Browsing by Author "Louw, Graham"

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    Circulus arteriosus cerebri: Anatomical variations and their correlation to cerebral aneurysms
    (2015) Du Toit, Francesca; Louw, Graham
    The anatomical structure of circulus arteriosus cerebri was first described by Thomas Willis in 1664. Many variations in the circulus arteriosus cerebri have since been reported. The extent to which anatomical variations within the circle influence aneurysm formation in a South African sample has not yet been established. The results of such a study would be of value to clinicians treating patients with vascular diseases. The aim of the study was to determine if there is a correlation between arterial variations in the circulus arteriosus cerebri and cerebral aneurysm formation. The brains of 39 cadavers at the Faculty of Health Sciences were removed and the circulus arteriosus dissected. In addition, 113 patients who underwent a MRI or MRA of the circulus arteriosus cerebri at the Department of Radiology at the Groote Schuur Hospital, Cape Town were included. For both of these samples the anatomical variations and any aneurysms present were documented. The external diameters of the arteries forming the circulus arteriosus cerebri were also measured. No aneurysms were found in the cadaver sample, thus the correlation could not be tested. In the sample of images from the 113 patients, 111 images showed one or more anatomical variation of the circulus arteriosus cerebri. Of these, 59 had one or more cerebral aneurysm and 52 had no aneurysms. Statistical analysis showed no significant correlation between cerebral aneurysms and anatomical variations in the circulus arteriosus cerebri for a South Africans ample. This is contradictory to what is seen in the literature. Further investigation is required to establish the reason why the results from this South African sample differ from the results reported in the international literature.
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    Conceptualising differentiated forms of knowledge : the Medical (MBChB) curriculum of the University of Cape Town
    ([2010]) Louw, Graham; Shay, Suellen
    Two major features characterise the change to the Medical curriculum at the University of Cape Town, which occurred in 2002, namely: a traditional didactic approach to teaching was replaced by a problem-based learning programme, and the traditional biomedical model was replaced by a bio-psychosocial model, unofficially referred to as a bio-psychosocial / spiritual model by the staff. The change to the curriculum necessitated a lengthy process of planning and design, implementation, and continuous review. Crucial to this on-going process of curriculum review is a better understanding of how disciplinary knowledge is recontextualised into educational knowledge. This study is an investigation into the concepts of differentiated forms of knowledge that inform the Medical (MBChB) curriculum of the University of Cape Town (UCT). The object of this research project is to classify, describe and compare the forms of knowledge present in two selected subject areas, each made up of specific specialities (disciplines), within courses in Years 2 and 3 that form a major portion of the programme. Using the concepts of - hard and - soft‖ sciences (Natural Sciences versus the Humanities), two subjects were identified that fell into different quadrants of Biglan's classification of subjects (Biglan, 1973a,b). The two subjects chosen were Chemical Pathology and Culture, Psyche and Illness. Data were collected from course documentation, interviews with members of staff, and examples of assessments. These data were then analysed using Maton's legitimation code theory, which identifies four legitimation codes based on the Epistemic Relation (ER) and the Social Relation (SR), namely a Knowledge Code, a Knower Code, a Relativist Code, and an Élite Code. These four categories were used to determine what is valued in the two subjects, using the relative strength or weakness of each of ER, SR, classification and framing.
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    An investigation into the ultrastructural parameters of abdominal muscles in children and adolescents with spastic type cerebral palsy and the effect on postural muscle performance
    (2014) Adjenti, Saviour Kweku; Louw, Graham; Jelsma, Jennifer; Unger, Marianne
    Cerebral palsy (CP) is an abnormality in motor function and postural tone that usually occurs at an early age. Spastic type cerebral palsy (STCP) - the most common type of motor disorder - involves increased muscle tone, a rigid posture in the limbs and muscle weakness resulting in impairment of gross motor function, trunk instability and co-ordination. The management of CP cases includes a broad spectrum of therapeutic interventions, therefore involving a large multi-professional team, and providing an ideal opportunity for collaboration amongst professionals. The primary determinants of muscle function are the architectural parameters (MAP's) of the muscle which determine the macroscopic arrangement of muscle fibres relative to the axis of force generation. Ultrasonography was used to quantify these MAP's while the NORAXAN® electromyograph was used to monitor neuromuscular activity in children and adolescents with STCP (N = 63) and the results were compared with the findings from aged-matched individuals with typical development (TD), (N = 82). All the muscles - external oblique (EO), internal oblique (IO), transversus abdominis (TrA) and rectus abdominis (RA) - were thicker in the STCP group than in the TD group. The EO, IO and TrA muscles in the STCP group were thicker at rest than in individuals with TD. The MAP's of EO, IO and TrA in the STCP group decreased when the muscles changed from the resting to an active state, as opposed to increasing in the TD group. The four muscles of individuals with TD and the RA of the STCP group showed significant changes (p < 0.001) in the frequency of EMG activity between the resting and active states. With regards to pennation, the abdominal muscles could be regarded as a transition group of muscles, lying somewhere between pennated and non-pennated muscle bellies. The findings from this study revealed that the RA may be targeted during rehabilitation regimens in the provision of stability for the bony pelvis, however, the force generated by this muscle may not be sufficient for the maintenance of trunk stability without optimal support from the EO and IO. An elevated tone at rest in the EO and IO, coupled with unilateral activity of the RA may lead to mal-rotation of the bony pelvis. The gross motor function measure (GMFM), which tested the five main domains of activity in individuals with STCP was well aligned with the gross motor function classification system (GMFCS) Levels (disability status) but did not correlate with changes in MAP's or with changes in the frequency of EMG activity between resting and active states. The performance of daily activities by individuals with STCP may not be a reflection of the activity of a muscle. The physiological cost index (PCI) was performed as an outcome measure to determine and compare the level of energy consumption between the two groups. The participants with STCP consumed significantly more (p < 0.001) energy than the TD group. However, this test showed no association with MAP, EMG activity and the changes in these muscle parameters from resting to active states (rho ranged from -0.009 to 0.27 in the STCP group; rho ranging from - 0.423 to 0.199 in the TD group). The PCI may not be a useful test in determining the morphological transformation taking place in a muscle or muscle groups. The MAP's of the unaffected side of the abdominal muscles of the STCP individuals with hemiplegia showed similar characteristics to those of TD individuals. The STCP adversely affects the trunk musculature in a similar fashion to the limbs. Knowledge of the macroscopic arrangement of the abdominal muscles is important in the management of pelvic stability in individuals with STCP.
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    Medical students' attitudes towards and perceptions of the Primary Health Care approach
    (2005) Draper, Catherine; Louw, Graham; Taylor, David; Gibbs, Trevor
    The aim of this research was to provide an understanding of medical students' attitudes towards and perceptions of the PHC approach, and this was done using mainly qualitative methods, namely focus groups, interviews, and one questionnaire. This research also investigated students' views of the way in which the PHC approach was taught, their understanding of the PHC approach, what could influence students' views of the PHC approach, the appropriateness of the PHC approach in South Africa, their opinions of the fact that UCT has a PHC-driven MBChB curriculum, their views of the role of doctors in the PHC approach, and a number of other related issues. The main findings were that students enter their medical degree with an expectation of a biomedical emphasis and a lecture-based curriculum.
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    Parameters related to the equinus ankle in ambulatory children with cerebral palsy : an investigation of the differences between children with the diplegic and hemiplegic subtypes
    (2008) Gangata, Hope; Louw, Graham; Jelsma, Jennifer
    The equinus ankle is one of the most treated conditions of the ankle and foot. Previous studies have investigated the lower limbs in children with either the diplegic (D-Group) or hemiplegic subtypes (H-Group) of cerebral palsy (CP). Children presenting with diplegia have been reported to have crouched knees (knee in flexion deformity) and an equinovalgus, while children with hemiplegia tend to have genu recurvatum (over extended knees), ankle equinovarus and a shorter affected limb (AL) than the unaffected limb (UL). No study has specifically compared the impairments related to the equinus ankle between the subtypes of CP. In addition, treatment outcomes for the management of the equinus ankle have not been satisfactory documented and there may be crucial differences in the parameters related to the equinus ankle between the D-Group and the H-Group.