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A M Bakheit

Publications and source records attributed to A M Bakheit.

At least 19 recordsLinked to original sources
PubMed2001

Opinion statement on the minimal acceptable standards of healthcare in cerebral palsy.

PURPOSE: Recent studies have shown a marked variation in the standards of healthcare for young people with disabilities in different regions of the UK and even within the same health district. Equity in the provision of healthcare is a fundamental principle of the NHS. However, this can only be measured against an agreed minimal standard of healthcare that serves as a benchmark for healthcare purchasers and providers. The aim of the present document is to develop a set of minimum standards of healthcare for children and adults with cerebral palsy (CP). METHODS: The document was developed in two stages by a multi-professional and multi-disciplinary group of practitioners in the field of CP. Initially, members of the panel jointly formulated a statement of what they believed should be the minimal acceptable standards of healthcare in CP drawing on their own experience and the published scientific evidence. In the second stage the views of some of the relevant professional bodies and voluntary organizations on the draft statement were sought. The responses of these organizations were incorporated into the final document if agreed by the panel. RESULTS AND CONCLUSIONS: Twenty-two recommendations were made. These were considered the minimum standards of care in a district general hospital. The emphasis was on the organisation and delivery of healthcare for children with CP. The statement is intended to stimulate debate especially in relation to the equity of service provision throughout the country and may be used to inform purchasers of healthcare. Similarly, it may also be useful to providers of healthcare as an audit tool.

Adult↗
PubMed2001

Safety profile and efficacy of botulinum toxin A (Dysport) in children with muscle spasticity.

Botulinum toxin A (BTX-A) is widely used in the management of muscle spasticity in children. However, at present the dose of BTX-A for a given patient is selected empirically. The aim of this study is to provide dosage guidelines that are based on risk/benefit assessment. This was a multicentre retrospective study of the safety profile and efficacy of BTX-A in children with chronic muscle spasticity. Data in 758 patients who received a total of 1594 treatments were analysed (mean age 7.2 years; 429 males, 329 females). Spastic cerebral palsy (CP) was the most common diagnosis (94% of the study sample). Of all treatments 7% resulted in adverse events; incidence was related to the total dose rather than the dose calculated on the basis of body weight. The highest incidence of adverse events was observed in patients who received >1000 IU of BTX-A per treatment session. The odds of an adverse event was 5.1 times greater for this group of patients than for those who had 250 IU or less (p<0.001). A good overall response to treatment was reported in 82% and treatment goals were fully or partially achieved in 3% and 94% of participants respectively. More patients in the highest dose group reported functional deterioration. Interestingly, multilevel treatments resulted in a better response than single-level treatments (odds ratio 1.7, 95% CI 1.3 to 2.2,p=0.001).

Age Factors↗
PubMed2001

A randomized, double-blind, placebo-controlled study of the efficacy and safety of botulinum toxin type A in upper limb spasticity in patients with stroke.

OBJECTIVE: To study the efficacy and safety of botulinum toxin type A (BtxA) in the treatment of upper limb muscle spasticity, caused by stroke. METHODS: This was a randomized, controlled trial. Patients received either placebo injections or a total of 1000 IU of BtxA (Dysport) into five muscles of the affected arm. Muscle tone was assessed using the Modified Ashworth Scale (MAS). Other outcome measures were the change in the joint range of motion (ROM), the Barthel index, pain score, goal attainment and the subjective evaluation of benefit by patients and investigators. The patients were assessed blind to randomization at baseline and 4, 8, 12 and 16 weeks after treatment. RESULTS: Fifty nine patients were recruited and received treatment. One patient was lost to follow-up before the last scheduled visit of the study. The group of patients who received BtxA had a significant reduction in the summed MAS score at week 4 compared with the placebo group (P=0.004). The magnitude of benefit over the 16 week follow-up period was significantly reduced for the BtxA group in the wrist (P=0.004) and the finger joints (P=0.001) when compared with the placebo. There was no statistically significant difference between the groups in the joint ROM, muscle pain, goal-attainment or the Barthel index scores at week 4 of the study. At week 16, the BtxA group showed significantly greater improvement in the passive ROM at the elbow (P=0.036). The patients' global assessment of benefit at the end of the study showed that 16 (50%) patients in the placebo group had 'much improved' or had 'some improvement' compared with 24 (92.3%) patients in the BtxA group (P=0.007). The investigators' rating for the same item was 16 (50%) and 23 (88.4%) patients, respectively (P=0.002). Sixteen and twenty patients in the BtxA and placebo groups, respectively, had an adverse event. The most frequently reported adverse events were accidental injury, respiratory and urinary tract infections and muscle pain. CONCLUSION: The findings of the present study suggest that treatment with BtxA in a dose of 1000 units reduces muscle tone in patients with post-stroke upper limb spasticity. This effect is sustained for at least 16 weeks. BtxA is safe in the dose used in this study. IMPORTANT NOTE: The authors wish to emphasize that the botulinum toxin preparation used in this study was Dysport (Ipsen Ltd) which has a different therapeutic equivalence from other commercially available product, Botox (Allergan Inc.).

Aged↗
PubMed2000

The social impact of multiple sclerosis--a study of 305 patients and their relatives.

PURPOSE: to assess the effects of multiple sclerosis (MS) on the patients' ability to fulfil their chosen family and social roles and to examine the impact of the disease on their relatives. METHODS: a population-based survey of all known patients with MS and their relatives in Hampshire County, England, between 1986 and 1989. RESULTS: Seventy-four% of the total study population of 411 completed the study. The patients' mean age was 48.3 years (range 19-82) and the mean disease duration was 15.8 years. About 16% of patients were depressed on a mood rating scale and a similar number also exhibited symptoms of anxiety. The marital status of most patients had not changed since the onset of MS but 53% of those who were employed at the time of diagnosis gave up their jobs and the standards of living of 37% of patients and their families had declined as a direct result of the disease. The ability to continue in gainful employment or to maintain social contacts and leisure activities correlated with the course and severity of the disease and cognitive function. Most carers reported symptoms that clearly related to organic pathologies, anxiety and symptoms of depression. The occurrence of these symptoms was associated with disease severity. The professional career of 57% of relatives was also adversely affected by the patient's illness. CONCLUSIONS: MS has a profound impact on the patients' social roles and their relatives' well-being. In contrast to previous studies, a high divorce/separation rate among patients with MS was not observed. Severe disability and cognitive impairment are predictors of loss of employment, decline in the standards of living and withdrawal from social and leisure activities among patients and are strong indicators of stress among relatives.

Adult↗
PubMed2000

A randomized, double-blind, placebo-controlled, dose-ranging study to compare the efficacy and safety of three doses of botulinum toxin type A (Dysport) with placebo in upper limb spasticity after stroke.

BACKGROUND AND PURPOSE: We sought to define an effective and safe dose of botulinum toxin type A (Dysport) for the treatment of upper limb muscle spasticity due to stroke. METHODS: This was a prospective, randomized, double-blind, placebo-controlled, dose-ranging study. Patients received either a placebo or 1 of 3 doses of Dysport (500, 1000, 1500 U) into 5 muscles of the affected arm. Efficacy was assessed periodically by the Modified Ashworth Scale and a battery of functional outcome measures. RESULTS: Eighty-three patients were recruited, and 82 completed the study. The 4 study groups were comparable at baseline with respect to their demographic characteristics and severity of spasticity. All doses of Dysport studied showed a significant reduction from baseline of muscle tone compared with placebo. However, the effect on functional disability was not statistically significant and was best at a dose of 1000 U. There were no statistically significant differences between the groups in the incidence of adverse events. CONCLUSIONS: The present study suggests that treatment with Dysport reduces muscle tone in patients with poststroke upper limb spasticity. Treatment was effective at doses of Dysport of 500, 1000, and 1500 U. The optimal dose for treatment of patients with residual voluntary movements in the upper limb appears to be 1000 U. Dysport is safe in the doses used in this study.

Arm↗
PubMed2000

Evaluation of the benefits of monitoring fluid thickness in the dietary management of dysphagic stroke patients.

OBJECTIVE: Safe swallowing may be achieved in most patients with neurogenic dysphagia by manipulating the viscosity of ingested fluids. However, in clinical practice fluids are thickened using subjective judgement. This may lead to errors in the preparation of drinks to the prescribed viscosity. The aim of the present study is to examine whether the use of a viscometer improves the dietary management of dysphagic stroke patients. STUDY DESIGN: A randomized controlled study design was used. The speech and language therapist determined the optimal fluid thickness for each patient. The prescribed fluid viscosity for the study group was obtained using a viscometer. Patients in the control group received fluids prepared according to current practice, i.e. the amount of thickener required to produce the prescribed viscosity was judged subjectively by the nursing staff. The two methods of fluid thickening were used for seven consecutive days. Assessment was made blind to randomization. MAIN OUTCOME MEASURE: Pulmonary aspiration, assessed clinically and with pulse oximetry. If the patient did not drink all the fluid that was offered the residue was measured. RESULTS: Ten patients in the study group (n = 23) and nine in the control group (n = 23) aspirated. The mean viscosity of fluids offered to patients in the control group was significantly higher than that of the study patients. There was a statistically significant correlation between the viscosity and the residual volume of fluid (Pearson's test: r = 0.7, p <0.02). The findings of the study suggest that fluids prepared by subjectively assessing the amount of thickener required to produce a given consistency tend to have a higher viscosity than those prepared using the viscometer. However, the higher viscosity does not appear to protect against pulmonary aspiration and may lead to a reduced fluid intake. CONCLUSION: Manipulation of fluid thickness using objective measurements with a viscometer may improve the dietary management of dysphagic stroke patients.

Aged↗
PubMed1998

A study of the factors which influence the length of hospital stay of stroke patients.

OBJECTIVE: To examine the factors which influence the length of hospitalization of stroke patients. DESIGN: Analysis of the relative importance of 10 preselected variables on the length of hospital stay of all patients admitted with a clinical diagnosis of stroke. The data were collected prospectively. SETTING: Two teaching hospitals serving the city of Southampton and southwest Hampshire, England (approximate population 450000). SUBJECTS: Forty-six consecutive stroke patients. RESULTS: Data were complete on 38 patients. The mean and (median) length of hospital stay was 74.9 (80.5) days for men and 74.7 (73.5) for women. The mean age of women in the study sample was higher than that of men (73.2 vs 71.6). Patients who were less than 70 years of age stayed shorter periods in hospital than older subjects. Other factors associated with shorter hospitalization were a stroke type other than total anterior circulation infarct, a Barthel score of 12 or more on admission or at the time of discharge and a frequency of consultants' ward rounds of more than one per week. A delay in the provision of equipment and home adaptations and waiting for placement in a private nursing home were the best predictors of long hospital stays of stroke patients. CONCLUSIONS: Early liaison of rehabilitation staff with Social Services in order to secure the quick provision of environmental aids and adaptations or placement in residential care of stroke patients with a poor prognosis for functional recovery would probably reduce the unnecessary hospitalization of these patients.

Activities of Daily Living↗
PubMed1998

A study of the effectiveness of botulinum toxin type A (Dysport) in the management of muscle spasticity.

Severe muscle spasticity is common in patients with neurological disease. It is often associated with pain and distressing spasms, and frequently leads to functional motor disability. Antispasticity drugs usually result in systemic adverse effects, and peripheral nerve blocks have some disadvantages such as sensory loss and painful dysaesthesiae. In recent years botulinum toxin type A (BT/A) has been advocated for the treatment of muscle spasticity. We studied, using a functional assessment scale, the effects of BT/A on the patients' symptoms and the functional disability due to spasticity in five children and eight adults who were referred for treatment. In 10 patients the treatment goals were achieved, and children generally had a better and more sustained response than adults. There were no adverse effects reported. The present study suggests that BT/A is safe and effective in improving the motor functional disability which is often associated with severe localized muscle spasticity.

Adolescent↗
PubMed1997

Dysphagia in Parkinson's disease.

The prevalence of dysphagia and its relationship to the nutritional status of the subject was examined in 53 patients with Parkinson's disease (PD). Forty-three patients (81%) had swallowing difficulties but this was mild in most of them. The nutritional status of patients with PD was similar to that of age- and sex-matched control subjects. Disease duration and severity correlated with the severity of dysphagia. The study also identified tremor and speech disturbances as the main predictors of dysphagia in PD.

Aged↗
PubMed1997

Does pulse oximetry reliably detect aspiration in dysphagic stroke patients?

BACKGROUND AND PURPOSE: The aim of the present study was to examine the value of pulse oximetry in the diagnosis of aspiration by comparing it with the gold standard, videofluoroscopy, by use of a prospective, controlled, single-blind study design. METHODS: Pulse oximetry was performed simultaneously with videofluoroscopy in 54 consecutive dysphagic stroke patients. Oxygen saturation measurements were taken before the video-fluoroscopic examination (baseline), on swallowing and continuously for 2 minutes after swallowing, and 10 minutes later. RESULTS: Pulse oximetry reliably predicted aspiration or lack of it in 81.5% of cases. The predictive value of the test was low in patients aged > or = 65 years and possibly those with chronic lung disease. One smoker also had a false-negative pulse oximetry result, ie, normal oxygen saturation despite radiological evidence of aspiration. CONCLUSIONS: Pulse oximetry is a reliable method of diagnosis of aspiration in most dysphagic patients. However, careful interpretation of pulse oximetry data is necessary in older subjects, possibly those with chronic pulmonary disease, and smokers. The method is noninvasive, simple, and quick, and can be used routinely in the clinical assessment of dysphagic patients.

Adult↗
PubMed1997

A study of the attitudes of a rural Indian community toward people with physical disabilities.

OBJECTIVE: To examine the attitudes of a rural community in southern India toward its disabled members. DESIGN: Prospective cross-sectional study. METHOD: One hundred and twenty randomly selected villagers around the town of Vellore in southern India were invited to take part in the study. The attitudes towards individuals with physical disabilities were examined using a modified version of the Scale of Attitudes Toward Disabled Persons (SADP). The questionnaire was administered in its original English format with simultaneous translation into Tamil. RESULTS: Data were complete in 111 cases, 82% of whom showed a positive attitude toward people with disability. Gender and employment status did not appear to have an influence on whether the respondent regarded disabled people in a positive or negative way but most older individuals expressed prejudice and/or challenged the rights of disabled people to equal opportunities in education, employment and social integration. Further data analysis demonstrated that more subjects with than without a disabled family member supported the rights of disabled individuals to education, employment and social integration. By contrast, the items of SADP which described the personal attributes of disabled people did not discriminate between the two groups. CONCLUSION: The attitudes of the rural community studied toward people with disabilities were unrelated to the sex or educational status of the respondents but was influenced by their age. This suggests that older subjects in rural communities in developing countries should be the main target for educational programmes which promote positive images of disability.

Adolescent↗
PubMed1997

The prevalence of verbal communication disability in patients with Parkinson's disease.

Previous studies of speech dysfunction in patients with Parkinson's disease (PD) consisted of postal surveys, which rely on the subjective opinions of patients, or were primarily focused on the detailed assessment of impairments without addressing the disabilities resulting from them. Similarly, the impact of the communication disability on the patient's everyday life was not assessed. The aim of the present study was to examine the prevalence of verbal communication disability in these patients, using a validated objective measurement tool. A secondary aim was to establish the patients' awareness of their disability and its impact on their lifestyle. Verbal communication disability was examined in 48 patients with PD using a modified version of the Intelligibility of Dysarthric Speech Assessment Scale. Nearly two-thirds of patients had reduced intelligibility of speech but this was mild, causing no disability, in the majority of them. Two out of seven patients with severely or moderately severely reduced intelligibility of speech were unaware of their disability, and none of the patients reported that the speech difficulties interfered with their lifestyle. The study also identified some predictors of verbal communication disability in these patients.

Aged↗