RMP-NEURO-005 Post-landing balance testing: a crewmember spots, the CMO runs the tests, the robot records (support-only at an Earth landing)

1 · Identity and scope

After a landing on the Moon or Mars, on the CMO's command, the robot shows the balance and mobility tests the flight surgeon's checklist lists (for example sit-to-stand, rising from lying down, and heel-to-toe walking), keeps the fall space the CMO names clear, and logs each result word for word as the CMO states it, with the clock times the CMO calls. A crewmember spots beside the person being tested, and the CMO chooses and runs every test. The robot never touches anyone and never asks anyone to move. At an Earth landing, NASA flight surgeons and the recovery team run any tests; the robot only fetches kit and hands over records when the landing medical lead asks.

Why this protocol was chosen. Gravity transitions cause problems with posture, walking and spatial orientation, and motion sickness (OCHMO-TB-010). Field tests run on landing day after 6-month ISS missions (sit-to-stand, recovery from a fall, tandem walk, in increasing difficulty) were challenging and temporarily increased motion sickness; early movement may help recovery when it stays within each crewmember's limits, while movements past those limits may have slowed it (Rosenberg 2022). The recovery-from-fall task includes standing for up to 4 minutes, in effect a stand test, so the vital signs are logged and light-headedness is checked first (OCHMO-TB-019; RMP-CARD-004). After flight, bones may not be as strong as before the mission, and "fracture may occur for activities otherwise unlikely to induce fracture" (OCHMO-MTB-013), so a fall during testing is treated as an injury until the CMO decides otherwise. After landing on the Moon or Mars after weeks or months of weightlessness, where there is no recovery team, the CMO leads under the onboard checklist and the flight surgeon advises over the link. At an Earth landing, NASA flight surgeons and the recovery team lead with their own kit (OCHMO-TB-051); there the robot is support-only: it fetches kit and hands over records when the landing medical lead asks, never leads or directs care, and never touches or moves anyone (design judgment). Which tests run, in what order, and when to stop are set by the flight surgeon's checklist; the robot's role (records only, keeps the fall space clear, a human spotter) is design judgment and matches RMP-EGR-003.

Autonomy: Raised from rung 1 in the library outline to rung 2 for supervised fetching, showing the flight surgeon's test list, keeping the fall space clear and recording results as stated, the same as RMP-EGR-003. "Spot" means a crewmember spots: the robot never touches, catches or supports anyone, never asks anyone to stand, walk or close their eyes, and never times or scores a test. At an Earth landing the robot is support-only: it fetches kit and hands over records when the landing medical lead asks.

Related: RMP-EGR-003 · RMP-CARD-004 · RMP-EGR-002 · RMP-MSK-001 · RMP-MSK-002 · RMP-MSK-004 · RMP-NEURO-001 · RMP-GI-002 · RMP-EGR-001

2 · Roles

Medical authority

Flight surgeon (ground). Holds medical authority for every run.

Onboard lead

Crew medical officer (CMO), acting under delegated care; uses the pre-approved onboard checklist when there is no link.

Others

• Landing medical lead: the CMO on the Moon or Mars, advised by the flight surgeon over the link; at an Earth landing, the NASA flight surgeon with the recovery team
• Spotter: a crewmember beside the crewmember during every test, who is the only one to steady them
• Second trained CMO: receives every alert and takes over if the CMO is the patient

Commercial flights

On commercial flights, 'flight surgeon' and 'CMO' mean the operator's designated medical authority and trained onboard responder. If no trained responder is aboard, this protocol is not used. (NASA-STD-3001 requires two CMOs per vehicle for NASA programs [V1 3006]; FAA rules set no medical standards for spaceflight participants.) [14]

3 · Preconditions and consent

• PRE-1 The CMO started the protocol by command after a Moon or Mars landing, and a spotter is named. At an Earth landing only the support role applies, on the landing medical lead's request.human_start == trueV2 10174
• PRE-2 Robot self-test passed; kit stowage locations known.V2 10161V2 7059
• PRE-3 Robot and supplies restrained when not moving.V2 7046
• PRE-4 Link status known. The crew never wait for the robot before acting.link_state in [live, delayed, down]
• PRE-5 Before any standing test, the RMP-EGR-003 vital signs are logged and the CMO states that the crewmember has no light-headedness on sitting up; otherwise RMP-CARD-004 runs first.V1 4010

Consent

The crewmember agrees to each test and to the results being recorded and sent to the flight surgeon.

Emergency consent

If the crewmember cannot agree, no test runs; the robot sends an URGENT alert (X7).

Withdrawal

The crewmember can stop any test at any time; the robot logs "stopped by the crewmember" and the CMO decides what happens next.

4 · Required sensor inputs

5–6 · Steps and decision points

Each step names who acts. Decision points sit after the step they follow and say who decides: Robot Crew Ground. Any stop rule in section 7 can interrupt any step.

1. S1RobotRung 2

   Log the start and the landing type the person who started the protocol states (Earth landing, or Moon or Mars). At a Moon or Mars landing: tell the flight surgeon and the CMO that post-landing balance testing has started (URGENT if any red flag is stated). Every URGENT alert goes to the CMO and the flight surgeon at the same time (queued for the flight surgeon if the link is down). If the CMO is the patient, is busy treating, or does not answer, the alert goes to the second trained CMO, or the crewmember named before flight [V1 3006]. An URGENT alert that is not acknowledged within <set by validation> seconds is repeated and sent to the next named crewmember. At an Earth landing the robot only tells the landing medical lead that it is in the support-only role.

   Done when: Notice acknowledged.

   V1 3006V2 10174

   D6DecisionCrew decides

   Is this an Earth landing, as the person who started the protocol states (the robot never decides it)?

   • Yes (Earth landing) → Support-only: only the kit-fetch step (checked kit fetch, or the emergency fetch) and the RMP-EGR-001 record hand-over run, each on the landing medical lead's request; every step marked "Moon or Mars only" is skipped, and the robot holds outside every route until asked.
   • No (Moon or Mars landing) → Continue with every step.
2. S2RobotRung 2

   On the CMO's command (at an Earth landing, on the landing medical lead's request), run a checked kit fetch of the landing medical kit (as the kit list states): check the kit ID and seal before hand-over, and quarantine a kit whose ID or seal does not match (no hand-over; the CMO is told). Any medicine goes only through RMP-PHARM-001. If an URGENT red flag has fired or a human states an emergency, bring it instead as an emergency fetch: This is an emergency fetch on a human command (CMO): no barcode check runs before hand-over and nothing waits for one. The robot reads the kit's own label and seal status only if that adds no delay, says "EMERGENCY FETCH – NOT VERIFIED (CMO command)", and "seal not intact" if so, and hands the kit over anyway. The fetch is logged as an override: time, who asked, the reason as stated, kit ID and seal status. It never says "verified".

   Done when: Kit within reach after a matched ID and seal, or quarantined, or emergency fetch logged.

   Limit: <set by validation>

   V2 7046V2 7059

   D1DecisionRobot decides

   Which kit fetch was it, and what did the checked kit fetch show?

   • EMERGENCY FETCH (an URGENT red flag had fired, or a crewmember or the CMO stated an emergency) → Hand-over already done as an emergency fetch, logged as an override; reconciled afterwards (not a check before use).
   • KIT ID AND SEAL MATCH → Hand the kit over closed; log "KIT ID AND SEAL MATCH. Not a check of the contents." and the clock time.
   • MISMATCH, seal not intact or CANNOT VERIFY → Shown with the reason. No hand-over under this protocol: the kit stays sealed in quarantine (the RMP-PHARM-001 default), and the robot never hands it over unprompted or to anyone but the CMO. The robot does not offer or suggest an override. Only if the CMO explicitly makes the two-step override request inside RMP-PHARM-001 can the kit go to the CMO, logged there as an override with the reason, and flagged to the flight surgeon. If the need becomes an emergency, a crewmember or the CMO states it and the emergency fetch applies.No hand-over
3. S3RobotRung 2

   Moon or Mars only: before a test starts, clear the fall space the CMO names of loose items, then hold beyond the keep-out distance and outside every route. The robot clears the fall space only before a test starts; while a test is under way it does not move, except to move clear under X9 or X11. Show the flight surgeon's test list on screen where the CMO can see it; the CMO, not the robot, tells the crewmember each test.

   Done when: Fall space clear; list in view.

   Limit: <set by validation>

   V1 6003V2 10172

4. S4Crew

   The CMO runs each test on the list, in order, with the spotter beside the crewmember; the crewmember sits or lies down at once on any symptom, and the CMO stops the series at the limit the checklist sets.

   Done when: Tests done or stopped as the CMO states.

   V1 4010V1 3017

5. S5RobotRung 2

   Moon or Mars only: log each result word for word as the CMO states it, with the start and stop clock times the CMO calls; the robot never gives its own score. On request only, the robot shows the time elapsed since the start the CMO called, as a clock-time entry; it never announces a time, and never says "time reached", "done", "passed" or "failed". Show an on-screen symptom prompt between tests that the crewmember can accept, and log answers word for word.

   Done when: Results and answers logged.

   V1 6003

   D2DecisionRobot decides

   Checked after every answer and at any point in the run (even mid-question or mid-step): does any answer, reading or observation meet a red flag?

   • Yes → Stop the current question or step at once and apply the action listed for each matching red flag (URGENT alert, flag, or stop), with the answer or reading itself, never a cause. Every URGENT alert goes to the CMO and the flight surgeon at the same time (queued for the flight surgeon if the link is down). If the CMO is the patient, is busy treating, or does not answer, the alert goes to the second trained CMO, or the crewmember named before flight [V1 3006]. An URGENT alert that is not acknowledged within <set by validation> seconds is repeated and sent to the next named crewmember.
   • No → Continue.
   D3DecisionRobot decides

   Did the crewmember answer the symptom prompt, or say they want to skip it?

   • Yes → Continue.
   • Declined explicitly (the crewmember says no to a question) → Log "declined" for that question only; the alert already sent stands.
   • No response, or the answer does not make sense → URGENT: log "no response" (never "declined"); the CMO, or the second trained CMO if the CMO is the patient, checks the crewmember in person at once.
6. S6RobotRung 2

   After any URGENT alert: After an URGENT alert the robot does not leave on its own: it stays at its rest position in the module, with its screen and voice link available, until a human has taken over or tells it to go. It never follows, blocks or touches anyone. It keeps time-stamping what humans say they did, and repeats the alert if it is not acknowledged.

   Done when: Robot at rest in the module until a human releases it; alert acknowledged or escalated.

   V2 10173V1 3006

7. S7Ground

   The flight surgeon (or the CMO under the onboard checklist when there is no link) decides on activity limits, repeat testing and the reconditioning plan.

   Done when: Decision logged.

   V1 3017V1 4010

   D4DecisionGround decides

   What activity limits, repeat tests and reconditioning plan apply?

   • Link live → Flight surgeon decides; robot logs.
   • Link down or delay too long → The CMO decides under the pre-approved onboard checklist; the flight surgeon reviews the log at the next contact.
8. S8RobotRung 2

   Moon or Mars only: only after the CMO or flight surgeon has placed an order, run RMP-PHARM-001 for the ordered item (fetch, barcode match to every order field, recipient check). This protocol adds nothing to that check, never suggests an order, and never hands anything over outside RMP-PHARM-001.

   Done when: RMP-PHARM-001 run logged with its result, or none ordered.

   V2 7059

   D5DecisionRobot decides

   What did RMP-PHARM-001 show for the ordered item?

   • MATCH TO ORDER → RMP-PHARM-001 completes its own recipient check and hand-over; this protocol only logs "MATCH TO ORDER. Not a dose, interaction or allergy review." and the clock time.
   • MISMATCH or CANNOT VERIFY on any field, or a failed scan or recipient check → MISMATCH or CANNOT VERIFY shown with the fields named. No hand-over under this protocol: the item stays sealed in the NOT VERIFIED bag in quarantine (the RMP-PHARM-001 default), and the robot never hands it over unprompted or to anyone but the CMO. The robot does not offer or suggest an override. Only if the CMO explicitly makes the two-step override request inside RMP-PHARM-001 can the item go to the CMO, logged there as an override with the reason and the mismatched fields, and flagged to the flight surgeon.No hand-over
9. S9RobotRung 2

   When the CMO says the event is over, run RMP-PHARM-001 reconciliation on each kit fetched: record the items the CMO or crew state were used, the remaining contents against the kit list, seal status and expiry, labelled "inventory reconciliation after emergency use – not a check before use". Flag the override to the flight surgeon and the pharmacy lead, and show each kit as "opened – not restocked" until a human restocks and reseals it.

   Done when: Kit reconciled or shown as "opened – not restocked".

   V2 7059

10. S10RobotRung 2

    Send the flight surgeon one package: results and times as stated, answers, alerts and decisions. At an Earth landing: hand over the records under RMP-EGR-001 when the landing medical lead asks.

    Done when: Package delivered or queued.

    V1 6003V1 7003

7 · Stop and escalate rules, red flags

Red flags

The robot reports the sign or value only, never what it means. Numeric thresholds are placeholders for the clinical lead.

8 · Safety limits

9 · Logs and audit

• LOG-1 Every input, robot action, decision (with who made it) and hand-off, time-stamped to the second.V2 10163V2 10164
• LOG-2 Mode changes and safety-limit events are announced to the operator as they happen and logged.V2 10162V2 10172
• LOG-3 Records are stored and sent as private medical data, encrypted, with access limited to the medical team.V1 6003V1 7003
• LOG-4 Results are kept in a permanent, retrievable format so the flight surgeon can see trends.V1 7001
• LOG-5 Test results and times as the CMO states them; the spotter named; tests stopped and by whom; answers as stated.
• LOG-6 Each URGENT alert, who received it, the time it was acknowledged (or the escalation to the next named crewmember), and the time a human released the robot.V2 10163
• LOG-7 Each emergency fetch as an override (time, who asked, reason as stated, kit ID, seal status) and the later inventory reconciliation, labelled "not a check before use".V2 7059

10 · Links to NASA-STD-3001

IDs as published in Volume 1 Revision C [9] and Volume 2 Revision F [10]. NASA-STD-3001 binds NASA programs; it is not a regulation for commercial flights. Its robot rules are general automation requirements, not medical-device rules.

11 · Validation

1. Simulation. Scripted tests with a near-fall, no spotter, a fall with pain, new back pain, CMO as patient, lost link. Pass: Zero prompts to stand or walk; zero contact; every red flag raised.
2. Training model. Balance test drill with a spotter. Pass: Results logged as the CMO states them; fall space clear.
3. Parabolic or station demonstration. Not applicable (landing only); a surface analogue test instead. Pass: Keep-out held.
4. Flight use under flight surgeon supervision. First use after a surface landing. Pass: No safety events.

No stage has been run. Pass and fail criteria must be fixed in advance by the clinical lead and safety board.

12 · Human sign-off

Before any use

• Clinical lead for the specialty (sets every clinical threshold marked <set by clinical lead>)
• Flight surgeon, as medical authority
• Robotics and medical-device safety board
• Program approval for the mission

Each run

Started by the CMO after a Moon or Mars landing, with a named spotter; at an Earth landing, support only, on the landing medical lead's request. The CMO chooses and runs every test.

Restart after a stop

Human only. After any emergency or protective stop, a crewmember must restart the robot; the robot never restarts itself.

None of these sign-offs has happened. This is a Draft v0.3.

13 · Change control for learning

• Every change gets a new version number and a written reason; earlier versions are kept.
• Any change to steps, thresholds, limits or software that touches the patient repeats validation from the simulation stage before use.
• Software and learned-skill updates follow a pre-agreed change plan (what may change, how it is tested, how to roll back), modeled on the FDA predetermined change control plan approach.
• If a new version misbehaves, the robot rolls back to the last validated version and the event is reviewed by the flight surgeon and safety board.
• The robot never changes its own protocol, thresholds or limits.

Change-plan model: FDA guidance [13].

Loss of signal and Mars delay

Live link

Earth landing site: NASA flight surgeons and the recovery team are present and lead; the robot fetches kit and hands over records only. Moon: the flight surgeon advises over a link with a few seconds of delay; the CMO leads on the surface.

Loss of signal

• Only the robot pauses non-essential motion, at a position clear of hatch routes and crew routes, and tells the CMO; it resumes offline only on the CMO's confirmation.
• Crew tests already under way, help sitting or lying down, CPR and the CMO's care continue under the onboard checklist and never wait for the link or the robot.
• The CMO leads under the onboard checklist; results are queued.

Mars-class delay

• Mars: no real-time guidance; the test list and stop limits are set before flight.

[12]

Sources

1. NASA OCHMO. Sensorimotor Overview. Technical Brief OCHMO-TB-010 Rev A (2023). www.nasa.gov/wp-content/uploads/2023/12/ochmo-tb-010-sensori… Supports: Gravity transitions (weightlessness to a planetary surface or Earth) cause decrements in postural control and locomotion, spatial disorientation and motion sickness during and after the transition; these affect egress and early surface activity.
2. Rosenberg MJ, Reschke MF, Tomilovskaya ES, Wood SJ. Multiple field tests on landing day: early mobility may improve postural recovery following spaceflight. Front Physiol. 2022;13:921368. PMID 36187781. doi:10.3389/fphys.2022.921368 Supports: Field tests (for example sit-to-stand, recovery from a fall from prone to standing, and tandem walk, in increasing difficulty) were run on landing day after 6-month ISS missions; the protocol was challenging and temporarily increased motion sickness symptoms; early movement may help recovery when kept within individual thresholds, while movements above aversive thresholds may have impaired adaptation in others. Full text read Oct 21, 2026.
3. NASA OCHMO. Bone Loss. Medical Technical Brief OCHMO-MTB-013 Rev D (2026). www.nasa.gov/wp-content/uploads/2026/02/ochmo-mtb-013-bone-l… Supports: Bones during and after spaceflight may not be as strong as before the mission, and "fracture may occur for activities otherwise unlikely to induce fracture prior to space missions". Saved copy read Oct 21, 2026.
4. NASA OCHMO. Crew Medical Support for Entry, Descent, and Landing. Technical Brief OCHMO-TB-051. www.nasa.gov/wp-content/uploads/2026/05/ochmo-tb-051-crew-me… Supports: Flight surgeons are present at the landing site; launch and landing sites need medical capability for contingencies; depending on the location, transport may be by ground, water or air, with rescue vehicles able to give advanced trauma life support until transfer to a definitive medical care facility (DMCF) [V1 3013, V1 3014]. Read Oct 21, 2026.
5. NASA OCHMO. Orthostatic Intolerance. Technical Brief OCHMO-TB-019 Rev B. www.nasa.gov/wp-content/uploads/2023/12/ochmo-tb-019-orthost… Supports: Spaceflight reduces intravascular fluid volume by around 15%; fluid loading before reentry is an important countermeasure to decrease orthostatic intolerance, and current protocols include 24-48 oz of salt-water solution before deorbit, depending on body weight.
6. Johnston SL, Campbell MR, Scheuring R, Feiveson AH. Risk of herniated nucleus pulposus among U.S. astronauts. Aviat Space Environ Med. 2010;81(6):566-574. PMID 20540448. doi:10.3357/asem.2427.2010 Supports: In-flight back pain is presumably due to elongation of the spine; disc herniation was 4.3 times more common in US astronauts (321) than matched controls (983), relatively more often in the neck, with evidence that the risk is increased immediately after spaceflight.
7. Kleinman ME, Buick JE, Huber N, et al. Part 7: Adult Basic Life Support: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(16_suppl_2):S448-S478. PMID 41122888. doi:10.1161/CIR.0000000000001369 Supports: Adult basic life support: initial recognition of cardiac arrest, activation of the emergency response, high-quality CPR and use of an automated external defibrillator; also respiratory arrest and foreign-body airway obstruction. Earth guidance; the onboard checklist leads. Abstract read via PubMed Oct 21, 2026; full text not read.
8. NASA OCHMO. Space Adaptation Sickness (SAS) and Space Readaptation Syndrome. Medical Technical Brief OCHMO-MTB-004 Rev A (Sept 25, 2025). www.nasa.gov/wp-content/uploads/2025/09/ochmo-mtb-004-space-… Supports: Space adaptation sickness and its parts (motion sickness, congestion, headache, back pain, urinary retention) in the first days of flight.
9. NASA. NASA-STD-3001, Space Flight Human-System Standard, Volume 1: Crew Health, Revision C (2023). www.nasa.gov/wp-content/uploads/2023/11/nasa-std-3001-vol-1-… Supports: NASA-STD-3001 Vol 1 Rev C: V1 3006, V1 3017 (reconditioning starts at egress), V1 4010 (sensorimotor reconditioning monitored), V1 6003, V1 7003.
10. NASA. NASA-STD-3001, Volume 2: Human Factors, Habitability, and Environmental Health (Rev F, 2026), including Section 10.6 Automated and Robotic Systems. standards.nasa.gov/standard/NASA/NASA-STD-3001_VOL_2 Supports: Requirement IDs beginning V2.
11. NASA OCHMO. Medical Operations. Technical Brief OCHMO-TB-044 (2025). www.nasa.gov/wp-content/uploads/2025/08/ochmo-tb-044-medical… Supports: The crew surgeon keeps medical authority when care is delegated; crew medical officers train on the JSC 48522 medical checklist.
12. NASA. Mars communications disruption and delay (fact sheet, 2023 Moon to Mars Architecture Concept Review). www.nasa.gov/wp-content/uploads/2024/01/mars-communications-… Supports: One-way Earth-Mars delay up to about 21-23 minutes, plus blackouts of about 2-3 weeks near solar conjunction.
13. U.S. Food and Drug Administration. Marketing submission recommendations for a predetermined change control plan for artificial intelligence-enabled device software functions (guidance). www.fda.gov/regulatory-information/search-fda-guidance-docum… Supports: A model for planning, validating and rolling back software updates.
14. U.S. Code of Federal Regulations, Title 14, Part 460: Human space flight requirements. www.ecfr.gov/current/title-14/chapter-III/subchapter-C/part-… Supports: Federal rules for crew and spaceflight participants on licensed commercial flights; they set no medical standards for spaceflight participants.

Checked on 2026-10-20: links opened (HTTP 200 or publisher redirect), DOIs and PubMed IDs matched, NASA documents read in full text. The framework comes from Part 1.