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A PROJECT ON

ROLE OF PHYSIOTHERAPY IN ASTRONAUT


TRAINING

Project submitted to
Dr N.T.R. University of health and sciences, Vijayawada towards
The partial fulfillment of the degree,

BACHELOR OF PHYSIOTHERAPY
By
M.UMA MAHESH
Reg.no.11040010

VISAKHA ACADEMY OF PARAMEDICAL SCIENCES


COLLEGE OF PHYSIOTHERAPY,
MADHURWADA, VISAKHAPATNAM
2011-2016

ACKNOWLEDGEMENT
My whole hearted thanks to the VAPMS management especially to late professor
Dr.K.S.N.R.V.Subba Rao, founder chairman, VAPMS charitable trust, Visakhapatnam for
giving me an opportunity to shape my carrier in his institution and also to
Mr.K.V.Ramesh(Tresorer),Secretary for providing necessary requirements to complete this
study.
I would like to express my sincere thanks to Dr.Sidharth Dara M.P.T Ortho, Principal
and Professor of VAPMS College of physiotherapy for his supportive guidance,
encouragement and valuable advices.
I Would like to express my heartfelt gratitude and would never forget to gratify
Dr. Venkata Ramaiah, MPT Ortho , associate professor of VAPMS college without whose
guidance, suggestions, support and continues encouragement, I would not have completed my
work successfully.
My sincere gratitude to Associate Professor Dr. K. Neeraja, MPT Cardio, Associate
Professor Dr. M. Rajani cartor, MPT Ortho, Dr.T.Sirisha, MPT Neuro, Associate
Professor, , Associate professor Dr.Ch.Sri Vidya

MPT Neurology Assistant Professor,

Dr.Supriya Sudharashini MPT Orthopaedics, MPT Orhto, Assistant professor Dr., MPT
and Assistant professor Dr. P. Visweswara Rao MPT Cardio, of our college extended their
support in academic career.
I am very thankful to my clinical posting in charges during my academic year Dr. Navya
MPT Cardiology Assistant Professor, Dr.Madhuri MPT Neurology Assistant professor,
Dr.Bharath MPT Neurology ,Dr .Nisse raj MPT Neurology Assistant professor.
Last but not least I like to specially thank Mrs. R. Krishna Kumari, Librarian and my
friends who extended their help in completion of this project.

M.UMA MAHESH

SPECIAL THANKS
I would fail my duty if I do not express my gratitudes to my loving parents, especially
my sincere thanks to Dr. M. Rajini cator sir and my friends Prathusha, K.Harish, Swathi
,Chaitanya,Prabhudas always stood behind me and without whose encouragement and support
this work could not have been completed.
`

DEDICATED
TO
MY LOVING PARENTS
&
INDIAN ASTRONAUTS

ROLE OF
PHYSIOTHERAPY IN
ASTRONAUT TRAINING

INDEX
S.NO

Pg.No

1) INTRODUCTION

1-2

2) BIO-PHYSICS

3-7

3) MICRO GRAVITY EFFECTS ON HUMAN PHYSIOLOGY

8-16

4) INVESTIGATIONS

17-18

5) MEDICAL MANAGEMENT

19-20

6) PHYSIOTHERAPY MANAGEMENT
PRE-FLIGHT PHASE
IN FLIGHT PHASE
POST FLIGHT PHASE

26-47

7) CONCLUSION

48

8) BIBILOGRAPHY

49-52

INTRODUCTION

INTRODUCTION
Space exploration is the ongoing discovery and exploration of celestial structures in outer space by
means of continuously evolving and growing space technology1.
While the study of space is carried out mainly by astronomers with telescopes, the physical
exploration of space is conducted both by unmanned robotic probes and human spaceflight.
Human space flight started as a race between the two super powers of the world( RUSSIA AND
USA) however, already during the Cold War, human space flight became emblematic that peaceful
cooperation was possible (Soyuz-Apollo, Shuttle-Mir mission)14.
Today, human space flight is characterized by a worldwide cooperation by many countries. Future
human space flight32 endeavors will be worldwide cooperation efforts, maybe including emerging
space-faring countries (China, India), and this for several reasons: political, financial, technological
and scientific.
The human body is an extraordinary but, also, an astonishingly complex machine. Like other living
organisms, the human body has evolved by adapting.14
To Earths gravitational field, and the biological structure and mechanisms of the body have
developed to suit normal Earth gravity31.
The gravitational force that acts on human beings at the Earths surface is the result of the interaction
between Earth and the human body. As Earth is more massive, it pulls the body toward the centre of
the Earth.
Thus, on the Moon, gravity is six times weaker than on Earth. So an astronaut would weigh a sixth as
much on the lunar surface. The Moons gravity is six times less than the Earths gravity.
When in Earth orbit, the astronauts body is still acted on by gravity, but much more weakly because
of the distance. In addition, the speed acquired by the spacecraft to send the astronaut into space
partially counteracts the gravitational force that continues to act on the spacecraft. This is the law of
inertia. Thus, gravity disappears and the astronauts body becomes weightless.
Weightless means that there is no sensation of weight.10 The term zero gravity is also used, but to
avoid promising too much scientists have adopted the term microgravity, because the effects of
Earths gravitational force, and other forces, are not completely cancelled out.

Space research has given us a better understanding of the physical and chemical properties of matter.
This broad field of research is known as microgravity science.
The effects of gravity on our bodies and the biological mechanisms involved in adapting to
weightlessness are studied under real microgravity conditions. Research on astronauts has shown that
body function is disturbed in microgravity.
Effects of space travel on the human body like space sickness, 52 disorientation, migration of organic
fluids to the upper body, bone deterioration, muscular atrophy, lengthening of the spine, backaches,
gait disturbances motor performance degradation, electrical activity disturbances neuroreflexes
readjustment, motionsickness,fluid loss,electrolight changes etc.
In space the astronaut adapts to microgravity53 and we see different changes to the body when the
astronaut is back on Earth. For example, changes in the bone and muscular skeletal system. My job is
to make sure the astronaut readapts to gravity conditions on Earth as soon as possible.
The astronaut who is assigned for a mission in the preflight period to make them fit for space and
to train all exercises he/she has to do while on the ISS.
During the in-flight period we control the exercises via video, sometimes in real time, to make sure
that the performance is perfect and the effect optimal.28
To restore the normal physiological function of the body by more physical activity is necessary to
rebuild the muscle strength, bone health and cardiovascular activity.
For this we are training each system with specific techniques to rearranging body functions normal.
The aim of this project is to present the role of physiotherapeutic intervention and its benefits to
improve the health status of astronauts along with other interventions. Along with medical
management, the Physiotherapy treatment can give to prevent muscle atrophy by strengthening and
endurance exercises. To improve cardio vascular function by ergonomics and aerobics exercises. To
maintain balance and co-ordination by adaptability training, Swiss ball exercises.

BIO-PHYSICS

BIO-PHYSICS
Earth: Earth (1 AU from the Sun) is the largest and densest of the inner planets, the only one known
to have current geological activity, and the only place where life is known to exist. 53

Fig no-01
no
earth

 Its liquid hydrosphere is unique among the terrestrial planets, and it is the only planet
where plate tectonics has been observed.
 Earth's atmosphere is radically different from those of the other planets, having been altered
by the presence
nce of life to contain 21% free oxygen.
 It has one natural satellite, the Moon, the only large satellite of a terrestrial planet in the
Solar System

ATMOSPHERE
DEFINITION:The atmosphere is a gaseous envelope that covers the earth. 52

ABOUT THE ATMOSPHERE:One of the primary problems of flight related to physiology has to do with the fact that the pressure
of gases in the atmosphere change as we ascend and descend. It is essential that we have an
understanding of the gases found in the atmosphere and their effects upon the body. Other factors,
such as temperature change, also need to be understood so we can protect ourselves from these
potential hazards.

52

BENEFITS OF THE ATMOSPHERE:ATMOSPHERE:


 Without the atmosphere there would be no life on earth.
 The atmosphere provides protection from harmful ultraviolet (UV) rays, cosmic rays, and
meteorites.

52

 The atmosphere also protects the earth from extreme temperature variations.
 It supports animal and plant life through its gaseous content and provides rain to grow crops.

The Earths Atmosphere Is Divided Into Several Altitude


Altitude Regions.
R

Fig no -02 different level of atmosphere


 These regions start and finish at varying heights depending on season and distance from the
poles. The altitudes started below or averages .52
 Troposphere surface to 8,000 metres (5.0 mi) at the poles
18,000 metres (11 mi) at the equator, ending at the Tropopause
 Stratosphere Troposphere to 50 kilometres (31 mi)
 Mesosphere Stratosphere to 85 kilometres (53 mi)
 Thermosphere Mesosphere to 675 kilometres (419 mi)
 Exosphere Thermosphere
mosphere to 10,000 kilometres (6,200 mi0)

PHYSICS OF ATMOSPHERE

Gravity:Gravity is a natural phenomenon by which all physical bodies attract each other. Gravity gives
weight to physical objects and causes them to fall toward one another.

Newtons theory of gravitation:


Newton's law of universal gravitation states that any two bodies in the universe attract each other
with a force that is directly proportional to the product of their masses and inversely
nversely proportional to
the square of the distance between them.

where:

F is the force between the masses.

G is the gravitational constant (6.6731011 N(m/kg)2).

m1 is the first mass.

m2 is the second mass.

r is the distance between the centers of the masses.

Microgravity: State of a body such that the set of forces of gravitational origin to which it is
subject to have a very small resultant compared to Earth-normal
Earth
gravity.4

Fig no-03
no
parabolic flight for astronaut

Zero gravity (or weightlessness): State of a body such that the set of gravitational and inertial
forces to which it is subject have a zero resultant.
 Weightless means that there is no sensation of weight4. The term zero gravity is also used,
but
ut to avoid promising too much scientists have adopted the term microgravity, because the
effects of Earths gravitational force, and other forces,52 are not completely cancelled out.

ig no -04 Gravity varies from earth to space


Fig
 An astronaut is in free fall when orbiting Earth. The reason the astronaut floats inside the
spacecraft is that he or she is falling at the same speed as it is.

 The phenomenon of floating caused by free fall can also take place on Earth. Consider the
example of a person in an elevator that suddenly breaks free and falls from the 30th floor of
6

a building. The person inside, who would be falling at the same speed as the elevator, would
float inside.
 Naturally our astronaut does not fall to Earth, despite being in free fall, because the speed
imparted to the spacecraft keeps it in orbit.6
 Both phenomena, microgravity and floating, have an impact on an astronauts body in space.
 Space research has given us a better understanding of the physical and chemical properties
of matter. This broad field of research is known as microgravity science.
 The effects of gravity on our bodies and the biological mechanisms involved in adapting to
weightlessness are studied under real microgravity conditions. 11
 Research on astronauts has shown that body function is disturbed in microgravity.
 Space agencies are therefore continuing their research in hope of eventually reducing or
eliminating some of these undesirable physical effects that appear during a stay in space.
 Results of this research will make prolonged space missions safer, at a time when
construction of the international space station is just getting under way, and may one day
allow human beings to go on to Mars.21

MICROGRAVITY
INFLUENSE ON HUMAN
PHYSIOLOGY

Fig no -05 physiological changes due to microgravity


8

PHYSIOLOGICAL CHANGES DUE TO MICROGRAVITY


MUSCULOSKELETAL SYSTEM:
 LOSS OF MUSCLE MASS :
 In space, the musculoskeletal system continuously deteriorates.The
The muscles, in particular the leg
muscles, which are underused, become flabby and lose tone and mass11.

Fig no -6 Muscle wasting due to space travel


 The astronauts are then subject to muscular atrophy. The bones, too, become weaker because of
a loss of minerals (calcium, potassium and sodium).
 This bone degradation7 can reduce bone in the lower limbs by up to 10%.
 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.

 Astronauts rely on research in the following areas to build muscle and maintain body mass:
1) Exercise may build muscle if at least two hours a day is spent doing resistance training
routines.
2) Hormone supplements (hGH) may be a way to tap into the bodys natural growth signals.
3) Medication may trigger the body into producing muscle growth proteins.

Fig no -7 muscle wasting comparing from earth and space

 LOSS OF BONE DENSITY:


 Shifting from an environment with gravity to a microgravity8 environment causes changes in
an astronauts body.
 One area of concern for the astronauts health is the loss of bone density7. On Earth, a
persons bone density peaks around the age of 30. After the age of 35, the bone density
decreases on average by < 1% each year.
 Space travelers aren't the only ones who worry about bone loss.7

Fig no- 8 picture shows that how microgravity influence on bone growth

10

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 bone10:

Diet and Exercise changes may reduce osteoporosis.

Vibration Therapy may stimulate bone growth.

Medication could trigger the body to produce more of the protein responsible for bone growth
and formation.

 CIRCULATORY SYSTEM:

Fig no-9 Body fluid shift due to zero gravity


 In spaceflight, shortly after reaching orbit, astronauts experience much lower gravity than on
Earth. This is known as microgravity.12
 Therefore, the average physical exertion of astronauts on board the space shuttle and the
International Space Station (ISS) is reduced compared to pre-flight, with the exception of
challenging extravehicular activities such as a space walk.
 An astronauts circulatory system, 34which is accustomed to working against gravity, receives
a different set of signals and stimuli in microgravity and adapts to the new environment.17
 The heart does not need to work as hard to send blood to the upper body as it does when it
working against gravity. This causes blood volume to increase in the upper body42.
11

 During systole, ventricles contract to pump a volume of blood through the body which
increases the volume of blood in the arteries and therefore also increases the pressure in the
arteries.
 During diastole, the heart relaxes and fills with blood; therefore, the volume of blood and the
pressure in the arteries decreases.

Fig no -10 Fluids shifting from the head towards the feet
 A microgravity environment leads to changes in fluid distribution, muscle loading, and
altered signaling pathways.
 Some basic changes include alterations in blood pressure and the quantity of blood that is
pumped by the heart with each beat.
 The human heart is designed to force blood to the body, and the most difficult organ to
perfuse is the brain since it is above the heart.42
 In space your heart does not have to work against gravity to pump blood to your brain and
blood accumulates in the upper body because gravity is not there to pull it toward your feet.
 Your body takes advantage of this lack of work and begins to be less efficient as
demonstrated by the lower stroke volume.
 The heart generates slightly higher systolic and diastolic pressures because large muscle
groups (like the legs) are inactive and do not demand blood, resulting in vasoconstriction.
 Also, since the heart is less efficient some blood remains in the heart after each contraction
which slightly increases the pressure during the relaxation phase known as diastole.

12

 Taken together, the amount of blood that is being pumped out of the heart (stroke volume)
will change.
 As the flight duration increases, these changes become slightly more dramatic, and may
affect an astronauts other physiological functions.33
 There could even be permanent changes in the way organs and blood vessels behave.
 Resistance training (weight lifting) and cardiovascular (aerobic) exercise to minimize muscle
atrophy and cardiovascular de-conditioning are very important countermeasures

Fig no-10.1 microgravity effect on circulation


 Lack of activity and a sedentary lifestyle may lead to the same problems that astronauts face
in microgravity.
 As the heart

12

becomes less efficient, other physiological functions of the body are affected.

Long term sedentary lifestyle may lead to permanent changes that may increase risks of
certain cardiac diseases.

INFLUENCE ON BLOOD CIRCULATION:


 One of the most visible effects of a space mission is no doubt the puffy-face, bird-leg
look that astronauts42 get.
 On Earth, the heart is programmed to distribute blood evenly throughout the body.

13

 The heart must do more work to supply the upper body, because blood is naturally drawn
downward by the force of gravity.
 The lower limbs do not have this problem, as the blood
blood coming to them is gravity-assisted.
gravity

Fig no- 11 Influence of microgravity and body changes


 In space, bodily fluids no longer flow back down naturally by gravity.
 The heart is still programmed the way it was on Earth. So, under the pressure of the heart and the
veins and arteries, the blood rushes to the persons torso and head, and they then experience
puffy face syndrome.
 The veins of the neck and face stand out more than usual; the eyes become red and swollen.
 This effect
ffect is often accompanied by nasal congestion and sometimes even headaches. Astronauts
legs also grow thinner, because instead of dropping effortlessly down to the lower limbs, the
blood has to be pumped there by the heart.
 Particularly because of physiological
physiological changes such as these, astronauts suffer from space
sickness or space adaptation syndrome (the space version of what we call motion sickness on
Earth).
 About 40% of those who have gone into space have had dizziness or nausea.
 Both generally wear off after 2 or 3 days, as soon as the astronauts body has had time to adapt.

 CARDIAC RHYTHMS::
 Heart rhythm disturbances have been seen among astronauts. 27
14

 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.12
 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.

 ORTHOSTATIC INTOLARENC:
 In space, astronauts lose fluid volumeincluding up to 22% of their blood volume.
 Because it has less blood to pump, the heart will atrophy. A weakened heart results in low blood
pressure and can produce a problem with orthostatic tolerance,23 or the bodys ability to send
enough oxygen to the brain without fainting or becoming dizzy.
 "Under the effects of the earth's gravity, blood and other body fluids are pulled towards the lower
body.
 When gravity is taken away or reduced during space exploration,36 the blood tends to collect in
the upper body instead, resulting in facial edema and other unwelcome side effects.
 Upon return to earth, the blood begins to pool in the lower extremities again, resulting
in orthostatic hypotension."27

 LOSS OF BALANCE:
 Leaving and returning to Earths gravity causes space sickness, dizziness, and loss of balance
in astronauts31. By studying how changes can affect balance in the human bodyinvolving the
senses, the brain, the inner ear, and blood pressureNASA hopes to develop treatments that can
be used on Earth and in space to correct balance disorders53.
 Until then, NASAs 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.43

15

 DECREASED IMMUNE SYSTEM FUNCTIONING:


 Astronauts in space have weakened immune systems, which means that in addition to increased
vulnerability to new exposures, viruses already present in the bodywhich would normally be
suppressedbecome active.42
 In space, T-cells (a part of white blood cells) do not reproduce properly.
 T-cells that do exist are less able to fight off infection. NASA research is measuring the change
in the immune systems of its astronauts as well as performing experiments with T-cells in space.

 PSYHOLOGICAL FACTORS:
 Alzheimer's disease (AD), also known as Alzheimer disease, or just Alzheimer's, accounts for
60% to 70% of cases of dementia. It is a chronic neurodegenerative disease that usually starts
slowly and gets worse over time. The most common early symptom is difficulty in remembering
recent events (short-term memory loss)

 OTHER PHYSIOLOGICAL CHANGES:


1. Expose to high energy cosmic waves radiation increases risk of neurodegenerative disease31.
2. Eye abnormalities may arises due to UV exposure increases the intra cranial pressure.
3. Due to microgravity, distributions of fluid to upper body result in "puffy face" appearance.
4. Nasal congestion due to fluid distribution causes anosmia (loss of smell) and diminished taste.
5. Heart stroke volume decreases as cardiovascular system adapts to microgravity. RBC count also
decreases.
6. Musculoskeletal adaptation to microgravity leads to loss of muscle mass and bone density.
7. Blood plasma volume is reduced by increased kidney output , elevated calcium secretions results
in increased risk of kidney stones17.
8. Stresses of spaceflight, including ionizing radiation, results in compromised immune system
function.
9. Fluids redistribution from leg to upper body results in 10-30% decreased leg circulations.
10. Sleep disorder.

16

INVESTIGATIONS

Examination:
PRE FLIGHT:Physical examinations include

Abdominal Organs and Gastrointestinal System

Blood and BloodForming Tissue Diseases

Body Build

Dental

Ears and Hearing

Endocrine and Metabolic Disorders

Upper Extremities

Lower Extremities

Miscellaneous Conditions of the Extremities

Mental Health

Eyes and vision

General and Miscellaneous Conditions and Defects

Genitalia and Reproductive Organs

Head

Heart and Vascular System

Height and Weight

Lungs, Chest Wall, Pleura, and Mediastinum

Mouth

Neck

Neurological Disorders

Nose, Sinuses, and Larynx

Skin and Cellular Tissues

Spine and Sacroiliac Joints

Systemic Diseases

Tumors and Malignant Diseases

Urinary System

17

POST FLIGHT:

Blood tests

Brain CT to detect any bleeding ,tumour,anurysums.

Electrocardiogram (ECG)- to know the heart functioning.

Magnetic resonance imaging(MRI)- to know any changes occer in brain.

Muscle biopsy-to assess for muscle atrophy.

Electromyography(EMG)-to analyzed to detect medical abnormalities and biomechanics of


human.

Bone scan- To know density of bone .

18

MEDICAL
INTERVENTIONS

MEDICAL INTERVENTIONS

Exercise to maintain muscle strength and function

Sleep cap

Medication, including hormone replacement therapy.

FOR IMPROVING THE BONE HEALTH:


 Bone and calcium metabolism have been a concern for space travelers, literally since before
human space flight was a reality.43
 Vitamin D is a concern for space travelers, in part because their dietary sources of vitamin D
are insufficient, and in part because they lack ultraviolet light exposure.
 Vitamin D stores decline during flight if supplemental intake of this vitamin is inadequate.
 Recent studies have documented that supplementation with 800 IU vitamin D/day will
maintain vitamin D stores in astronauts on 6-month space missions.
 Although vitamin D is likely not a countermeasure for space flight-induced bone loss,
vitamin D deficiency will surely exacerbate the problem.

FOR IMPROVING THE MUSCLE HEALTH:


 Treatment will depend on the diagnosis and the severity of your muscle loss. Any underlying
medical conditions must be addressed.
 Common treatments for muscle atrophy include:
1) In severe cases of muscular atrophy, the use of an anabolic steroid such as methandrostenolone is
administered to patients as a potential cure.
2) Novel classes of drugs, called SARM (selective androgen receptor modulators) are being
investigated with promising results. 47
3) They would have fewer side-effects, while still promoting muscle and bone tissue growth and
regeneration.

 SURGERY may be necessary if your tendons, ligaments, skin, or muscles are too tight and
prevent you from moving.

Surgery may be able to correct it if your muscle atrophy is due to malnutrition.

19

TO IMPROVE CADIOVASCULAR SYSTEM:


Medication:
Over-the-counter and prescription medications37 are readily available, such as
1. Dramamine (dimenhydrinate),
2. Stugeron (cinnarizine), and
3.

Bonine/Antivert (meclizine).

4. Scopolamine is effective and is sometimes used in the form of transdermal patches (1.5 mg)
or as a newer tablet form (0.4 mg).
 The selection of a transdermal patch or scopolamine tablet is determined by a doctor after
consideration of the patient's age, weight, and length of treatment time required.

TO IMPROVE VESTIBULAR SYSTEM:


 Many pharmacological treatments which are effective for nausea and vomiting in some medical
conditions may not be effective for motion sickness. 47
 For example,
1. metoclopramide and
2. prochlorperazine,

 Although widely used for nausea, are ineffective for motion-sickness prevention and treatment.
 This is due to the physiology of the CNS vomiting centre and its inputs from the chemoreceptor
trigger zone versus the inner ear.
 Sedating anti-histamine medications such as promethazine work quite well for motion sickness,
although they can cause significant drowsiness.
 As astronauts frequently have motion sickness, NASA has done extensive research on the causes
and treatments for motion sickness. One very promising looking treatment is for the person
suffering from motion sickness to wear LCD shutter glasses that create a stroboscopic vision of 4
Hz with a dwell of 10 milliseconds.53

20

MANAGEMENT

ASSESSMENT
NAME:.
AGE:SEX:OCCUPATION:.
I.PNOOPNO.DOA:ADDRESS
.

..PhoneNo

CHIEF COMPLAINTS-

HISTORY OF PRESENT ILLNESS:


MEDICAL HISTORYFAMILY HISTORYPERSONAL HISTORYSOCIOECONOMIC STATUSHAND DOMINACE-

OBSERVATION a) Built

b) Posture

c) Attitude of limbs

d) Trophical movements

e) Facial Expressions

f) External Appliances

g) Deformity

h) Gait/mode of locomotion :

21

ON EXAMINATION
Higher cortical function

Consciousness/unconsciousness(GCS Score)

Orientation

Memory

Attention

Calculation

Emotion

Problem Solving

Judgement

Speech and language

Perceptual disorders

CRANIAL NERVE EXAMINATION:


I.
II.
III.
IV.
V.
VI.
VII.
VIII.
IX.
X.
XI.
XII.
SENSORY EVALUATION :

22

Superficial

Deep

Combined cortical sensation

MOTOR ASSESMENT

Muscle Tone

Muscle Power/Voluntary control

Developmental Reflexes

Milestones Assesment

REFLEXES

Superficial

Deep

MUSCULOSKELETAL ASSESSMENT:
AROM

PROM

T/C/DS

CO-ORDINATION TESTS
BALANCE ASESSMENT

:
:

Sitting balance

Static

Dynamic

Standing balance

Static

Dynamic

BLADDER /BOWEL CONTROL :

23

POSTURE ASSESMENT :
GAIT ASSESSMENT

OTHER SYSTEM ASSESSMENT :


CARDIO RESPIRATORY SYSTEM :
A. CHEST EXAMINATION:
They are 4 phases:
-inspection
-auscultation
-palpation
-percussion

B.OBJECTIVE FOR CHEST EXAMINATION ;


a) Pulmonary problems
Eg: cough, sputum, dyspnoea, chest pain
b) Co existing signs of pulmonary disease
Eg: symptoms of chest pain
c) Determine the need for further evaluation procedures
Eg: X-ray, E.C.G and PFT
d)Indentify R goals & formulate plan to track progress
Eg; proper guidelines & scales

SKIN CHANGES

FUNCTIONAL ASSESSMENT :

24

INVESTIGATION

CLINICAL IMPRESSION

DIFFERENTIAL DIAGNOSIS

PROBLEM LIST

AIMS

GOALS
STG:

LTG:

MEANS OF TREATMENT

FOLLOW

UP:

25

PHYSIOTHERAPY MANAGEMENT
AIMS:
1. TO IMPROVE MUSCLE STRENGTH
2. TO IMPROVE ENDURENCE
3. TO IMPROVE BALANCE AND CO-ORDINATION

PHYSICAL ACTIVITY IMPORTANCE:


 Physical activity is an overarching concept which is expressed in many forms, for example;
play, physical education, daily activities including walking, going up and down stairs, cycling
to work, movement activities, exercise, and sports.28
 Physical activity can be defined as "all physical motion produced by skeletal muscles
resulting in a substantial increase of energy consumption beyond the normal level" .
 Moderate physical activity is defined as an activity that requires three to six times as much
energy as the energy used at rest.
 Exercise is physical activity that is planned, structured and repeated, aiming to improve or
maintain physical fitness.

26

PRE-FLIGHT PHASE

PRE-FLITE PHASE
 MOTOR FITNESS:
Motor fitness training develops the endurance, strength, power, balance, agility and flexibility to
climb efficiently on steep and challenging terrain.52

STRENGTH AND POWER TRAINING:


In addition to leg strength, mountaineering requires a strong core (back and stomach) as heavy
pack weights add a new dimension to climbing. Strength training principles are essentially the
same for upper and lower bodies. Strength training can involve body weight exercises as well as
routines using traditional weights.21

CORE STRENTHENING EXERCICES:


Core strength exercises strengthen your core muscles, including your abdominal muscles, back
muscles and the muscles around the pelvis. Strong core muscles make it easier to do many
physical activities.

Core exercises build abs and other core muscles.

DEEP (FULL) SQUATS:Full squats push the knee joint past 90 degrees. Whether they are done with or without weights (a
barbell or a weight held across the shoulders or in the hands) this can strain the ligaments, cartilage
and muscle of the knee joint and lower back, and create problems with the tracking (movement) of
the kneecap. Suggestions include: Fig no- 12.

Perform half-squats instead (45-degree bend of the knee).

Use a mirror to check when your knee joint is at 90 degrees. You could also ask someone else
to watch you or seek instruction from a qualified fitness professional.

27

a)

b)

Fig no- 12 a)deep squat with weights b) full squat

DOUBLE LEG RISES:Avoid double leg raises. This exercise involves lying on your back and raising both legs at the same
time. This places enormous stress on the lower back.
Another potentially harmful variation is to lie on your stomach and lift both legs at the same time.

Fig no-13 double leg rise


An alternative is to perform the exercise one leg at a time, making sure your hips remain stable
throughout the movement. Keep the other leg bent, with your foot on the ground. Blow shown
diagram.

BEHIND THE NECK PRESS:The behind the neck presses or latpulldown behind the neck should be avoided, especially if you
have been told you have instability in the front of your shoulder.

28

Fig no-14 neck press strengthening of back muscles

Push-ups:Push-ups can range in difficulty from very easy to so difficult that few people can do them.
Adjusting the difficulty level is simply a matter of changing hand placement and body level to alter
leverage and load. 52

Fig no-15 picture showing the which muscles are strengthen by push ups
Keeping the body upright and the hands in line with the shoulders scales the pushup for people who
are just beginning their fitness journey. Placing the feet high and moving the hands lower, toward the
hips, increases the loads dramatically and can challenge world-class athletes.

29

Decline push-up:To do push-ups with little or no resistance, start in a standing position, arms-length from a wall.
Extend the arms in front of you at shoulder height to place your hands on the wall slightly wider than
shoulder-width. These push-ups (or, more literally, push-outs) are appropriate for beginners and
those who are rehabilitating injuries. With the body almost completely vertical, these can be used to
restore and build mobility in the arms and shoulders, to teach the plank body position, and to work
toward a horizontal push-up on the floor.

Fig no-16 pushups with no resistance


Even with this simple movement it is important to keep a rigid body and full range of motion
(ROM). Each rep should bring the chest and face as close as possible to the wall and finish with the
arms completely straight and the shoulders fully extended.
The degree of difficulty can be additionally fine tuned by adjusting the distance of the feet from the
wall. Obviously, the farther out they are - and the more acute the angle of the body - the more
difficult they will be.

L-sit/V-sit:L-sits can be performed on the ground, with legs extended straight in front of you and hands flat on
the floor on either side of the legs. This requires a conscious effort to push the shoulders down to lift
the body high enough to perform the L on flat ground. ( Fig;17)You can also do a straddle L, with
hands on the ground between your legs.

30

Fig no- 17, L- sit/v sit for the triceps and abs

STANDING AND TOE TOUCH:Avoid standing toe-touches altogether. Bending down to touch the toes, with straight legs, can
overstretch the lower back muscles and hamstrings, and stress the vertebrae, discs and muscles of the
lower
Back and hamstrings. Adding a twisting movement to the toe-touch can cause damage to the joints.

Alternative stretches for the abdominal muscles or the lower back muscles and hamstrings include:

Stretch the hamstrings and lower back muscles by placing one foot on a low bench or chair,
with both legs slightly bent so as not to stress the knee joints and, keeping your back straight,
gently reach forward with your arms.

An alternative hamstring stretch involves lying on your back with both knees bent. Straighten
one leg by lifting it towards the ceiling, keeping the knee slightly bent. Support this leg by
clasping both hands behind the knee. Hold. Repeat for the other leg. You should feel the
stretch on the back thigh of the straight leg.

For an alternative lower-back stretch, sit cross-legged on the floor then slowly lean forward,
keeping your back straight while reaching your arms out to the floor. Hold.

Fig no- 18 toe touching


31

SIT UPS:Two common but potentially harmful variations of the sit-up include anchoring the feet (where
your training partner holds your feet) or keeping the legs straight along the floor.
The hands are held behind the head or neck, and the upper body lifted. These types of sit-ups strain
the lower back and tend to target the muscles of the hips and thighs rather than the abdomen.
Suggestions include:

Fig no-19 sit ups training

Avoid this style of sit-up altogether.

Perform abdominal curls instead. Lie on your back with your knees bent, feet flat on the floor
and arms folded across your chest or alongside your body. Breathe out and curl your ribcage
towards your pelvis.

Hollow rock:The starting position is lying on the back in a hollow. A hollow position for this purpose is one in
which the pelvis is turned under (i.e., tail tucked), legs are lifted slightly off the floor, lower back is
touching the ground, head and shoulders are lifted slightly off the floor, and arms are held by the
ears, off the ground.
From this position, rock smoothly back and forth, keeping the body tight, the hip angle constant (no
pinking of the hip), and the lower back rounded.
32

Any thumping in the motion shows that the hollow position has been compromised, which indicates
that the trainees abs are not strong enough to keep the pelvis turned under in this position. Continued
training will alleviate this deficiency.

Fig no-20 hallo rock moves

BURPEE:To do a burpee in its most basic form, start from standing, squat with your hands on the floor, and
jump your feet back to put you in a prone position with straight arms (as at the top of a push-up).
Then bring your legs forward into a squat again and return to standing. This basic version is also
sometimes called a squat thrust.

Fig no-21 procedure to perform the burpee

33

Several modifications can be made to the burpee to increase its demands: add a push-up in the prone
position, add a jump at the end as you return to standing, perform the burpee under a bar and jump up
to do a pull-up in each rep, etc. Be creative with burpees and see what variations you can come up
with.

JUMPING JACK:Most people have done jumping jacks in a PE class at some point. They are an excellent way to
warm up, and they can be included in a conditioning set either as a station where fatigued muscles
are allowed to recover while metabolic demands are kept high, or as a significant component of a
metabolic conditioning circuit. Jumping jacks should be practiced both with arms and legs in concert
(legs straddling while arms are swung upward) and in opposition (legs straddling while arms are
brought down).

Fig no - 22 showing the changing leg by sequence

HANDSTAND AND PRESS HANDSTAND:Handstand pushup benefits are many. Some might even call it one of the greatest exercises
ever invented.fig 23
1. Strengthens the triceps, shoulders and chest
2. Strengthens many stabilizer muscles
3. Requires coordination and balance
4. Can be an effective muscle builder
5. Provides the benefits of inversion
6. Its an impressive skill few people can do
7. Can be handled very progressively

34

Handstand and press handstands are excellent exercises for developing strength

Fig no-23
no
hand stand and press

ANTI- GRAVITY TREADMILL TRAINING:TRAINING

In weightlessness at anti gravity treadmill, it makes running on treadmill more effective.


effective
Then a normal thread mill which can be adapted to the zero gravity. 28

Activates proprioceptors.

Fig no-24
no
Anti gravity thread mill

35

UNDER WATER STENGTH TRAINING:


HydroWorxs patented underwater treadmill is revolutionizing physical therapy, sports
medicine and conditioning. This proprietary feature comes standard in all of our therapy
pools. The powered underwater treadmills are integrated into the pool floor and feature a
polished stainless steel frame that is professionally welded for durability and safety. Our
endless rubberized treadmill belts offer excellent traction and may be utilized with bare feet
50

or shoes.

Fig no-25.1 under water thread mill

When a person runs on an underwater treadmill, his or her body undergoes greater exertion
due to the viscosity of the water. This leads to greater hip, leg and foot strength, as well as
improvements in core muscle groups throughout the body.

Fig no-25.2 An underwater treadmill also provides resistance for range of motion exercises and for
stretching and therapeutic exercises.

36

CARDIOVASCULAR FITNESS:

Cardiovascular training uses both aerobic exercises 12 and interval training and functions as
the foundation for your ability to climb for long periods of time.

A variety of aerobic exercises work well for training, including climbing and descending
hills, stairs or stadium bleachers, skiing, running and cycling.

Build your aerobic training over time, beginning with shorter sessions and increasing to
longer workouts.

By the time your climb approaches you should feel comfortable with an aerobic exertion that
is similar to any day of your anticipated climb.33

Fig no:-26 aerobics exercises

37

ENDURANCE TRAINING:Endurance is a motor skill like strength and balance and can be developed with training. In short,
endurance training is a focus on continually increasing the intensity of your training and not
becoming complacent in your routine or your level of fitness20. This will build a more durable body
and allow you to climb strongly for an extended period of time as well as adapt to the unanticipated
physical challenges of the climb.51

Fig no-27 training under parabolic flight.

38

 HYPOXIC MANAGEMENT
IHT or Intermittent Hypoxic Training involves short intervals of breathing (4-6 minutes) of
hypoxic20 air interspersed with intervals (4-6 minutes) inhaling ambient air.
Improve breathing economy and the ability.

Fig no-28 under clinical test

INTERMITTENT HYPOXIC TRAINING


Intermittent Hypoxic Training system (IHT) enables athletes, injured athletes, and sedentary
individuals to enhance performance, increase fitness while injured, and pre-acclimatize to high
altitudes.
IHT involves short intermittent inhalations (3-5 minutes) of hypoxic air (10% O2, 20,000ft/6000m)
interspersed with inhalations of ambient air (2-5 minutes).

39

IN-FLIGHT PHASE

IN FLIGHT
when they are in space station ,all astronauts are required to exercise 2-5 hours per day six
days a week in orde to prevent muscle atrophy14 and bone mineral density and cardio vascular
losses.

In weightlessness at zero gravity it moves running ona treadmil more effective

The treadmil features a rotating belt with or without resistance44

Fig no- 29, T2 treadmill (Normal thread mill without whistles or fancy bells)

Like treadmil the stationary bike appears to be a no- trils version of one that might befound in
a recreation gym, the only component it lacks and hardles a seat the later of which isn't
needed in space as long as the individual feet's anchored to the bike53. To keep them in place,
they were cycling shoes that clips to the bike pedals.[fig no-30]

Fig no - 30 cycle Ergo meter

40

ADVANCED RESISTIVE EXCERCISE DEVICE (ARED):

Advanced resistive exercise device which resembles the proto type of a bow flex or a
similarly at home gym with a bench weight resistance levels provided by two vacuum
cylinder.41

The high load is needed because we have to compensate for no body weight in zero gravity.

Although daily strength training is non-negotiate in space, astronauts are able to choose their
cardiac workout.53

Fig no- 31weights lifting with resistence

Fig no-32 Advance resistive exercise device with combination ofwholebody vibration
specially designed for astronauts in space.

41

ELECTRICAL STIMULATION TO MUSCLES:Electrical muscle stimulation37 at zero gravity to prevent the muscle atrophy and
Demineralization of bone.

Fig no-33 electrical stimulation for the quadriceps and Doris flexors.

42

POST-FLIGHT PHASE

POST FLIGHT PHASE


Astronauts returning from challenging long-duration missions face one more challenge when they
get back to Earth - standing up and walking.
Upon returning to normal gravity, astronauts often suffer from balance problems that lead to
dizziness and difficulty standing, walking and turning corners.

Tilt Table:Astronauts after the

space travel , they may get dizzy when they stand up

39

(orthostatic

hypotensionsee Dizziness or Light-Headedness When Standing Up). A tilt table may be used to
help astronauts. This procedure may retrain blood vessels to narrow (constrict) and widen (dilate)
appropriately in response to changes in posture43. People lie face up on a padded table with a
footboard and are held in place with a safety belt. The table is tilted very slowly, determined by how
well people tolerate it, until they are nearly upright. The slow change in posture enables the blood
vessels to regain the ability to constrict. How long the upright position is maintained depends on how
well people tolerate it, but it should not exceed 45 minutes.The tilt-table procedure is done once or
twice a day. Its effectiveness varies depending on the type and degree of disability.13

Fig no-34 tilt table

43

Adaptability Training System:National Space Biomedical Research Institute (NSBRI) scientists51 in a project to develop techniques
to help astronauts adapt quickly to a new gravity environment and to overcome balance disturbances.
This concept will also have benefits for non-astronaut populations such as the elderly or people with
balance disorders.
They use a system that consists of a treadmill mounted on a base that can be actively moved in
different directions to simulate balance disturbances called an Adaptability Training System.
The treadmill has a projection screen in front of it that shows an image of a room or hallway that
moves as the user walks. Disturbances are simulated by tilting the treadmill in one direction as the
image is tilted in another.

Fig no-35 treadmill with front facing projection screen.

"At first, people find it difficult to walk on the treadmill since its movement and images are out of
sync. But over time, they learn to walk on it efficiently. We call this concept 'learning to learn,'"
In order to perform everyday activities, the brain interprets information provided by the body's
sensory systems: the eyes, the inner ear balance43 organs, the skin and muscle movement receptors.
The problems for astronauts occur during the transition period in which the brain is trying to adapt to
a new gravity environment - either returning to Earth or in the future adjusting to lunar or Martian
gravity.
44

"In space, information from the sensory systems is different, particularly when you take away
gravity. The brain reinterprets that information, makes adjustments and allows you to do the
activities you need to do in space,"
The down side to that is when you return to Earth, the sensory systems are not used to a normal
gravity environment."
An astronaut has been in space on a typical two-week shuttle mission, it may take several days to
recover. For six-month stays aboard the ISS, it could take at least several weeks to return to normal.
Adaptability Training System that induces balance disturbances through support surface movement
and changes in visual information. The system consists of a treadmill mounted on a base that can be
actively moved in different directions paired with a virtual scene projected in front of the subject
providing a variety of balance challenges as the user walks.

To Build Up Atrophied Muscles Progressive exercise program.


Step 1
Begin with isometric exercises to improve circulation and increase strength in the atrophied muscle.
Isometric exercises involve simply contracting the muscle for a few seconds at a time. For example,
contracting your quadriceps with your leg straight would begin to improve quad strength just as
contracting your biceps while your arm remains in a relaxed, bent position would begin to rebuild
atrophied arm muscle. Gradually increase the contraction time and repetitions as your strength
improves.fig no- 36

Fig no-36 isometric exercise for quadriceps

45

Step 2
Progress to range of motion exercises that involve joint movement but do not use outside resistance.
For atrophied quadriceps muscles, for example, sit in a chair and simply straighten your leg to
engage the atrophied muscles. These types of exercises can be performed several times throughout
the day to keep your blood flowing and muscles limber.

Fig no-37 range of motion exercise for quadriceps


Step 3
Use light resistance such as small hand weights or resistance tubing to begin rebuilding your lost
muscle mass. Resistance needs to be added gradually, adding too much too quickly can result in
injury. A leg extension with a resistance band is an example exercise for atrophied quadriceps
muscles.

Fig no-38 light resistence exercises through theraband

46

Step 4
Add more resistance, moderately, in the form of heavier free weights or weight machines. Include
more functional movements into your exercise program. Squats and step-ups will help to continue to
build up atrophied quadriceps muscles while overhead presses will strengthen atrophied muscles in
the upper body.

Fig no-39 weight training

47

CONCLUSION
Space science is a specialized field, astronauts need a special preparation to overcome the varied
changes in the gravitational pull at various levels of ascent and duration of the stay in specified
situations in the space stations.
1. Bone demineralization
2. Muscle atrophy
3. Circulatory problems
4. Respiratory complications

A specialized physiotherapy rehabilitation team needed to train certain conditions like strength
training, muscle, balance, coordination and cardio respiratory conditions etc.
The whole topic deals with the physiotherapeutic measures to shorten the microgravity effects on
astronauts. Physiotherapy helps to improve the muscle strength, endurance, co-ordination and
balance. To shorten the complications of micro gravity on astronaut through the physiotherapy
intervention. Physical Therapy focuses on to restore overall function to get them moving faster and
feeling better. Physiotherapist will provide you with a customized recovery program that will restore
you to your maximal potential, and get you moving faster. The ultimate goal is to enable our patients
to manage their own physical well-being independently.

48

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52