From Space station to clinic: complex neurological remote care Seminar

In particular, the requirement to diagnose and manage complex cases remotely and the need to empower on-site medically trained personnel to undertake the physiological measurements and decision-making. The common aim is to reduce the need for hospitalisation -- in both cases the issues are logistics, convenience and cost. With long duration space travel, these become major issues if the crewmember needs to be returned to earth. For space exploration at greater distances, the telemedicine system requires added sophistication to support autonomous crew medical diagnosis and interventions1.

The 2020 healthcare vision is that the majority of patient care will be undertaken at primary healthcare level and within the community. There is a requirement for new medical screening devices that facilitate reliable and cost-effective triage at primary healthcare level, and devices that have a positive impact on the huge social-economic costs of the long-term care of patients with familiar chronic medical conditions. We have built telemedicine equipment for NASA that screens for complex neurological and oto-neurological conditions, with the capability of assessing intracranial hypo- and hypertension. These are the conditions suffered by some of the major patient groups – US and European estimates are that 2 to 3% of the population are suffering the long-term/life-time effects of brain injuries such as traumatic brain injury (TBI) and 30% of patients visiting a primary-care doctor complain of dizziness or vertigo.

This capability has become a priority for space medicine since the discovery of visual impairment with intracranial hypertension in astronauts after long-duration space travel2. The NASA telemedicine instrument (nicknamed ‘Old Peculiar’) integrates a video link, with non-invasive assessment of intracranial and blood pressure (discrete and continuous measurements), ECG, oximetry as well as middle and inner ear assessments that are pertinent to balance disorders. The device includes an easy-to-use and ‘unambiguous’ user-interface and is designed to be self-administered if need be. Questionnaires are included to document patient/subject status and any medication being taken. We believe that the same specification is relevant to remote medical centres or for the management of complex neurological conditions within the community.

The clinical use of the device will be mentioned as well as research partnerships including acute care management of comatose children with cerebral malaria in Kenya; continuous intracranial pressure monitoring; pressure wave 'signatures' of brain injuries and dementia research.

1. Williams DR, Bashshur RL, Pool SL, Doran CR, Merrell RC, Logan JS. A strategic vision for telemedicine and medical informatics in space flight. Telemedicine J and e-Health 2000; 6: 441-448.
2. Mader TH, Gibson CR, Pass AF, et al. Optic disc edema, global flattening, choroidal folds, and hyperopic shifts observed in astronauts after long-duration space flight. Ophthalmology 2011; 118(10): 2058-69.