4/03/2017

New Mobility Contributor Removed from American Airlines Flight




On March 27, 2017, Mark E. Smith, a regular contributor to New Mobility and power chair user with cerebral palsy, was removed with no explanation from his Los Angeles to Philadelphia flight by American Airlines staff.
To say Smith is a frequent flyer is an understatement. Part of his job as general manager of public relations for Quantum Rehab includes travel to trade shows, and over the years he has flown hundreds of times both nationally and internationally.
The incident began after Smith had transferred to his row 27 seat, and the doors were about to close for an 11:30 a.m. on time departure. As he described in his blog, “Powerchair Diaries,” Smith saw “a large group of American Airlines’ flight attendants, gate agents and ground crew — a sea of varying uniforms and two-way chatter — coming up the aisle.” Without speaking to Smith, they asked the two women sitting next to him to move from their seats, explaining they were removing Smith from the plane.
He was strapped into an aisle chair and wheeled up out of the plane, past most of the passengers, who watched in silence. “No one — flight attendants, ground crew — gave me a direct answer as to why I was being removed,” says Smith. “There was chatter among the group, but they were focused on simply saying ‘they had to remove me from the flight’ someone in the group mentioned ‘getting me off of the manifest’ I’m not sure what that meant.” In his blog, Smith says that the people from American Airlines said he was being removed because of captains’ orders.
Flight 121 departed without Smith, and he waited in the jet way, still strapped in the aisle chair for a half hour before his power chair finally arrived, with the leg rests incorrectly installed. “I had to go into a wheelchair stall for my own privacy to get my leg rests, arm rests, and positioning straps straightened out,” says Smith.
He was re-booked on the next AA flight to Philadelphia, which departed at 3 p.m.. “My flight home was flawless,” he says.
This story has gone viral on social media, which has prompted American Airlines to reach out to Smith and open an investigation. They issued a formal statement, which was sent to several news organizations via email:
“We apologize to Mr. Smith for his recent experience and have reached out to him to gather additional information. American does not tolerate discrimination of any kind and we are committed to providing a positive travel experience for all of our customers.”
“I still have not been given a reason why I was removed,” says Smith. “As one with a life-long disability and frequent flyer this was a confusing, disturbing incident. I certainly don’t want anyone else to experience the indignities I experienced that day.”

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Erradicación de La poliomielitis

Polio Tricisilla Adaptada

March Of Dimes Polio History

Dr. Bruno

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A 41-year-old man developed an acute illness at the age of 9 months during which, following a viral illness with headache, he developed severe weakness and wasting of the limbs of the left side. After several months he began to recover, such that he was able to walk at the age of 2 years and later was able to run, although he was never very good at sports. He had stable function until the age of 18 when he began to notice greater than usual difficulty lifting heavy objects. By the age of 25 he was noticing progressive difficulty walking due to weakness of both legs, and he noticed that the right calf had become larger. The symptoms became more noticeable over the course of the next 10 years and ultimately both upper as well as both lower limbs had become noticeably weaker.

On examination there was wasting of the muscles of upper and lower limbs on the left, and massively hypertrophied gastrocnemius, soleus and tensor fascia late on the right. The calf circumference on the right exceeded that on the left by 10 cm (figure1). The right shoulder girdle, triceps, thenar eminence and small muscles of the hand were wasted and there was winging of both scapulae. The right quadriceps was also wasted. The wasted muscles were also weak but the hypertrophied right ankle plantar flexors had normal power. The tendon reflexes were absent in the lower limbs and present in the upper limbs, although the right triceps was reduced. The remainder of the examination was normal.

Figure 1

The patient's legs, showing massive enlargement of the right calf and wasting on the left

Questions

1
What is that nature of the acute illness in infancy?
2
What is the nature of the subsequent deterioration?
3
What investigations should be performed?
4
What is the differential diagnosis of the cause of the progressive calf hypertrophy?

Answers

QUESTION 1

An acute paralytic illness which follows symptoms of a viral infection with or without signs of meningitis is typical of poliomyelitis. Usually caused by one of the three polio viruses, it may also occur following vaccination and following infections with other enteroviruses.1 Other disorders which would cause a similar syndrome but with upper motor neurone signs would include acute vascular lesions, meningoencephalitis and acute disseminated encephalomyelitis.

QUESTION 2

A progressive functional deterioration many years after paralytic poliomyelitis is well known, although its pathogenesis is not fully understood.2 It is a diagnosis of exclusion; a careful search for alternative causes, for example, orthopaedic deformities such as osteoarthritis or worsening scoliosis, superimposed neurological disorders such as entrapment neuropathies or coincidental muscle disease or neuropathy, and general medical causes such as respiratory complications and endocrinopathies.3

QUESTION 3

Investigations revealed normal blood count and erythrocyte sedimentation rate and normal biochemistry apart from a raised creatine kinase at 330 IU/l (normal range 60–120 IU/l), which is commonly seen in cases of ongoing denervation. Electromyography showed evidence of denervation in the right APB and FDI with polyphasic motor units and complex repetitive discharges, no spontaneous activity in the left calf and large polyphasic units in the right calf consistent with chronic partial denervation. Motor and sensory conduction velocities were normal. A lumbar myelogram was normal. Magnetic resonance imaging (MRI) scan of the calves is shown in figure2.

Figure 2

Axial T1 weighted MRI scan (TR 588 ms, TE 15 ms) of the calves, showing gross muscle atrophy and replacement by adipose tissue on the left, and hypertrophy of the muscles on the right, with only minor adipose tissue deposition

QUESTION 4

The differential diagnosis of the progressive calf hypertrophy is given in the box.

Causes of calf muscle hypertrophy

Chronic partial denervation

  • radiculopathy

  • peripheral neuropathy

  • hereditary motor and sensory neuropathy

  • spinal muscular atrophy

  • following paralytic poliomyelitis

    Neuromyotonia and myokymia

  • Isaac's syndrome

  • generalised myokymia

  • neurotonia

  • continuous muscle fibre activity due to: chronic inflammatory demyelinating polyradiculopathy, Guillain Barre syndrome, myasthenia gravis, thymoma, thyrotoxicosis, thyroiditis

    Muscular dystrophies

    Myositis

    Infiltration

  • tumours

  • amyloidosis

  • cysticercosis

    Link here