
Everyone Must void in the void
Everyone voided on this short flight
Twice, it seemed like
Prior experience matters
We Recruited MedOps officers who have screened a lot of flyers
We Recruited MedOps officers who cares for adapted patient
PTs, OTs – work with adapted people all day long
We learned that function is a spectrum.
You look at someone with no limbs and think, “What can they do?” but the better question is, “What might they need assistance doing in this environment and how?”
Because in the microgravity environment, acutely, needing assistance is common, not uncommon
People have uncommon abilities of which you are not aware until you put them in that environment
And in the end, we’re so glad we put them in that environment
Slide 17:
So what did we learn?
- Prescreening is essential.
-Running the candidate list in the traditional fashion worked well
-Red, green, yellow: Not good for deuteranopia, but great for risk assessment
-Having a lot of input from a different specialists who work with this population: Dr. Gifford, Jody Greenough from Stamford OT
-And the two flight surgeons who have flown adapted populations before . That was medOps dream team
2.Pre flight and in flight Protocols were key. Here’s what we didn’t do as well as we could have: bladder management
3.People needed to pee. A lot. During this flight People who manage their bladders in the traditional fashion and those who use adaptive equipment.
4.Prior experience matters. We Recruited MedOps officers who have screened a lot of flyers We Recruited MedOps officers who cares for adapted patient PTs, OTs – work with adapted people all day long
5.We learned that function is a spectrum. You look at someone with no limbs and think, “What can they do?” but the better question is, “What might they need assistance doing in this environment and how?”
6. Because in the microgravity environment, acutely, needing assistance is common, not uncommon. People have uncommon abilities of which you are not aware until you put them in that environment. And in the end, we’re so glad we put them in that environment
Slide 18:
We know to keep up the screening and protocols
We know not to try to do too much in each 20 second parabola
We know to let people try to do whatever they think they can.
They usually succeed and even when they do not, they learn how to fail better
We learned that the flyers are not our only patients
That an all-volunteer flight support crew can run themselves so ragged the flight surgeon may need to take the keys away for safety
For example
Next time we’ll do it again but more
MedOps with people who work with this population and fly a lot of people of all types
That’s the way this field is going and that’s the key to success, we feel
Slide 19:
In parastronautics, the goal is that same as always
Happy crew
Happy flight surgeon
If such a thing is possible
MedOps found that what was different about the MAA experience vs their previous spaceflight experience is that the goal felt closer to what we do when we conduct pilot medical exams
the goal was getting to yes.
The MedOps team observe that as the population of space and Earth converge, the philosophy behind flying people to space seem to be approaching the philosophy of pilot certification:
get to yes
get people there
All kinds of people.
People we could not imagine flying planes fly planes.
People without arms fly unmodified light sport aircraft. I
Similarly, People you might pass in the grocery store and never think that would make an outstanding astronaut might just surprise us all
Slide 20:
By being able to compete on a level we never thought possible.