public NeurologyForm()
{
C1 = new NeurologyFormLevel
{
Ordinal = 0,
IsKeyMuscle = false,
IsLowerMuscle = false,
Name = "C1",
Previous = null,
RightMotorName = "5",
RightMotorValue = 5,
LeftMotorName = "5",
LeftMotorValue = 5,
RightTouchName = "2",
RightTouchValue = 2,
LeftTouchName = "2",
LeftTouchValue = 2,
RightPrickName = "2",
RightPrickValue = 2,
LeftPrickName = "2",
LeftPrickValue = 2
};
_levels = new Dictionary<string, NeurologyFormLevel>();
var previousLevel = C1;
for (var i = 0; i < LevelNames.Length; i++)
{
var name = LevelNames[i];
var currentLevel = new NeurologyFormLevel
{
IsKeyMuscle = KeyMuscles.Contains(name),
IsLowerMuscle = (i >= 20 && i <= 24),
Name = name,
Ordinal = i + 1,
Previous = previousLevel
};
previousLevel.Next = currentLevel;
previousLevel = currentLevel;
_levels.Add(name, currentLevel);
}
}
public void AddRightSensoryZppValue(NeurologyFormLevel level)
{
if (_rightSensoryZppValues.Any(l => l.Name.ToUpper() == level.Name)
|| "S4_5".Equals(level.Name))
return;
_rightSensoryZppValues.Add(level);
}
public void AddRightMotorValue(NeurologyFormLevel level)
{
if (_rightMotorValues.Any(l => l.Name.ToUpper() == level.Name))
return;
if (MostRostralRightMotor == null || level.Ordinal < MostRostralRightMotor.Ordinal)
MostRostralRightMotor = level;
if (MostCaudalRightMotor == null || level.Ordinal > MostCaudalRightMotor.Ordinal)
MostCaudalRightMotor = level;
_rightMotorValues.Add(level);
}
public void AddNeurologicalLevelOfInjury(NeurologyFormLevel level)
{
if (_neurologicalLevelsOfInjury.Any(l => l.Name.ToLower() == level.Name.ToLower()))
return;
if (MostRostralNeurologicalLevelOfInjury == null || level.Ordinal < MostRostralNeurologicalLevelOfInjury.Ordinal)
MostRostralNeurologicalLevelOfInjury = level;
if (MostCaudalNeurologicalLevelOfInjury == null || level.Ordinal > MostCaudalNeurologicalLevelOfInjury.Ordinal)
MostCaudalNeurologicalLevelOfInjury = level;
_neurologicalLevelsOfInjury.Add(level);
}
public void AddLeftSensoryValue(NeurologyFormLevel level)
{
if (_leftSensoryValues.Any(l => l.Name.ToUpper() == level.Name))
return;
_leftSensoryValues.Add(level);
}
public void AddLeftMotorZppValue(NeurologyFormLevel level)
{
if (_leftMotorZppValues.Any(l => l.Name.ToUpper() == level.Name)
|| "S4_5".Equals(level.Name))
return;
_leftMotorZppValues.Add(level);
}
private static void UpdateLevel(NeurologyFormLevel level, string rightTouchName, string leftTouchName,
string rightPrickName, string leftPrickName, string rightMotorName, string leftMotorName)
{
// Right Touch
level.RightTouchName = rightTouchName;
level.RightTouchValue = GetDermatomeValue(rightTouchName, NormalSensoryValue);
level.RightTouchImpairmentNotDueToSci = NonSciImpairmentRegex.IsMatch(rightTouchName);
// Left Touch
level.LeftTouchName = leftTouchName;
level.LeftTouchValue = GetDermatomeValue(leftTouchName, NormalSensoryValue);
level.LeftTouchImpairmentNotDueToSci = NonSciImpairmentRegex.IsMatch(leftTouchName);
// Right Prick
level.RightPrickName = rightPrickName;
level.RightPrickValue = GetDermatomeValue(rightPrickName, NormalSensoryValue);
level.RightPrickImpairmentNotDueToSci = NonSciImpairmentRegex.IsMatch(rightPrickName);
// Left Prick
level.LeftPrickName = leftPrickName;
level.LeftPrickValue = GetDermatomeValue(leftPrickName, NormalSensoryValue);
level.LeftPrickImpairmentNotDueToSci = NonSciImpairmentRegex.IsMatch(leftPrickName);
// Right Motor
level.RightMotorName = rightMotorName;
level.RightMotorValue = GetDermatomeValue(rightMotorName, NormalMotorValue);
level.RightMotorImpairmentNotDueToSci = NonSciImpairmentRegex.IsMatch(rightMotorName);
// Left Motor
level.LeftMotorName = leftMotorName;
level.LeftMotorValue = GetDermatomeValue(leftMotorName, NormalMotorValue);
level.LeftMotorImpairmentNotDueToSci = NonSciImpairmentRegex.IsMatch(leftMotorName);
if (!level.IsKeyMuscle)
{
if ((level.RightTouchValue == 2 || level.RightTouchImpairmentNotDueToSci)
&& (level.RightPrickValue == 2 || level.RightPrickImpairmentNotDueToSci))
{
level.RightMotorName = "5";
level.RightMotorValue = 5;
}
else
{
level.RightMotorName = (NtRegex.IsMatch(level.RightTouchName) || level.RightTouchValue == 2)
&& (NtRegex.IsMatch(level.RightPrickName) || level.RightPrickValue == 2) ? "NT" : "0";
level.RightMotorValue = 0;
}
if ((level.LeftTouchValue == 2 || level.LeftTouchImpairmentNotDueToSci)
&& (level.LeftPrickValue == 2 || level.LeftPrickImpairmentNotDueToSci))
{
level.LeftMotorName = "5";
level.LeftMotorValue = 5;
}
else
{
level.LeftMotorName = (NtRegex.IsMatch(level.LeftTouchName) || level.LeftTouchValue == 2)
&& (NtRegex.IsMatch(level.LeftPrickName) || level.LeftPrickValue == 2) ? "NT" : "0";
level.LeftMotorValue = 0;
}
}
}
public void SetRightLowestNonKeyMuscleWithMotorFunction(string levelName)
{
if (string.IsNullOrEmpty(levelName))
return;
var key = levelName.ToUpper();
if (!_levels.ContainsKey(key))
return;
if (RightLowestNonKeyMuscleWithMotorFunction != null)
RightLowestNonKeyMuscleWithMotorFunction.HasOtherRightMotorFunction = false;
RightLowestNonKeyMuscleWithMotorFunction = _levels[key];
RightLowestNonKeyMuscleWithMotorFunction.HasOtherRightMotorFunction = true;
}
/// <summary>
/// Recursive method which iterates through the values in a nuerology form while it updates the totals generating the results produced by the algorithm.
/// </summary>
/// <param name="neurologyForm">Form being evaluated.</param>
/// <param name="totals">Brand new totals object where the results are to be stored.</param>
/// <param name="level">Current neurology level being evaluated</param>
/// <param name="nextNonKeyMuscleShouldBeRightMotor">Flag used to evaluate the Kathy Collins condition on the right motor results.</param>
/// <param name="nextNonKeyMuscleShouldBeLeftMotor">Flag used to evaluate the Kathy Collins condition on the left motor results.</param>
private static void UpdateTotalsWithLevelAt(NeurologyForm neurologyForm, NeurologyFormTotals totals, NeurologyFormLevel level, bool nextNonKeyMuscleShouldBeRightMotor, bool nextNonKeyMuscleShouldBeLeftMotor)
{
totals.RightTouchTotal += level.RightTouchValue;
totals.LeftTouchTotal += level.LeftTouchValue;
totals.RightPrickTotal += level.RightPrickValue;
totals.LeftPrickTotal += level.LeftPrickValue;
if (level.IsKeyMuscle)
{
if (level.IsLowerMuscle)
{
if (level.RightMotorImpairmentNotDueToSci && !totals.RightLowerMotorTotalHasImpairmentNotDueToSci)
totals.RightLowerMotorTotalHasImpairmentNotDueToSci = true;
if (level.LeftMotorImpairmentNotDueToSci && !totals.LeftLowerMotorTotalHasImpairmentNotDueToSci)
totals.LeftLowerMotorTotalHasImpairmentNotDueToSci = true;
if (NtRegex.IsMatch(level.RightMotorName) && !level.RightMotorImpairmentNotDueToSci)
totals.RightLowerMotorContainsNt = true;
if (NtRegex.IsMatch(level.LeftMotorName) && !level.LeftMotorImpairmentNotDueToSci)
totals.LeftLowerMotorContainsNt = true;
}
else
{
if (level.RightMotorImpairmentNotDueToSci && !totals.RightUpperMotorTotalHasImpairmentNotDueToSci)
totals.RightUpperMotorTotalHasImpairmentNotDueToSci = true;
if (level.LeftMotorImpairmentNotDueToSci && !totals.LeftUpperMotorTotalHasImpairmentNotDueToSci)
totals.LeftUpperMotorTotalHasImpairmentNotDueToSci = true;
if (NtRegex.IsMatch(level.RightMotorName) && !level.RightMotorImpairmentNotDueToSci)
totals.RightUpperMotorContainsNt = true;
if (NtRegex.IsMatch(level.LeftMotorName) && !level.LeftMotorImpairmentNotDueToSci)
totals.LeftUpperMotorContainsNt = true;
}
}
else
{
if (nextNonKeyMuscleShouldBeRightMotor)
{
nextNonKeyMuscleShouldBeRightMotor = false;
totals.AddRightMotorValue(level.Previous);
if (!totals.RightSensoryHasOnlySoftValues)
totals.RightMotorHasOnlySoftValues = false;
}
if (nextNonKeyMuscleShouldBeLeftMotor)
{
nextNonKeyMuscleShouldBeLeftMotor = false;
totals.AddLeftMotorValue(level.Previous);
if (!totals.LeftSensoryHasOnlySoftValues)
totals.LeftMotorHasOnlySoftValues = false;
}
}
if (level.RightTouchImpairmentNotDueToSci && !totals.RightTouchTotalHasImpairmentNotDueToSci)
totals.RightTouchTotalHasImpairmentNotDueToSci = true;
if (level.LeftTouchImpairmentNotDueToSci && !totals.LeftTouchTotalHasImpairmentNotDueToSci)
totals.LeftTouchTotalHasImpairmentNotDueToSci = true;
if (level.RightPrickImpairmentNotDueToSci && !totals.RightPrickTotalHasImpairmentNotDueToSci)
totals.RightPrickTotalHasImpairmentNotDueToSci = true;
if (level.LeftPrickImpairmentNotDueToSci && !totals.LeftPrickTotalHasImpairmentNotDueToSci)
totals.LeftPrickTotalHasImpairmentNotDueToSci = true;
// Check if a column contains any NT value so we can properly format the total presented to the user
if (NtRegex.IsMatch(level.RightTouchName) && !level.RightTouchImpairmentNotDueToSci && !totals.RightTouchContainsNt)
totals.RightTouchContainsNt = true;
if (NtRegex.IsMatch(level.LeftTouchName) && !level.LeftTouchImpairmentNotDueToSci && !totals.LeftTouchContainsNt)
totals.LeftTouchContainsNt = true;
if (NtRegex.IsMatch(level.RightPrickName) && !level.RightPrickImpairmentNotDueToSci && !totals.RightPrickContainsNt)
totals.RightPrickContainsNt = true;
if (NtRegex.IsMatch(level.LeftPrickName) && !level.LeftPrickImpairmentNotDueToSci && !totals.LeftPrickContainsNt)
totals.LeftPrickContainsNt = true;
if (totals.RightSensoryHasOnlySoftValues &&
((level.RightTouchValue != 2 && !level.RightTouchImpairmentNotDueToSci) ||
(level.RightPrickValue != 2 && !level.RightPrickImpairmentNotDueToSci)))
{
totals.AddRightSensoryValue(level.Previous);
if ("S4_5".Equals(level.Name)
&& (level.RightTouchValue == 2 || NtRegex.IsMatch(level.RightTouchName))
&& (level.RightPrickValue == 2 || NtRegex.IsMatch(level.RightPrickName)))
{
totals.AddRightSensoryValue(level);
if (totals.NeurologicalLevelOfInjuryHasOnlySoftValues)
totals.AddNeurologicalLevelOfInjury(level);
}
if (totals.NeurologicalLevelOfInjuryHasOnlySoftValues)
totals.AddNeurologicalLevelOfInjury(level.Previous);
if ((level.RightTouchValue != 2 && !NtRegex.IsMatch(level.RightTouchName))
|| (level.RightPrickValue != 2 && !NtRegex.IsMatch(level.RightPrickName)))
{
totals.RightSensoryHasOnlySoftValues = false;
totals.NeurologicalLevelOfInjuryHasOnlySoftValues = false;
}
if (level.IsKeyMuscle)
{
nextNonKeyMuscleShouldBeRightMotor = true;
totals.HasRightCollins = true;
}
}
if (totals.LeftSensoryHasOnlySoftValues &&
((level.LeftTouchValue != 2 && !level.LeftTouchImpairmentNotDueToSci) ||
(level.LeftPrickValue != 2 && !level.LeftPrickImpairmentNotDueToSci)))
{
totals.AddLeftSensoryValue(level.Previous);
if ("S4_5".Equals(level.Name)
&& (level.LeftTouchValue == 2 || NtRegex.IsMatch(level.LeftTouchName))
&& (level.LeftPrickValue == 2 || NtRegex.IsMatch(level.LeftPrickName)))
{
totals.AddLeftSensoryValue(level);
if (totals.NeurologicalLevelOfInjuryHasOnlySoftValues)
totals.AddNeurologicalLevelOfInjury(level);
}
if (totals.NeurologicalLevelOfInjuryHasOnlySoftValues)
totals.AddNeurologicalLevelOfInjury(level.Previous);
if ((level.LeftTouchValue != 2 && !NtRegex.IsMatch(level.LeftTouchName))
|| (level.LeftPrickValue != 2 && !NtRegex.IsMatch(level.LeftPrickName)))
{
totals.LeftSensoryHasOnlySoftValues = false;
totals.NeurologicalLevelOfInjuryHasOnlySoftValues = false;
}
if (level.IsKeyMuscle)
{
nextNonKeyMuscleShouldBeLeftMotor = true;
totals.HasLeftCollins = true;
}
}
if (totals.RightMotorHasOnlySoftValues && level.RightMotorValue != 5 && !level.RightMotorImpairmentNotDueToSci)
{
if (level.IsKeyMuscle && (level.RightMotorValue >= 3 || NtRegex.IsMatch(level.RightMotorName)))
{
totals.AddRightMotorValue(level);
// Check if left won't make the NLI have to be the previous level.
// Let the logic for left motor handle the SNL instead
if (totals.NeurologicalLevelOfInjuryHasOnlySoftValues
&& (level.LeftMotorValue > 2 || level.LeftMotorImpairmentNotDueToSci || NtRegex.IsMatch(level.LeftMotorName)))
{
totals.AddNeurologicalLevelOfInjury(level);
if (!NtRegex.IsMatch(level.RightMotorName))
totals.NeurologicalLevelOfInjuryHasOnlySoftValues = false;
}
}
if (level.RightMotorValue < 3 || NtRegex.IsMatch(level.RightMotorName))
{
totals.AddRightMotorValue(level.Previous);
if (totals.NeurologicalLevelOfInjuryHasOnlySoftValues)
{
totals.AddNeurologicalLevelOfInjury(level.Previous);
if (!NtRegex.IsMatch(level.RightMotorName))
totals.NeurologicalLevelOfInjuryHasOnlySoftValues = false;
}
}
if (!NtRegex.IsMatch(level.RightMotorName))
totals.RightMotorHasOnlySoftValues = false;
}
if (totals.LeftMotorHasOnlySoftValues && level.LeftMotorValue != 5 && !level.LeftMotorImpairmentNotDueToSci)
{
if (level.IsKeyMuscle && (level.LeftMotorValue >= 3 || NtRegex.IsMatch(level.LeftMotorName)))
{
totals.AddLeftMotorValue(level);
if (totals.NeurologicalLevelOfInjuryHasOnlySoftValues)
totals.AddNeurologicalLevelOfInjury(level);
}
if (level.LeftMotorValue < 3 || NtRegex.IsMatch(level.LeftMotorName))
{
totals.AddLeftMotorValue(level.Previous);
if (totals.NeurologicalLevelOfInjuryHasOnlySoftValues)
totals.AddNeurologicalLevelOfInjury(level.Previous);
}
if (!NtRegex.IsMatch(level.LeftMotorName))
{
totals.LeftMotorHasOnlySoftValues = false;
totals.NeurologicalLevelOfInjuryHasOnlySoftValues = false;
}
}
/* -- RECURSIVE CALL --------------- */
if (level.Next != null)
UpdateTotalsWithLevelAt(neurologyForm, totals, level.Next,
nextNonKeyMuscleShouldBeRightMotor && totals.RightMotorHasOnlySoftValues,
nextNonKeyMuscleShouldBeLeftMotor && totals.LeftMotorHasOnlySoftValues);
#region This happens when there are INTACT values -------------------------------------------
if ("S4_5".Equals(level.Name))
{
if (totals.RightSensoryHasOnlySoftValues && totals.LeftSensoryHasOnlySoftValues
&& totals.RightMotorHasOnlySoftValues && totals.LeftMotorHasOnlySoftValues)
totals.AddNeurologicalLevelOfInjury(level);
if (totals.RightSensoryHasOnlySoftValues)
{
totals.AddRightSensoryValue(level);
totals.RightSensoryHasOnlySoftValues = false;
}
if (totals.LeftSensoryHasOnlySoftValues)
{
totals.AddLeftSensoryValue(level);
totals.LeftSensoryHasOnlySoftValues = false;
}
if (totals.RightMotorHasOnlySoftValues)
{
totals.AddRightMotorValue(level);
totals.RightMotorHasOnlySoftValues = false;
}
if (totals.LeftMotorHasOnlySoftValues)
{
totals.AddLeftMotorValue(level);
totals.LeftMotorHasOnlySoftValues = false;
}
}
#endregion
if (totals.RightSensoryZppHasOnlySoftValues && (!"0".Equals(level.RightTouchName) || !"0".Equals(level.RightPrickName)))
{
if ((level.RightTouchValue > 0 || level.RightTouchImpairmentNotDueToSci)
|| (level.RightPrickValue > 0 || level.RightPrickImpairmentNotDueToSci))
totals.RightSensoryZppHasOnlySoftValues = false;
totals.AddRightSensoryZppValue(level);
}
if (totals.LeftSensoryZppHasOnlySoftValues && (!"0".Equals(level.LeftTouchName) || !"0".Equals(level.LeftPrickName)))
{
if ((level.LeftTouchValue > 0 || level.LeftTouchImpairmentNotDueToSci)
|| (level.LeftPrickValue > 0 || level.LeftPrickImpairmentNotDueToSci))
totals.LeftSensoryZppHasOnlySoftValues = false;
totals.AddLeftSensoryZppValue(level);
}
if (totals.RightMotorZppHasOnlySoftValues
&& (level.HasOtherRightMotorFunction
|| (!"0".Equals(level.RightMotorName) && (level.IsKeyMuscle || totals.RightMotorContains(level.Name)))))
{
if ((level.RightMotorImpairmentNotDueToSci || level.HasOtherRightMotorFunction || !NtRegex.IsMatch(level.RightMotorName)) &&
(level.IsKeyMuscle
|| level.Ordinal < 4
|| (level.Ordinal > 25 && !totals.RightUpperMotorContainsNt && !totals.RightLowerMotorContainsNt && !totals.HasRightCollins)
|| (level.Ordinal > 8 && level.Ordinal < 21 && !totals.RightUpperMotorContainsNt)))
totals.RightMotorZppHasOnlySoftValues = false;
totals.AddRightMotorZppValue(level);
}
if (totals.LeftMotorZppHasOnlySoftValues
&& (level.HasOtherLeftMotorFunction
|| (!"0".Equals(level.LeftMotorName) && (level.IsKeyMuscle || totals.LeftMotorContains(level.Name)))))
{
if ((level.LeftMotorImpairmentNotDueToSci || level.HasOtherLeftMotorFunction || !NtRegex.IsMatch(level.LeftMotorName)) &&
(level.IsKeyMuscle
|| level.Ordinal < 4
|| (level.Ordinal > 25 && !totals.LeftUpperMotorContainsNt && !totals.LeftLowerMotorContainsNt && !totals.HasLeftCollins)
|| (level.Ordinal > 8 && level.Ordinal < 21 && !totals.LeftUpperMotorContainsNt)))
totals.LeftMotorZppHasOnlySoftValues = false;
totals.AddLeftMotorZppValue(level);
}
// Update most Rostral levels with motor function
if ((level.IsKeyMuscle || level.HasOtherRightMotorFunction)
&& totals.MostRostralRightLevelWithMotorFunction == null
&& (level.RightMotorImpairmentNotDueToSci || level.HasOtherRightMotorFunction || (level.RightMotorValue != 0 && level.IsKeyMuscle)))
totals.MostRostralRightLevelWithMotorFunction = level;
if ((level.IsKeyMuscle || level.HasOtherLeftMotorFunction)
&& totals.MostRostralLeftLevelWithMotorFunction == null
&& (level.LeftMotorImpairmentNotDueToSci || level.HasOtherLeftMotorFunction || (level.LeftMotorValue != 0 && level.IsKeyMuscle)))
totals.MostRostralLeftLevelWithMotorFunction = level;
// Update most Caudal levels with motor function
if ((level.IsKeyMuscle || level.HasOtherRightMotorFunction)
&& totals.MostCaudalRightLevelWithMotorFunction == null
&& (!"0".Equals(level.RightMotorName) || level.HasOtherRightMotorFunction))
totals.MostCaudalRightLevelWithMotorFunction = level;
if ((level.IsKeyMuscle || level.HasOtherLeftMotorFunction)
&& totals.MostCaudalLeftLevelWithMotorFunction == null
&& (!"0".Equals(level.LeftMotorName) || level.HasOtherLeftMotorFunction))
totals.MostCaudalLeftLevelWithMotorFunction = level;
if (!level.IsKeyMuscle)
return;
if (level.IsLowerMuscle)
{
totals.RightLowerMotorTotal += level.RightMotorValue;
totals.LeftLowerMotorTotal += level.LeftMotorValue;
}
else
{
totals.RightUpperMotorTotal += level.RightMotorValue;
totals.LeftUpperMotorTotal += level.LeftMotorValue;
}
}
/// <summary>
/// Compares two neurology levels based on property "Ordinal".
/// </summary>
/// <param name="a">Neurology form level A</param>
/// <param name="b">Neurology form level B</param>
/// <returns>
/// Returns
/// – 1 if a is more caudal (the ordinal of a is greater than the one of b)
/// – 0 if both ordinal values are the same
/// – -1 if b is more caudal (the ordinal of b is greater than the one of a).
/// </returns>
private static int CompareNeurologyFormTotalsLevelByOrdinal(NeurologyFormLevel a,
NeurologyFormLevel b)
{
// Both are null so they are equal
// OR
// a is null and b is not so b is greater
if (a == null)
return b == null ? 0 : -1;
// b is null and a is not so a is greater
if (b == null)
return 1;
return a.Ordinal > b.Ordinal ? 1 : a.Ordinal == b.Ordinal ? 0 : -1;
}
