Individual differences in susceptibility to motion sickness among six Skylab astronauts

One of the Skylab experiments dealt with motion sickness, comparing susceptibility in the workshop aloft with susceptibility preflight and postflight. Tests were conducted on and after mission-day 8 (MD 8) by which time the astronauts were adapted to working conditions. Stressful accelerations were generated by requiring the astronauts, with eyes covered, to execute standardized head movements (front, back, left, and right) while in a chair that could be rotated at angular velocities up to 30 rpm. The selected endpoint was either 150 discrete head movements or a very mild level of motion sickness. In all rotation experiments aloft, the five astronauts tested (astronaut 1 did not participate) were virtually symptom free, thus demonstrating lower susceptibility aloft than in preflight and postflight tests on the ground when symptoms were always elicited. Inasmuch as the eyes were covered and the canalicular stimuli were the same aloft as on the ground, it would appear that lifting the stimulus to the otolith organs due to gravity was an important factor in reducing susceptibility to motion sickness even though the transient stimuli generated under the test conditions were substantial and abnormal in pattern. Some of the astronauts experienced motion sickness under operational conditions aloft or after splashdown, but attention is centered chiefly on symptoms manifested in zero gravity. None of the Skylab-II crew (astronauts 1 to 3) was motion sick aloft. Astronaut 6 of the Skylab-III crew (astronauts 4 to 6) experienced motion sickness within an hour after transition into orbit; this constitutes the earliest such diagnosis on record under orbital flight conditions. The eliciting stimuli were associated with head and body movements, and astronaut 6 obtained relief by avoiding such movements and by one dose of the drug combination 1-scopolamine 0.35 mg + d-amphetamine 5.0 mg. All three astronauts of Skylab-III experienced motion sickness in the workshop where astronaut 6 was most susceptible and astronaut 4, least susceptible. The higher susceptibility of SL-III crewmen in the workshop, as compared with SL-II crewmen, may be attributable to the fact that they were based in the command module less than one-third as long as SL-II crewmen. The unnatural movements, often resembling acrobatics, permitted in the open spaces of the workshop revealed the great potentialities in weightlessness for generating complex interactions of abnormal or unusual vestibular and visual stimuli. Symptoms were controlled by body restraint and by drugs, but high susceptibility to motion sickness persisted for 3 days and probably much longer; restoration was complete on MD 7. From the foregoing statements it is clear that on and after MD 8 the susceptibility of SL-II and SL-III crewmen to motion sickness under experimental conditions was indistinguishable. The role played by the acquisition of adaptation effects prior to MD 8 is less clear and is a subject to be discussed.     

Artificial gravity: head movements during short-radius centrifugation.

Short-radius centrifugation is a potential countermeasure to long-term weightlessness. Unfortunately, head movements in a rotating environment induce serious discomfort, non-compensatory vestibulo-ocular reflexes, and subjective illusions of body tilt. In two experiments we investigated the effects of pitch and yaw head movements in participants placed supine on a rotating bed with their head at the center of rotation, feet at the rim. The vast majority of participants experienced motion sickness, inappropriate vertical nystagmus and illusory tilt and roll as predicted by a semicircular canal model. However, a small but significant number of the 28 participants experienced tilt in the predicted plane but in the opposite direction. Heart rate was elevated following one-second duration head turns. Significant adaptation occurred following a series of head turns in the light. Vertical nystagmus, motion sickness and illusory tilt all decreased with adaptation. Consequences for artificial gravity produced by short-radius centrifuges as a countermeasure are discussed. Grant numbers: NCC 9-58.     

Motion sickness susceptibility during rotation at 30 rpm in free-fall parabolic flight

Free fall per se whether in parabolic or orbital flight may be regarded as a "partial" motion environment with respect to eliciting motion sickness, requiring an additional component to render this environment "complete" or stressful. Parabolic flight in toto falls in the category of a "complete" motion environment in that some persons became motion sick with head fixed and eyes closed. In the present experiment we selected subjects who were symptom free or nearly symptom free in the KC-135 with head fixed. All tests were conducted with the subject rotating at 30 rpm in a rotating litter chair, and comparisons were made between head-fixed and head-moving conditions (right-left) in the free-fall phase of parabolic flight and under simulated free-fall phases in the laboratory. With head fixed most subjects were insusceptible; with head moving left-right susceptibility was slightly higher in the laboratory than aloft. An additional comparison was made correlating susceptibility in the free-fall phases of parabolic flight with susceptibility to experimental motion sickness in Skylab. In both situations cross-coupled angular accelerations were generated by executing head and body movements out of the plane of rotation. In parabolic flight 9 of 15 subjects reached an endpoint just short of frank motion sickness. In the Skylab workshop all eight of the astronauts tested were symptom free at the end of the test. The explanation for the difference in susceptibility rests in two factors: (1) Basic susceptibility in free fall is lower than on the ground, and (2) in Skylab the astronauts who needed to adapt had achieved this goal prior to the first test on Mission-Day 8.     

Vestibular factors influencing the biomedical support of humans in space

This paper will describe the biomedical support aspects of humans in space with respect to the vestibular system. The vestibular system is thought to be the primary sensory system involved in the short-term effects of space motion sickness although there is increasing evidence that many factors play a role in this complex set of symptoms. There is the possibility that an individual's inner sense of orientation may be strongly coupled with the susceptibility to space motion sickness. A variety of suggested countermeasures for space motion sickness will be described. Although there are no known ground-based tests that can predict space motion sickness, the search should go on. The long term effects of the vestibular system in weightlessness are still relatively unknown. Some preliminary data has shown that the otoconia are irregular in size and distribution following extended periods of weightlessness. The ramifications of this data are not yet known and because the data was obtained on lower order animals, definitive studies and results must wait until the space station era when higher primates can be studied for long durations. This leads us to artificial gravity, the last topic of this paper. The vestibular system is intimately tied to this question since it has been shown on Earth that exposure to a slow rotating room causes motion sickness for some period of time before adaptation occurs. If the artificial gravity is intermittent, will this mean that people will get sick every time they experience it? The data from many astronauts returning to Earth indicates that a variety of sensory illusions are present, especially immediately upon return to a 1-g environment. Oscillopsia or apparent motion of the visual surround upon head motion along with inappropriate eye motions for a given head motion, all indicate that there is much to be studied yet about the vestibular and CNS systems reaction to a sudden application of a steady state acceleration field like 1-g. From the above information it is obvious that the vestibular system does have unique requirements when it comes to the biomedical support of space flight. This is not to say that other areas such as cardiovascular, musculo-skeletal, immunological and hematological systems do not have their own unique requirements but that possible solutions to one system can provide continuing problems to another system. For example, artificial gravity might be helpful for long term stabilization of bone demineralization or cardiovascular deconditioning but might introduce a new set of problems in orientation, vestibular conflict and just plain body motion in a rotating space vehicle.     

Artificial gravity--head movements during short-radius centrifugation: influence of cognitive effects

Short-radius centrifugation is a potential countermeasure against the effects of prolonged weightlessness. Head movements in a rotating environment, however, induce serious side effects: inappropriate vestibular ocular reflexes (VOR), body-tilt illusions and motion sickness induced by cross-coupled accelerations on a rotating platform. These are well predicted by a semicircular canal model. The present study investigates cognitive effects on the inappropriate VOR and the illusory sensations experienced by subjects rotating on a short-radius centrifuge (SRC). Subjects (N=19) were placed supine on a rotating horizontal bed with their head at the center of rotation. To investigate the extent to which they could control their sensations voluntarily, subjects were asked alternatively to "fight" (i.e. to try to resist and suppress) those sensations, or to "go" with (i.e. try to enhance or, at least, acquiesce in) them. The only significant effect on the VOR of this cognitive intervention was to diminish the time constant characterizing the decay of the nystagmus in subjects who had performed the "go" (rather than the "fight") trials. However, illusory sensations, as measured by reported subjective intensities, were significantly less intense during the "fight" than during the "go" trials. These measurements also verified an asymmetry in illusory sensation known from earlier experiments: the illusory sensations are greater when the head is rotated from right ear down (RED) to nose up (NU) posture than from NU to RED. The subjects habituated, modestly, to the rotation between their first and second sequences of trials, but showed no better (or worse) suppression of illusory sensations thereafter. No significant difference in habituation was observed between the "fight" and "go" trials.     

Neurohumoral mechanism of space motion sickness.

This paper reviews existing hypotheses concerning the mechanisms of adaptation of the vestibular apparatus and related somatosensory systems to microgravity with reference to the flight data. Having in view theoretical concepts and experimental data accumulated in space flights, a conceptual model of the development of a funtional system responsible for the termination of vestibular dysfuntion and space motion sickness manifestations is presented. It is also shown that changes in the hormonal status during motion sickness induced by vestibular stimulation give evidence that endocrine regulation of certain functions can be involved in adaptive responses.     

Free fall: a partial unique motion environment

Conditions leading to the elicitation of motion sickness have been divided into two main categories: partial motion environments, in which head movements are required to elicit motion sickness, and complete motion environments, in which independent movements of the head are not required for the production of symptoms. It is postulated that, according to this categorization, free fall constitutes a partial motion environment. In support of this hypothesis evidence is reviewed from Skylab missions, experiments in parabolic flight, and ground-based studies.     

An appraisal of the value of vitamin B12 in the prevention of motion sickness

Unpublished reports have suggested that hydroxycobalamin (B12, i.m.) prevents motion sickness. Some biomedical evidence supports this contention in that B12 influences the metabolism of histidine and choline; dietary precursors to neurotransmitters with established roles in motion sickness. Susceptibility to motion sickness was evaluated after B12 (1000 micrograms, i.m.). Subjects initially completed vestibular function and motion sickness susceptibility tests to establish normal vestibular function. The experimental motion stressor was a modified coriolis sickness susceptibility test. Subjects executed standardized head movements at successively higher RPM until a malaise III endpoint was reached. Following two baseline tests with this motion stressor, subjects received a B12 injection, a second injection two weeks later, and a final motion sickness test three weeks later. No significant differences in susceptibility were noted after B12. Hematological parameters revealed no B12 deficiency before injection. The possibility that patients with B12 deficiencies are more susceptible to motion sickness cannot be ruled out.     

Vestibular tests in the selection of cosmonauts.

Vestibulo-vegetative disorders in cosmonauts and astronauts occurring during space flight compel otolaryngologists to search for vestibular tests enabling a precise evaluation of the activity of the vestibular apparatus and showing disposition to motion sickness. Otoneurological investigation of Polish candidates for cosmonaut status consisted of the following vestibular tests: caloric, rotatory, optokinetic, swinging torsion, statokinesimetric and vestibulo-vegetative. The value of various vestibular tests for aviation and space medicine is presented in this paper, taking into account the results of investigations of the equilibrium system with the group of pilots selected for space flight as well as extensive experience with candidates for the air service and also trained pilots and patients. The relatively frequent lack of correlation between the results of the applied tests, which renders difficult the proper evaluation of the equilibrium system, is emphasized in the paper. Finally, the results of investigations of acute habituation of the vestibular apparatus are discussed.     

Vestibular function in the space environment

Adaptation to the weightless state and readaptation after space flight to the 1-G environment on the ground are accompanied by various transitory symptoms of vestibular instability, kinetosis, and illusory sensations. Aside from the problem of how to treat and if possible prevent such symptoms, they offer a clue to a better understanding of normal vestibular functions. Weightlessness is a powerful new "tool" of vestibular research. Graybiel reported as early as 1952 that human subjects observed the illusion that a real target and the visual afterimage seemed to raise in the visual field during centrifugation when the subjects were looking toward the axis of rotation (oculogravic illusion). In aircraft parabolic-flight weightlessness, human subjects observed that fixed real targets appeared to have moved downward while visual afterimages appeared to have moved upward (oculoagravic illusion). It can be shown by electronystagmography as well as by a method employing double afterimages that part of this illusion is caused by eye movements that are triggered by the changing input from the otolith system. Another part of the illusion is based on a change of the subjective horizontal and must be caused by convergence of vestibular and visual impulses "behind" the eyes. This part was measured independently of the first one by using a new method. Eye movements could be prevented during these experiments by optical fixation with the right eye on a target at the end of a 24-in. long tube which was rigidly attached parallel to the longitudinal axis of an aircraft. At the same time the subject tried to line up a shorter tube, which was pivoting around his left eye, with the subjective horizon.     

Space motion sickness

Space motion sickness, presumably triggered by sudden entry into a weightless environment, occurred with unexpected frequency and severity among astronauts who flew the Skylab missions. Recovery from symptoms was complete within 3-5 days, and as revealed by the Skylab M131 Human Vestibular Function Experiment, all crewmembers were immune to experimentally induced motion sickness after mission day 8. This syndrome has been recognized as a possible threat to the early mission well-being and operational efficiency of at least some individuals who will fly space missions in the future. The causes of space motion sickness are not clearly understood, nor have satisfactory methods been identified to date for its prediction, prevention and treatment. In order to minimize the potential impact of this syndrome on Space Shuttle crew operations the National Aeronautics and Space Administration has organized a broad program of inter-disciplinary research involving a large number of scientists in the United States. Current research on the etiology of space motion sickness is based to a large extent on the so called sensory conflict theory. Investigations of the behavioral and neurophysiological consequences of intralabyrinthine, as well as intermodality sensory conflict are being performed. The work in this area is being influenced by the presumed alterations that occur in otolith behavior in weightlessness. In addition to sensory conflict, the possible relationship between observed cephalad shifts of body fluids in weightlessness and space motion sickness is being investigated. Research to date has failed to support the fluid shift theory. Research underway to identify reliable test methods for the prediction of susceptibility to space motion sickness on an individual basis includes attempts to (a) correlate susceptibility in different provocative environments; (b) correlate susceptibility with vestibular and non-vestibular response parameters, the latter including behavioral, hemodynamic and biochemical factors and (c) correlate susceptibility with rate of acquisition and length of retention of sensory adaptation. Controlled studies are also being performed during parabolic flight as a means of attempting to validate predictive tests for susceptibility to this syndrome. Research to develop new or improved countermeasures for space motion sickness is underway in two primary areas. One of these involves anti-motion sickness drugs. Significant achievements have been realized with regard to the identification of new highly efficacious drug combinations, dose levels and routes of administration. Although pronounced individual variations must be accounted for in selecting the optimum drug and dose level, combinations of promethazine plus ephedrine or scopolamine plus dexidrine are presently the drugs of choice. Work is also underway to identify side effects associated with anti-motion sickness drug use and to identify new drugs which may selectively modify activity in central neural pathways involved in motion sickness. In addition to research on drugs, efforts are being made to develop practical vestibular training methods. Variables which influence rate of acquisition of adaptation, length of retention of adaptation and transfer of protective adaptation to new environments are being evaluated. Also, included in this area is the use of biofeedback and autogenic therapy to train individuals to regulate autonomic responses associated with motion sickness. While valuable new knowledge is expected to evolve from these combined research programs, it is concluded that the final validation of predictive tests and countermeasures will require a series of controlled space flight experiments.     

Male and female characteristics in vestibular testing: a step toward the selection of the best participants for space flight

Vestibular disturbances in connection with space flight were reported by a majority of participating astronauts and cosmonauts. These include motion sickness symptoms in the first few days of the space flight, as well as standing, gait and orientation disturbances after the return to Earth. The Aerospace Medical Community has been trying to select those people that are particularly adapted to the above stresses or that can be further adapted through training programs. As the circle of selectees extends to women, the problem arises as to whether differences between men and women exist under the conditions of space flight. In seeking answers to this question we studied a group of 42 women and 44 men, who were further subdivided according to their subjective motion sickness sensitivity, as determined by a questionnaire. Using this material, 26 men and 22 women were designated as motion sickness resistant, and 18 men and 20 women were designated as nonresistant. The vestibular test battery given these test subjects consisted of caloric, rotatory, optokinetic, vestibulo-spinal and vestibulo-vegetative testing. Because of the mixed orthostatic and vestibular problems seen after space flights, we also studied the response of the vestibular apparatus during peripheral blood pooling as induced by lower body negative pressure. The collected historical and test data are analyzed in this paper with emphasis on the relationship to motion sickness tendency.     

Spacelab experiments on space motion sickness

Recent research results from ground and flight experiments on motion sickness and space sickness conducted by the Man Vehicle Laboratory are reviewed. New tools developed include a mathematical model for motion sickness, a method for quantitative measurements of skin pallor and blush in ambulatory subjects, and a magnitude estimation technique for ratio scaling of nausea or discomfort. These have been used to experimentally study the time course of skin pallor and subjective symptoms in laboratory motion sickness. In prolonged sickness, subjects become hypersensitive to nauseogenic stimuli. Results of a Spacelab-1 flight experiment are described in which four observers documented the stimulus factors for and the symptoms/signs of space sickness. The clinical character of space sickness differs somewhat from acute laboratory motion sickness. However SL-1 findings support the view that space sickness is fundamentally a motion sickness. Symptoms were subjectively alleviated by head movement restriction, maintenance of a familiar orientation with respect to the visual environment, and wedging between or strapping onto surfaces which provided broad contact cues confirming the absence of body motion.     

Summary of experiments onboard Soviet biosatellites.

Physiological, morphological and biochemical studies of mammals flown onboard biosatellites of the series Cosmos revealed changes in their cardiovascular, musculoskeletal, endocrine and vestibular systems. Space flight resulted in moderate stress reactions, intralabyrinthine conflict information during movements and changes in fluid-electrolyte metabolism. Exposure to artificial gravity (1 g) decreased the level of myocardial, musculoskeletal and excretory changes, but disturbed the function of equilibrium. Studies with combined weightlessness and ionizing radiation demonstrated that weightlessness did not produce a significant modifying effect on radiation damage and postradiation recovery. Consistent changes in certain systems of animals and humans in weightlessness confirm the practical importance of biosatellite studies, which also contribute to the solution of general biology, problems associated with gravity effects on life processes.     

Otorhinolaryngological problems in medical support of space flights

At present the main trends among the most important problems of otorhinolaryngology in space medicine have become defined as vestibulology, audiology and clinical aspects (prophylaxis, diagnosis and treatment of ENT diseases in flight). The principal result of recent vestibular studies has probably been the establishment of an apparent relationship between the resistance of the vestibular system to adequate ground-based stimulation and tolerance to space flight. The findings of the studies formed the basis for the development of a new system of vestibular selection, as well as demonstrated the usefulness of special vestibular training of astronauts by active and passive methods. In audiology certain urgency is acquired by the problem of noise limitation in space cabins and auditory system reliability prediction for preserving a high work capability in crew members. The hemodynamic changes in weightlessness, as well as the possibility for allergic lesions, create conditions for distorted course of the ENT diseases and vaso-motor disorders. The prophylaxis of aspirations also deserves close attention since the possibilities of their onset increase in weightlessness. The rendering of immediate, timely aid will depend not only on the presence of the necessary medical equipment but also on the ability of the crew members to render the appropriate otorhinolaryngological aid.     

Relative efficacy of the proposed Space Shuttle antimotion sickness medications

Space motion sickness has been estimated as affecting between 1/3 and 1/2 of all space flight participants. NASA has at the moment proposed a combination of promethazine and ephedrine (P/E) and one of scopolamine and dextroamphetamine (S/D), both given orally, as well as a transdermally applied scopolamine (TAS), as preventive and ameliorative measures. The reported double-blind study, tests the early phase actions and efficacy of the transdermal scopolamine (Transderm (TM)-V of ALZA Corporation) and compares these in detail to the oral medications. Motion sickness resistance was tested by standardized head movements while accelerating at 0.2 degree/sec2 to a maximum rotation of 240 degrees/sec, with an intermediate plateau of 10 min at 180 degrees/sec. To permit weighting motion sickness protection against other system influences, cardiovascular, psychological (subjective and objective), and visual parameter changes were documented for the three therapeutic modes. The relative impact of the various modalities on operational and experimental components of space missions is discussed. A comparison to intramuscularly administered promethazine (a backup therapeutic mode suggested for Space Shuttle use) is also included.     

Voluntary head stabilization in space during trunk movements in weightlessness

The ability to voluntarily stabilize the head in space during lateral rhythmic oscillations of the trunk has been investigated during parabolic flights. Five healthy young subjects, who gave informed consent, were examined. The movements were performed with eyes open or eyes closed, either during phases of microgravity or phases of normal gravity. The main result to emerge from this study is that the head may be stabilized in space about the roll axis under microgravity conditions with, as well as without vision, despite the reduction of the vestibular afferent and the muscle proprioceptive inputs. Moreover, the absence of head stabilization about the yaw axis confirms that the degrees of freedom of the neck can be independently controlled, as it was previously shown [1]. These results seem to indicate that voluntary head stabilization does not depend crucially upon static vestibular afferents. Head stabilization in space may be in fact organized on the basis of either dynamic vestibular afferents or a postural body scheme.     

Future investigations onboard Soviet biosatellites of the Cosmos series.

Many rat experiments onboard Cosmos biosatellites have furnished information concerning the effects of weightlessness, artificial gravity, and ionizing radiation combined with weightlessness on structural and biochemical parameters of the animal body. The necessity to expand the scope of physiological investigations has led to the project of flight primate studies. It is planned to carry out the first primate experiments onboard the Cosmos biosatellite in 1982. At present investigations of weightlessness effects on the cardiovascular and vestibular systems, higher nervous activity, skeletal muscles and biorhythms of two rhesus monkeys are being developed and tested. It is also planned to conduct a study of weightlessness effects on embryogenesis of rats and bioenergetics of living systems onboard the same biosatellite. Further experiments onboard Cosmos biosatellites are planned.     

Arm end-point trajectories under normal and micro-gravity environments

The purpose of the present experiment was to study the way in which the CNS represents gravitational force during vertical arm pointing movements. Movements in upward and downward directions were executed by two cosmonauts in normal-gravity and weightlessness. Analyses focused upon finger kinematics in the sagittal plane. In normal-gravity, downward direction movements showed smaller curvatures and greater relative times to peak velocity (AT/MT) when compared with upward direction movements. Data from the weightlessness experiments showed that whilst downward movements decreased their curvature during space flight, curvatures of upward movements changed slightly. Furthermore, AT/MT was modified during the first days in micro-gravity for both directions, recovering, however, to pre-flight values after 18 days in space. Results from the present study, provide evidence that gravitational force is centrally treated constituting an important component of the motor plan for vertical arm movements.     

ELITE-S2: the multifactorial movement analysis facility for the International Space Station

Experimental observations of adaptation processes of the motor control system to altered gravity conditions can provide useful elements to the investigations on the mechanisms underlying motor control of human subject. The microgravity environment obtained on orbital flights represents a unique experimental condition for the monitoring of motor adaptation. The research in motor control exploits the changes caused by microgravity on the overall sensorimotor process, due to the impairment of the sensory systems whose function depends upon the presence of the gravity vector. Motor control in microgravity has been investigated during parabolic flights and short-term space missions, in particular for analysis of movement-posture co-ordination when equilibrium is no longer a constraint. Analysis of long-term adaptation would also be very interesting, calling for long-term body motion observations during the process of complete motor adaptation to the weightlessness environment. ELITE-S2 is an innovative facility for quantitative human movement analysis in weightless conditions onboard the International Space Station (ISS). ELITE-S2 is being developed by the Italian Space Agency, ASI is to be delivering the flight models to NASA to be included in an expressed rack in US Lab Module in February 2004. First mission is currently planned for summer 2004 (increment 10 ULF 2 ISS).