Space medicine

Space medicine


Space medicine is the practice of medicine on astronauts in outer space whereas astronautical hygiene is the application of science and technology to the prevention or control of exposure to the hazards that may cause astronaut ill health. Both these sciences work together to ensure that astronauts work in a safe environment. The main objective is to discover how well and for how long people can survive the extreme conditions in space, and how fast they can adapt to the Earth's environment after returning from their voyage. Medical consequences such as possible blindness and bone loss have been associated with human spaceflight.[2][3]


Hubertus Strughold (1898–1987), a former Nazi physician and physiologist, was brought to the United States after World War II as part of Operation Paperclip.[4] He first coined the term "space medicine" in 1948 and was the first and only Professor of Space Medicine at the School of Aviation Medicine (SAM) at Randolph Air Force Base, Texas. In 1949 Strughold was made director of the Department of Space Medicine at the SAM (which is now the US Air Force School of Aerospace Medicine (USAFSAM) at Brooks Air Force Base, Texas). He played an important role in developing the pressure suit worn by early American astronauts. He was a co-founder of the Space Medicine Branch of the Aerospace Medical Association in 1950. The aeromedical library at Brooks AFB was named after him in 1977, but later renamed because documents from the Nuremberg War Crimes Tribunal linked Strughold to medical experiments in which inmates of the Dachau concentration camp were tortured and killed.[5]



Medical space spinoffs (pre-Mercury through Apollo)

  • Radiation therapy for the treatment of cancer: In conjunction with the Cleveland Clinic, the cyclotron at Glenn Research Center in Cleveland, Ohio was used in the first clinical trials for the treatment and evaluation of neutron therapy for cancer patients.
  • Foldable walkers: Made from a lightweight metal material developed by NASA for aircraft and spacecraft, foldable walkers are portable and easy to manage.
  • Muscle stimulator device: This device is used for ½ hour per day to prevent muscle atrophy in paralyzed individuals. It provides electrical stimulation to muscles which is equal to jogging three miles per week. Christopher Reeve used these in his therapy.
  • Orthopedic evaluation tools: Equipment to evaluate posture, gait and balance disturbances was developed at NASA, along with a radiation-free way to measure bone flexibility using vibration.
  • Diabetic foot mapping: This technique was developed at NASA’s center in Cleveland, Ohio to help monitor the effects of diabetes in feet.
  • Kidney dialysis machines: These machines rely on technology developed by NASA in order to process and remove toxic waste from used dialysis fluid.
  • Talking wheelchairs: Paralyzed individuals who have difficulty speaking may use a talking feature on their wheelchairs which was developed by NASA to create synthesized speech for aircraft.
  • Collapsible, lightweight wheelchairs: These wheelchairs are designed for portability and can be folded and put into trunks of cars. They rely on synthetic materials that NASA developed for its air and space craft
  • Implantable heart defibrillator: This tool continuously monitors heart activity and can deliver an electric shock to restore heartbeat regularity.
  • Weightlessness therapy: The weightlessness of space can allow some individuals with limited mobility on Earth—even those normally confined to wheelchairs—the freedom to move about with ease. Physicist Stephen Hawking took advantage of weightlessness in NASA's Vomit Comet aircraft in 2007. This idea also led to the development of the Anti-Gravity Treadmill from NASA technology.

Medical investigations in space during the Space Shuttle era

John Glenn, the first American astronaut to orbit the Earth, returned with much fanfare to space once again on STS-95 at 77 years of age to confront the physiological challenges preventing long-term space travel for astronauts—loss of bone density, loss of muscle mass, balance disorders, sleep disturbances, cardiovascular changes, and immune system depression—all of which are problems confronting aging people as well as astronauts. Once again Glenn stepped forward to play a historic role in the future of space exploration, but this time he would provide new medical research in the field of gerontology as well.

Effects of space-travel

The effects of microgravity on fluid distribution around the body (greatly exaggerated) (NASA)

Cardiac rhythms

Heart rhythm disturbances have been seen among astronauts. Most of these have been related to cardiovascular disease, but it is not clear whether this was due to pre-existing conditions or effects of space flight. It is hoped that advanced screening for coronary disease has greatly mitigated this risk. Other heart rhythm problems, such as atrial fibrillation, can develop over time, necessitating periodic screening of crewmembers’ heart rhythms. Beyond these terrestrial heart risks, some concern exists that prolonged exposure to microgravity may lead to heart rhythm disturbances. Although this has not been observed to date, further surveillance is warranted.

Decompression sickness

Decompression illness in spaceflight



Decompression sickness






Barotrauma is the injury to the tissues of air filled spaces in the body as a result of differences in pressure between the body spaces and the ambient atmospheric pressure. Air filled spaces include the middle ears, paranasal sinuses, lungs and gastrointestinal tract. One would be predisposed by a pre-existing upper respiratory infection, nasal allergies, recurrent changing pressures, dehydration, or a poor equalizing technique.




Ultrasound and space

Ultrasound is the main diagnostic imaging tool on ISS and for the foreseeable future missions. X-rays and CT scans involve radiation which is unacceptable in the space environment. Though MRI uses magnetics to create images, it is too large at present to consider as a viable option. Ultrasound, which uses sound waves to create images and comes in laptop size packages, provides imaging of a wide variety of tissues and organs. It is currently being used to look at the eyeball and the optic nerve to help determine the cause(s) of changes that NASA has noted mostly in long duration astronauts. NASA is also pushing the limits of ultrasound use regarding musculoskeletal problems as these are some of the most common and most likely problems to occur. Significant challenges to using ultrasounds on space missions is training the astronaut to use the equipment (ultrasound technicians spend years in training and developing the skills necessary to be "good" at their job) as well as interpreting the images that are captured. Much of ultrasound interpretation is done real-time but it is impractical to train astronauts to actually read/interpret ultrasounds. Thus, the data is currently being sent back to mission control and forwarded to medical personnel to read and interpret. Future exploration class missions will need to be autonomous due to transmission times taking too long for urgent/emergent medical conditions. The ability to be autonomous, or to use other equipment such as MRIs, is currently being researched.

Medicine in space

The Advanced Diagnostic Ultrasound in Microgravity Study is funded by the National Space and Biomedical Research Institute and involves the use of ultrasound among Astronauts including former ISS Commanders Leroy Chiao and Gennady Padalka who are guided by remote experts to diagnose and potentially treat hundreds of medical conditions in space. This study has a widespread impact and has been extended to cover professional and Olympic sports injuries as well as medical students. It is anticipated that remote guided ultrasound will have application on Earth in emergency and rural care situations. Findings from this study were submitted for publication to the journal Radiology aboard the International Space Station; the first article submitted in space.[6][7][8]

Decreased immune system functioning



Effects of fatigue

Human performance

Loss of balance

Leaving and returning to Earth’s gravity causes “space sickness,” dizziness, and loss of balance in astronauts. By studying how changes can affect balance in the human body—involving the senses, the brain, the inner ear, and blood pressure—NASA hopes to develop treatments that can be used on Earth and in space to correct balance disorders. Until then, NASA’s astronauts must rely on a medication called Midodrine (an “anti-dizzy” pill that temporarily increases blood pressure) to help carry out the tasks they need to do to return home safely.

Loss of bone density

Spaceflight osteopenia is the bone loss associated with human spaceflight.[3] After a 3-4 month trip into space, it takes about 2–3 years to regain lost bone density. New techniques are being developed to help astronauts recover faster. Research in the following areas holds the potential to aid the process of growing new bone:

  • Diet and Exercise changes may reduce osteoporosis.
  • Vibration Therapy may stimulate bone growth.

Loss of muscle mass

In space, muscles in the legs, back, spine, and heart weaken and waste away because they no longer are needed to overcome gravity, just as people lose muscle when they age due to reduced physical activity.[3] Astronauts rely on research in the following areas to build muscle and maintain body mass:

  • Medication may trigger the body into producing muscle growth proteins.

Loss of eyesight

After long space flight missions, astronauts may experience severe eyesight problems.[2][3][10][11][12][13][14] Such eyesight problems may be a major concern for future deep space flight missions, including a manned mission to the planet Mars.[10][11][12][13][15]

Loss of mental abilities and risk of Alzheimer's Disease

On December 31, 2012, a NASA-supported study reported that manned spaceflight may harm the brain of astronauts and accelerate the onset of Alzheimer's disease.[16][17][18]

Human-machine interface

Comparison of Radiation Doses - includes the amount detected on the trip from Earth to Mars by the RAD on the MSL (2011 - 2013).[19][20][21][22]

Orthostatic intolerance


Psychological factors

Radiation effects

Soviet cosmonaut Valentin Lebedev, who spent 211 days in the orbit in 1982 (an absolute record for stay in Earth’s orbit), lost his eyesight to progressive cataract. Lebedev stated: “I suffered from a lot of radiation in space. It was all concealed back then, during the Soviet years, but now I can say that I caused damage to my health because of that flight.”[3][24] On 31 May 2013, NASA scientists reported that a possible manned mission to Mars may involve a great radiation risk based on the amount of energetic particle radiation detected by the RAD on the Mars Science Laboratory while traveling from the Earth to Mars in 2011-2012.[15][19][20][21][22]


Sleep disorders

Fifty percent of space shuttle astronauts take sleeping pills and still get two hours or less of sleep. NASA is researching two areas which may provide the keys to a better night’s sleep, as improved sleep decreases fatigue and increases daytime productivity. A variety of methods for combating this phenomenon are constantly under discussion. A partial list of remedies would include:

  • Go to sleep at the same time each night. With practice, you will (almost) always be tired and ready for sleep.
  • Melatonin, once thought to be an anti-aging wonder drug (this was due to the well-documented observation that as people age they gradually produce less and less of the hormone naturally). The amount of melatonin the body produces decreases linearly over a lifetime. Although the melatonin anti-aging fad was thoroughly debunked following a large number of randomized trials, it was soon in the spotlight once more due to the observation that a healthy person's normal melatonin levels varies widely throughout each day: usually, levels rise in the evening and fall in the morning. Ever since the discovery that melatonin levels are highest at bedtime, melatonin has been purported by some to be an effective sleep-aid - it is especially popular for jet-lag. Melatonin's efficacy in treating insomnia is hotly debated and therefore in the US it is sold as a dietary supplement. "These statements have not been evaluated by the FDA" is printed on the packaging even though melatonin has been studied very extensively.
  • Ramelteon, a melatonin receptor agonist, is a relatively new drug designed by using the melatonin molecule and the shapes of melatonin receptors as starting points. Ramelteon binds to the same M1 and M2 receptors in the suprachiasmatic nucleus (the "biological clock" in the brain) as melatonin (M1 and M2 get their names from melatonin). It also may derive some of its properties from its three-times greater elimination half-life. Ramelteon is not without detractors who claim that it is no more effective than melatonin, and melatonin is less expensive by orders of magnitude. It is unclear whether Ramelteon causes its receptors to behave differently than they do when bound to melatonin, and Ramelteon may have a significantly greater affinity for these receptors. Better information on Ramelteon's effectiveness should be available soon, and despite questions of its efficacy, the general lack of side effects makes Ramelteon one of the very few sleep medications that could potentially be safely used by astronauts.
  • Barbiturates and Benzodiazepines are both very strong sedatives. While they certainly would work (at least short term) in helping astronauts sleep, they have side effects that could affect the astronaut's ability to perform his/her job, especially in the "morning." This side effect renders barbiturates and benzodiazepines likely unfit as treatments for space insomnia. Narcotics and most tranquilizers also fall into this category.
  • Zolpidem and Zopiclone are sedative-hypnotics, better known by their trade names "Ambien" and "Lunesta". These are extremely popular sleep-aids, due in large part to their effectiveness and significantly reduced side-effect profiles vis-a-vis benzodiazepines and barbiturates. Although other drugs may be more effective in inducing sleep Zolpidem and Zopiclone essentially lack the sorts of side effects that disqualify other insomnia drugs for astronauts, for whom being able to wake up easily and quickly can be of paramount importance; astronauts who are not thinking clearly, are groggy, and are disoriented when a sudden emergency wakes them could end up trading their grogginess for the indifference of death in seconds. Zolpidem, Zopiclone, and the like - in most people - are significantly less likely to cause drug-related daytime sleepiness, nor excessive drowsiness if woken abruptly.
  • Practice good sleep hygiene. In other words, the bed is for sleeping only; get out of bed within a few moments of waking up. Do not sit in bed watching TV or using a laptop. When one is acclimated to spending many hours awake in bed, it can disrupt the body's natural set of daily cycles, called the circadian rhythm. While this is less of an issue for astronauts who have very limited entertainment options in their sleeping areas, another aspect of sleep hygiene is adhering to a specific pre-sleep routine (shower, brush teeth, fold up clothing, spend 20 minutes with a trashy novel, for example); observing this sort of routine regularly can significantly improve one's sleep quality. Of course, sleep hygiene studies have all been conducted at 1G, but it seems possible (if not likely) that observing sleep hygiene would retain at least some efficacy in micro-gravity.
  • Modafinil is a drug that is prescribed for narcolepsy and other disorders that involve excessive daytime exhaustion. It has been approved in various military situations and for astronauts thanks to its ability to stave off fatigue. It is unclear whether astronauts sometimes use the drug because they are sleep-deprived - it might only be used on spacewalks and in other high-risk situations.
  • Dexedrine is an amphetamine which used to be the gold-standard for fighter pilots flying long and multiple sorties in a row, and therefore may have at some point been available if astronauts were in need of a strong stimulant. Today, Modafinil has largely - if not entirely - replaced Dexedrine; reaction time and reasoning among pilots who are sleep-deprived and on Dexedrine suffer, and get worse the longer the pilot stays awake. In one study, helicopter pilots that were given six-hundred milligrams of Modafinil every three hours were able to perform with the same accuracy as they did at pre-deprivation levels for 40 hours without sleep; significant impairment would have been evident had the pilots been given Dexedrine instead.[25]

Spatial disorientation

Spaceflight analogues

Biomedical research in space is expensive and logistically and technically complicated, and thus limited. Conducting medical research in space alone will not provide humans with the depth of knowledge needed to ensure the safety of inter-planetary travellers. Complimentary to research in space is the use of spaceflight analogues. Analogues are particularly useful for the study of immunity, sleep, psychological factors, human performance, habitability, and telemedicine. Examples of spaceflight analogues include confinement chambers (Mars-500), sub-aqua habitats (NEEMO), and Antarctic (Concordia Station) and Arctic (Haughton–Mars Project) stations.[15]

Medical interventions

Space medicine careers

Related degrees, areas of specialization, and certifications

  • Aeromedical certification
  • Aerospace medicine
  • Aerospace studies
  • Anesthesiology
  • Emergency medicine
  • Internal medicine
  • Occupational and preventive medicine
  • Ophthalmology
  • Otolaryngology

Space nursing


See also


  1. ^ "International Space Station Medical Monitoring (ISS Medical Monitoring)". 3 December 2013. Retrieved January 13, 2014. 
  2. ^ a b Chang, Kenneth (January 27, 2014). "Beings Not Made for Space".  
  3. ^ a b c d e Mann, Adam (July 23, 2012). "Blindness, Bone Loss, and Space Farts: Astronaut Medical Oddities".  
  4. ^ Andrew Walker (21 November 2005). "Project Paperclip: Dark side of the Moon". BBC News. Retrieved 2012-04-25. 
  5. ^ "Former Nazi removed from Space Hall of Fame". MSNBC. Associated Press. 2006-05-19. Retrieved 2006-05-19. 
  6. ^ "Advanced Diagnostic Ultrasound in Microgravity (ADUM)". 2011-11-08. Retrieved 2012-02-10. 
  7. ^ Sishir Rao, BA, Lodewijk van Holsbeeck, BA, Joseph L. Musial, PhD, Alton Parker, MD, J. Antonio Bouffard, MD, Patrick Bridge, PhD, Matt Jackson, PhD and Scott A. Dulchavsky, MD, PhD (May 1, 2008). "A Pilot Study of Comprehensive Ultrasound Education at the Wayne State University School of Medicine". Journal of Ultrasound in Medicine 27 (5): 745–749.  
  8. ^ E. Michael Fincke, MS, Gennady Padalka, MS, Doohi Lee, MD, Marnix van Holsbeeck, MD, Ashot E. Sargsyan, MD, Douglas R. Hamilton, MD, PhD, David Martin, RDMS, Shannon L. Melton, BS, Kellie McFarlin, MD and Scott A. Dulchavsky, MD, PhD (February 2005). "Evaluation of Shoulder Integrity in Space: First Report of Musculoskeletal US on the International Space Station". Radiology 234 (2): 319–322.  
  9. ^ Kim W et al. (April 29, 2013). "Spaceflight Promotes Biofilm Formation by Pseudomonas aeruginosa".  
  10. ^ a b Mader, T. H. et al. (2011). Oph "Optic Disc Edema, Globe Flattening, Choroidal Folds, and Hyperopic Shifts Observed in Astronauts after Long-duration Space Flight".  
  12. ^ a b "Male Astronauts Return With Eye Problems (video)". CNN News. 9 Feb 2012. Retrieved 2012-04-25. 
  15. ^ a b c Fong, MD, Kevin (12 February 2014). "The Strange, Deadly Effects Mars Would Have on Your Body".  
  18. ^  
  22. ^ a b Gelling, Cristy (June 29, 2013). "Mars trip would deliver big radiation dose; Curiosity instrument confirms expectation of major exposures".  
  23. ^ "When Space Makes You Dizzy". NASA. 2002. Retrieved 2012-04-25. 
  24. ^ "Soviet cosmonauts burnt their eyes in space for USSR’s glory". Pravda.Ru. 17 Dec 2008. Retrieved 2012-04-25. 
  25. ^ John A. Caldwell, Jr., Nicholas K. Smythe, III, J. Lynn Caldwell, Kecia K. Hall, David N. Norman, Brian F. Prazinko, Arthur Estrada, Philip A. Johnson, John S. Crowley, Mary E. Brock (June 1999). "The Effects of Modafinil on Aviator Performance During 40 Hours of Continuous Wakefulness". U.S. Army Aeromedical Research Laboratory. Retrieved 2012-04-25. 
  26. ^ "Space Nursing Society". Retrieved 5 December 2011. 


  • Altitude Decompression Sickness Susceptibility, MacPherson, G; Aviation, Space, and Environmental Medicine, Volume 78, Number 6, June 2007, pp. 630–631(2)

External links

  • Description of space medicine
  • NASA History Series Publications (many of which are online)
  • Sleep in Space, Digital Sleep Recorder used by NASA in STS-90 and STS-95 missions
  • A Solution for Medical Needs and Cramped Quarters in Space - NASA


