Retrospect
The All-Union space motion sickness task program was developed and adopted in 1986 on the initiative of Gazenko O.G. and Grigoriev A.I., members of the USSR/Russian Academy of Sciences. Professor Kozlovskaya I.B. (now a corresponding member of the Russian academy of sciences) was assigned the leadership. She set up the Department of Sensorimotor Physiology and Prophylaxis at the IBMP, comprising several laboratories, including the Laboratory of Vestibular Physiology.
1986 is considered the year when the Laboratory for studying of the vestibular physiology and associated sensory systems was founded. From that time on, Prof. Kozlovskaya I.B. has been the scientific adviser of all laboratory projects; Dr.Med.Sci., Prof. Kornilova L.N. is the head of laboratory. The first laboratory members were: Kliushnikov O.N. (Cand.Med.Sci., researcher), Goncharenko A.M. (Cand.Biol.Sci., senior researcher), Arlashchenko N.I. (Dr.Biol.Sci., lead researcher) and Temnikova V.V. (reseacher).
With time the program of clinical-physiological vestibular check-up (BDC) first outlined by Kornilova L.N. not only was expanded (Fig. 1 and 2) but given a new breath. Kornilova L.N. was at the head of research and development of advanced methods and procedures, equipment and hardware-software complexes (HSC) which, added to the BDC protocol, made it possible to evaluate and differentiate the state of various parts of the vestibular system and to specify mechanisms of intersensory interactions in altered gravity (Table 1).
Table 1. Program of the vestibular BDC (“Salyut 4-7″ – “Mir”, 1970-2001)
Studied parameters | Equipment, method | Number of cosmonauts |
Perception of spatial orientation | Device “VERTICAL” (inventor’s certificate № 897220, Bokhov B.B., Kornilova L.N. et al., 1976) | 41 |
Otolith reflex | Device “OTHOLIMETRE” (inventor’s certificate № 8791129, Kornilova L.N. , Yakovleva I.Ya. et al., 1978) | 49 |
Spontaneous eye movements | EOG, positions: 0°; 90°; 120° | 49 |
Fixation succades | EOG, positions: 0°; 90°; 120° | 49 |
Smooth pursuit | EOG, positions: 0°; 90°; 120° | 49 |
Tactile-proprioceptive interaction (oculomotor reaction to muscle strain – Jendrassik maneuver) | EOG, positions: 0°; 90°; 120° | 49 |
Oculomotor reaction to the cerebellum tests | EOG, finger-to-nose test in positions 0°; 90°; 120° | 49 |
Oculomotor postural reaction | EOG, positions: 0°↔120°↔0° | 49 |
Otoliths-canals interaction | EOG, Voyachek test (rotation with and w/o head tilt at the stop stimulus) | 29 |
Vestibular-oculomotor reaction with and w/o fixation target | EOG, rotation w/o and with gaze fixation on a target rotating together with the chair | 18 |
Fig. 1. Preflight examination of precision of perception of the subjective visual vertical
Fig. 2. Preflight examination of the vestibulo-oculomotor reactions during rotation
Realization of the comprehensive vestibular BDC program in pre- and postflight examinations of cosmonauts provided the opportunity to differentiate mechanisms of vestibular disorders, to determine the specific contribution of different sensory inputs in their formation, and to assess the actual role of the sensory and hemodynamic factors in their development. Fragment of postflight examination of the vestibular and associated sensory systems within the BDC program is shown in Fig. 3.
Fig. 3. Postflight examination of cosmonaut Nikolai M. Budarin within the program of BDC
Development and implementation of the vestibular BDC was carried on simultaneously with preparation for and execution of international space experiments.
The Space Motion Sickness Program’ studies were a part of the international cooperation within the framework of INTERKOSMOS (Hungary, Czechoslovakia, German Democratic Republic, Poland, Bulgaria), and also within the broad international cooperation with Austria and USA. Enhanced hardware-software complexes were launched onboard the orbital stations and were made available for testing the vestibular function and visual tracking in weightnessness both during free floating and with additional visual, vestibular and support stimulation (Table 2).
Table 2. Space onboard experiments (1981-1999)
Name of experiment | Number of cosmonauts | Participating countries | Space stations |
“Anketa” (Questionnaire) | 104 | Russia | “Salyut-6″ – “Mir” (1981-2002) |
“Optokinez” (Optokinesis) | 6 | Russia – Hungary | “Salyut 6-7″ (1984-1986) |
Oculostim | 4 | Russia | “Salyut-7″ (1986-1987) |
Labirint-1, Labirint-2 | 8 | Russia – Bulgaria | “MIR” (1988-1991) |
Optovert-1, Optovert-2 | 17 | Russia – Austria | “MIR” (1992-1999) |
VOG | 4 | Russia – Germany | “MIR” (1996-1997) |
Asymmetry | 4 | Russia – Slovakia | “MIR” (1997-1999) |
Biocontrol | 4 | Russia – USA | “MIR” (1997-1999) |
In these space experiments for the first time there were recorded several unique phenomena such as absence and inversion of the otolith reflex and inversion of the vection illusion. It was also shown that reduction of the tonic (static) vestibular excitability is accompanied by an increase of the dynamic vestibular reactivity, which was confirmed by a statistically significant negative correlation. Figure 4 shows an episode of postflight examination of cosmonaut Valeri V. Polyakov following his 438-day MIR mission (experiment “Optovert” within the ASTROMIR program). Figure 5 shows postflight examination of cosmonaut Valeri G. Korzun.
Fig. 4. Postflight examination of cosmonaut Valeri V. Polyakov in experiment “Optovert”
Fig. 5. Postflight examination of cosmonaut Valeri G. Korzun in experiment “Sensory Adaptation”
Within the “SMS” Progam laboratory of Vestibular Physiology along with intensive research of neurovestibular mechanisms of adaptation to altered gravity in spaceflight started stuides in simulated/model experiments (5 and 7-day “dry” horizontal immersion) and clinical studies. These reseaches were carried out in cooperation with the Department of Neurology of the I.M. Sechenov First Moscow State Medical University and the Department of Otorhinolaryngology of the N.I. Pirogov Russian National Research Medical University.
The results obtained directly during the spaceflight, after landing, and in model (simulated experiments) and clinical studies allowed the laboratory of Vestibular Physiology to make an insight into how the vestibular system functions and interacts with other sensory systems in altered gravity.
It was shown that weightlessness triggers central deafferentation of distorted vestibular signal which forces to choose a new visual tracking’ strategy (so-called saccadic approximation), involving of innervation mechanisms of all levels of the vestibular and oculomotor systems.
Dry immersion experiments (Fig. 6) for the first time demonstrated that removal of support and decrease of proprioceptive afferentation may alter the functioning of the vestibular input itself (through the central integrative mechanisms of the vestibular system) and impact the precision, velocity and time parameters of all forms of visual and visual-manual tracking.
Fig. 6. The visual-manual tracking test with the use of the HSC “SENSOMOTOR” system in a dry immersion experiment>
Results of long-term studies of perceptive and sensorimotor disorders observed in weightlessness and complicating the movement control revealed signs of dysfunction of visual tracking and criteria, required to develop new methods for monitoring and training to optimize the quality of visual control of space objects’ motion.
Investigators from GCTC, Lomonosov Moscow State University and IBMP succeeded in theoretical justification and experimental verification of the possibility to reproduce some spaceflight factors that provoke sensory disorders in dynamic training facilities, centrifuge specifically. The centrifuge training is conducted using dedicated software with an in-built test of visual-manual performance. The new technology of cosmonauts’ professional selection and training for operation of complex ergative systems embodies the principle of simulating the physiological effects of microgravity by modeling the intravestibular (canal-otolith) conflict.
The team of authors of the unique intellectual dynamic facility of the centrifuge type with upgraded software for cosmonauts’ selection and training (V.A. Sadovnichy, V.V. Aleksandrov, S.S. Lemak, A.I. Grigoriev, I.B. Kozlovslaya, L.N. Kornilova, P.K. Klimuk, L.I. Voronin) was awarded with the Russian Federation State Prize in Science and Technology for 2002. The GCTC CF-18 centrifuge was retrofitted into the dynamic training facility (Fig. 7).
Fig. 7. Dynamic training facility (CF-18) for building up skills and to simulate operations in orbit and descent to Earth using programs of the orbital stations “MIR” and ISS
Modern neurology, vestibulogy, otoneurology, ophthalmology, psychophysiology, therapy and other medical disciplines need mobile portable multifunctional equipment and hardware-software complexes that will in a short time provide operative, diagnostically valuable and objective information about the state of sensorimotor systems responsible for spation orientation.
Special methods (Fig. 8) and computerized test programs were developed at laboratory of Vestibular Physiology to diagnose functional disorders in these systems (Kornilova L.N. et al., Russian Federation patent #1454374, 1993; #2301622, 2007; #2307575, 2007). Computerization of examinations and assessments was done with assistance of high-level applied software developers (Sagalovich V.N., Sagalovich S.V., Stefankov D.V., Azarov K.A., Naumov I.A.). These experts and partners from the LLC Scientific Medical Company “STATOKYN” (Dotsenko V.I., Director General), Special Design Office “RHYTM” (Sliva S.S., Head of Department) and LLC Scientific and Production Association “INNOVATIVE MEDICAL TECHNOLOGIES” (Borunov D.L.) designed and created a number of computerized systems including hardware-software complexes “SENSOMOTOR”, “VIRTUAL”, “OCULOSTIM” and “OCULOSTIM-CM”.
Fig. 8. Patents received by laboratory in 2007
Created hard-software complexes and new computerized test procedures to assess the state of the vestibular function, intersensory interactions, visual and visual-manual tracking were used to design and create: a) a new vestibular BDC for the ISS Russian crewmembers, b) pre- and postflight science experiments “SENSORY ADAPTATION-1″ and “SENSORY ADAPTATION-2″ (Fig. 9), and joint Russian-Belgium experiment “GazeSPIN” (Fig. 10). p>
Fig. 9. Postflight testing of cosmonauts (Sergei A. Volkov and Oleg V. Novitsky) participating in the science experiment “SENSORY ADAPTATION”
Fig. 10. Postflight testing of cosmonauts participating in the science experiment “GazeSPIN”
The multilevel approach to the studies of the orientation system and intersensory interactions was taken as a starting point for the development of test procedures to assess the vestibular function, intersensory interactions, visual and visual-manual tracking, and HSC “SENSOMOTOR”, “OCULOSTIM”, “OCULOSTIM-CM” and “VIRTUAL” with unique software (Fig. 11).
Fig. 11. OCULOSTIM complex. Examination of visually-induced oculomotor reactions and accuracy of visual-manual tracking with and w/o optokinetic noise
The developed innovative complexes, OCULOSTIM and VIRTUAL specifically, allow to study of the vestibular function and nearly all forms of visual and visual-manual tracking in weightlessness, on return to the normal gravity, and in ground-based model (simulated) and clinical conditions.
Trial application and approbation of the computerized tests and HSC OCULOSTIM for the needs of space medicine demonstrated their potentialities for:
- provision of realtime objective information about the state of the vestibular function and various levels of the CNS;
- assessment and prediction of the performance of visual and visual-manual tracking in conditions complicated by additional visual and vestibular stimuli.
Trial application and approbation of the HSC “OCULOSTIM-CM” in clinic at the Department of Neurology of the I.M. Sechenov First Moscow State Medical University, held jointly with the academician Vein A.M. and Professor Solovieva A.D., demonstrated the possibility of expert diagnostic assessment of the vestibular function, the oculomotor system, the orientation system in general and the possibility of objectification of subjective complaints of patients on dizziness, vertigo and equilibrium disturbances.
In recent years, staff of laboratory of Vestibular Physiology (Kornilova L.N., Sagalovich V.N., Naumov I.A., Khabarova E.V. and Ekimovskiy G.A.) was engaged in definition and creation of diagnostic criteria for differentiation of vestibulopathies of various genesis. To this end, methods of discriminant statistical analysis were used to process the results of assessment of over 200 clinical patients, which analysis allowed to propose a classification of vestibular pathologies depending on the origin of disorder.
For the first time, based on a defined set of diagnostic criteria there was created an integral computerized algorithm of differential diagnosis of peripheral, cerebral or psychogenic vestibulopathies in individual patient with pre-symptoms (subclinical) phase of the disease without additional clinical assessements using neurology and instrumental means.
The coincidence of the assessment/survey results obtained by the HSC OCULOSTIM-CM and by clinical diagnosis and magnetic resonance imaging (MRI) is following:
- peripheral vestibulopathy – 95.8 % of patients
- cerebral vestibulopathy – 88.9 % of patients
- psychogenic vestibulopathy – 81.0 % of patients
The developed concept and created algorithm of differentiation of vestibulopathies of various origins using complex computerized expert-diagnostic tests are original, have no analogues in domestic and foreign literature.
Using the clinical modification (CM) of the HSC “OCULOSTIM-CM” that has three alternative stimulation programs (visual, vestibular, and combined), researchers of laboratory of Vestibular Physiology developed a non-pharmacological (computerized) method to prevent, correct and cease of adverse perceptive and sensorimotor reactions (dizziness, vertigo and balance disorders) by training of the fixation reflex with separate or combined optokinetic and vestibular stimulation with biofeedback (Kornilova L.N. et al., Russian Federation patent #2301622, 2007).
Clinical trial and approbation of the non-pharmacological computerized method of therapy and prophylaxis of vertigo, dizziness and balance disorders demonstrated its benefits to patients with organic (peripheral or cerebral) as well as psychogenic vestibulopathies. The method was recommended for the program of Russian cosmonauts training.
After the trial application and approbation in the clinical environment and model experiments (2009-2013), the innovative computerized method of differential diagnosis of disorders in the vestibular system, intersensory interactions and visual tracking (HSC “VIRTUAL”) was successfully used before, during and after spaceflights in science experiment “VIRTUAL” with participation of the ISS-37/38 Russian crewmembers (cosmonauts Sergei N. Ryazansky and Oleg V. Kotov) (Fig. 12).
Fig. 12. Space experiment “VIRTUAL” aboard the ISS RS during the ISS-37/38/39 expeditions (Russian crewmembers Oleg V. Kotov, Sergei N. Ryazansky, Mikhail V. Tiurin)
New data have been obtained concerning the role of gravity in the functioning of the vestibular system, nature of intersensory interactions and accuracy of spatial visual perception. Statistical analysis of postflight data from 42 ISS cosmonauts pointed to the following effects of longterm exposure to weightlessness:
- a sharp decrease up to complete deafferentation of the tonic (static) otolith vestibular reflex and concurrent strengthening of canals reflexes (a significant negative correlation);
- statistically significant deterioration of all parameters of visual and visual-manual tracking (as for visual-manual tracking, manual tracking is much more accurate than visual);
- correlations between the vestibular’ and visual tracking parameters; absence of correlations between the vestibular’ and manual tracking parameters;
- statistically significant decrease of the time of posflight recovery of vestibular function, visual and visual-manual tracking after repeated spaceflight.
In 2011-2013 laboratory staff were actively involved in the design, construction and testing of the stochastic and galvanic vestibular stimulator (which is a property of our Department at this moment), created in collaboration with the St. Petersburg State University of Aerospace Instrumentation.
At present, laboratory of Vestibular Physiology plans to continue studies of the role of individual sensory inputs in intersensory interaction, which provides accurate perception and spatial orientation. In addition, of great promise seem to be: a) studies of the galvanic/stochastic vestibular stimulation to prevent and cease vertigo, dizziness and balance disorders, b) definition and creation of diagnostic criteria for objective diagnosis of systemic (vestibular) vertigo and non-systemic dizziness and balance disorders in subclinical phase of disease, c) as well as development and modernization of innovative computerized means and portative hardware-software complexes (including using a table PC with a touch screen).
Since the foundation of laboratory of Vestibular Physiology, Prof. Kornilova L.N. in co-authorship with her fellow researchers has published more than 200 articles in Russia and abroad including over 100 papers in peer-reviewed journals, has written 8 chapters in monographs, and received 9 patents.
Ludmila N. Kornilova – Dr.Med.Sci., Prof., M.D., Laureate of the State Prize of the Russian Federation for Science and Technology, academician of the International Academy of Astronautics.
Awards:
- medal “Veteran of Labor”
- medal “850 years of Moscow”
- gold and bronze medals of the Exhibition of Economic Achievements
- Endre Hogyes’ gold medal of the Hungarian Academy of Sciences
- gold medal of the Czechoslovak Academy of Sciences
- medal “20 Years of INTERKOSMOS” of the Slovak Academy of Sciences
- diploma “Who’s Who in Science and Engineering” “MARQUIS – WHO’S WHO”
- State Prize of the Russian Federation in the field of Science and Technology
- medal “Veteran of the IBMP”
- honorary title “Veteran of the Russian Cosmonautics”
- honorary title “Veteran of Space Medicine – GCTC”
- badge of honor “50 years of Yu.A. Gagarin’ spaceflight” – GCTC
- Yu.A. Gagarin Medal of the Federal Space Agency for personal creative contribution in the implementation of space programs and projects
- medal of academician O.G. Gazenko of the Russian Cosmonautics Federation for merits to the cosmonautics
The current staff of the laboratory of VESTIBULAR PHYSIOLOGY:
- Kornilova Ludmila N. – Dr.Med.Sci., Prof., head of laboratory
- Sagalovich Viktor N. – Dr.Tech.Sci., lead programmer
- Naumov Ivan A. – senior researcher
- Ekimovskiy Georgiy A. – M.D., senior specialist, senior researcher
- Glukhikh Dmitry O. – junior researcher, postgraduate
- Khabarova Ekaterina V. – junior researcher
- Pavlova Aleksandra S. – senior research assistant