public static NeurologyFormTotals LoadNeurologyFormTotalsFrom(XDocument xmlDocument)
{
var totalsXml = xmlDocument.Root.Element("NeurologyFormTotals");
var neurologyFormTotals = new NeurologyFormTotals
{
LeftPrickContainsNt = bool.Parse(totalsXml.Element("LeftPrickContainsNt").Value),
LeftPrickTotal = GetIntValueFrom(totalsXml.Element("LeftPrickTotal").Value),
LeftPrickTotalHasImpairmentNotDueToSci = DoesTotalHaveImpairmentNotDueToSci(totalsXml.Element("LeftPrickTotal").Value),
LeftTouchContainsNt = bool.Parse(totalsXml.Element("LeftTouchContainsNt").Value),
LeftTouchTotal = GetIntValueFrom(totalsXml.Element("LeftTouchTotal").Value),
LeftTouchTotalHasImpairmentNotDueToSci = DoesTotalHaveImpairmentNotDueToSci(totalsXml.Element("LeftTouchTotal").Value),
LeftLowerMotorContainsNt = bool.Parse(totalsXml.Element("LeftLowerMotorContainsNt").Value),
LeftLowerMotorTotal = GetIntValueFrom(totalsXml.Element("LeftLowerMotorTotal").Value),
LeftLowerMotorTotalHasImpairmentNotDueToSci = DoesTotalHaveImpairmentNotDueToSci(totalsXml.Element("LeftLowerMotorTotal").Value),
LeftUpperMotorContainsNt = bool.Parse(totalsXml.Element("LeftUpperMotorContainsNt").Value),
LeftUpperMotorTotal = GetIntValueFrom(totalsXml.Element("LeftUpperMotorTotal").Value),
LeftUpperMotorTotalHasImpairmentNotDueToSci = DoesTotalHaveImpairmentNotDueToSci(totalsXml.Element("LeftUpperMotorTotal").Value),
LowerMotorTotal = GetIntValueFrom(totalsXml.Element("LowerMotorTotal").Value),
PrickTotal = GetIntValueFrom(totalsXml.Element("PrickTotal").Value),
RightLowerMotorContainsNt = bool.Parse(totalsXml.Element("RightLowerMotorContainsNt").Value),
RightLowerMotorTotal = GetIntValueFrom(totalsXml.Element("RightLowerMotorTotal").Value),
RightLowerMotorTotalHasImpairmentNotDueToSci = DoesTotalHaveImpairmentNotDueToSci(totalsXml.Element("RightLowerMotorTotal").Value),
RightUpperMotorContainsNt = bool.Parse(totalsXml.Element("RightUpperMotorContainsNt").Value),
RightUpperMotorTotal = GetIntValueFrom(totalsXml.Element("RightUpperMotorTotal").Value),
RightUpperMotorTotalHasImpairmentNotDueToSci = DoesTotalHaveImpairmentNotDueToSci(totalsXml.Element("RightUpperMotorTotal").Value),
RightPrickContainsNt = bool.Parse(totalsXml.Element("RightPrickContainsNt").Value),
RightPrickTotal = GetIntValueFrom(totalsXml.Element("RightPrickTotal").Value),
RightPrickTotalHasImpairmentNotDueToSci = DoesTotalHaveImpairmentNotDueToSci(totalsXml.Element("RightPrickTotal").Value),
RightTouchContainsNt = bool.Parse(totalsXml.Element("RightTouchContainsNt").Value),
RightTouchTotal = GetIntValueFrom(totalsXml.Element("RightTouchTotal").Value),
RightTouchTotalHasImpairmentNotDueToSci = DoesTotalHaveImpairmentNotDueToSci(totalsXml.Element("RightTouchTotal").Value),
TouchTotal = GetIntValueFrom(totalsXml.Element("TouchTotal").Value),
UpperMotorTotal = GetIntValueFrom(totalsXml.Element("UpperMotorTotal").Value),
};
var levelsDictionary = GetLevelsDictionary();
foreach (var value in totalsXml.Element("RightSensory").Value.Split(',').Select(v => v.Trim()))
neurologyFormTotals.AddRightSensoryValue(levelsDictionary[value.ToUpper()]);
foreach (var value in totalsXml.Element("LeftSensory").Value.Split(',').Select(v => v.Trim()))
neurologyFormTotals.AddLeftSensoryValue(levelsDictionary[value.ToUpper()]);
foreach (var value in totalsXml.Element("RightMotor").Value.Split(',').Select(v => v.Trim()))
neurologyFormTotals.AddRightMotorValue(levelsDictionary[value.ToUpper()]);
foreach (var value in totalsXml.Element("LeftMotor").Value.Split(',').Select(v => v.Trim()))
neurologyFormTotals.AddLeftMotorValue(levelsDictionary[value.ToUpper()]);
foreach (var value in totalsXml.Element("NeurologicalLevelOfInjury").Value.Split(',').Select(v => v.Trim()))
neurologyFormTotals.AddNeurologicalLevelOfInjury(levelsDictionary[value.ToUpper()]);
foreach (var value in totalsXml.Element("RightSensoryZpp").Value.Split(',').Select(v => v.Trim()))
if (!string.IsNullOrEmpty(value))
neurologyFormTotals.AddRightSensoryZppValue(levelsDictionary[value.ToUpper()]);
foreach (var value in totalsXml.Element("LeftSensoryZpp").Value.Split(',').Select(v => v.Trim()))
if (!string.IsNullOrEmpty(value))
neurologyFormTotals.AddLeftSensoryZppValue(levelsDictionary[value.ToUpper()]);
foreach (var value in totalsXml.Element("RightMotorZpp").Value.Split(',').Select(v => v.Trim()))
if (!string.IsNullOrEmpty(value))
neurologyFormTotals.AddRightMotorZppValue(levelsDictionary[value.ToUpper()]);
foreach (var value in totalsXml.Element("LeftMotorZpp").Value.Split(',').Select(v => v.Trim()))
if (!string.IsNullOrEmpty(value))
neurologyFormTotals.AddLeftMotorZppValue(levelsDictionary[value.ToUpper()]);
foreach (var value in totalsXml.Element("AsiaImpairmentScale").Value.Split(',').Select(v => v.Trim()))
neurologyFormTotals.AddAsiaImpairmentScaleValue(value.ToUpper());
return neurologyFormTotals;
}
/// <summary>
/// Returns the results produced by the ISNCSCI Algorithm ir a raw values format.
/// </summary>
/// <param name="neurologyForm">Neurology form that has been populated with the values to be used in the algorithm calculations.</param>
/// <returns>
/// Totals in raw values format. The results contain lists with every prossible value for each field.
/// You can use the resulting object to obtained a summarized version, which uses ranges, by passing the result to the method GetTotalsSummaryFor
/// </returns>
public static NeurologyFormTotals GetTotalsFor(NeurologyForm neurologyForm)
{
var totals = new NeurologyFormTotals();
UpdateTotalsWithLevelAt(neurologyForm, totals, neurologyForm.GetLevelWithName("C2"), false, false);
totals.UpperMotorTotal = totals.RightUpperMotorTotal + totals.LeftUpperMotorTotal;
totals.LowerMotorTotal = totals.RightLowerMotorTotal + totals.LeftLowerMotorTotal;
totals.TouchTotal = totals.RightTouchTotal + totals.LeftTouchTotal;
totals.PrickTotal = totals.RightPrickTotal + totals.LeftPrickTotal;
var s4_5 = neurologyForm.GetLevelWithName("S4_5");
var c1 = neurologyForm.GetLevelWithName("C2").Previous;
if (totals.RightSensoryZppHasOnlySoftValues)
totals.AddRightSensoryZppValue(c1);
if (totals.LeftSensoryZppHasOnlySoftValues)
totals.AddLeftSensoryZppValue(c1);
if (totals.RightMotorZppHasOnlySoftValues)
totals.AddRightMotorZppValue(c1);
if (totals.LeftMotorZppHasOnlySoftValues)
totals.AddLeftMotorZppValue(c1);
if (totals.MostRostralRightLevelWithMotorFunction == null)
totals.MostRostralRightLevelWithMotorFunction = c1;
if (totals.MostRostralLeftLevelWithMotorFunction == null)
totals.MostRostralLeftLevelWithMotorFunction = c1;
if (totals.MostCaudalRightLevelWithMotorFunction == null)
totals.MostCaudalRightLevelWithMotorFunction = c1;
if (totals.MostCaudalLeftLevelWithMotorFunction == null)
totals.MostCaudalLeftLevelWithMotorFunction = c1;
// [ASIA learning center 2012-11-14] Sensory incomplete: Sacral sparing of sensory function
var isSensoryIncomplete = neurologyForm.AnalSensation == BinaryObservation.Yes || neurologyForm.AnalSensation == BinaryObservation.NT
|| !"0".Equals(s4_5.RightTouchName) || !"0".Equals(s4_5.LeftTouchName)
|| !"0".Equals(s4_5.RightPrickName) || !"0".Equals(s4_5.LeftPrickName);
var couldNotHaveMotorFunctionMoreThan3LevelsBelowMotorLevel = CouldNotHaveMotorFunctionMoreThan3LevelsBelowMotorLevel(neurologyForm, totals);
var couldNotBeMotorIncomplete = (neurologyForm.AnalContraction == BinaryObservation.No || neurologyForm.AnalContraction == BinaryObservation.NT)
&& isSensoryIncomplete && couldNotHaveMotorFunctionMoreThan3LevelsBelowMotorLevel;
if ((neurologyForm.AnalContraction == BinaryObservation.No || neurologyForm.AnalContraction == BinaryObservation.NT)
&& (neurologyForm.AnalSensation == BinaryObservation.No || neurologyForm.AnalSensation == BinaryObservation.NT)
&& s4_5.RightTouchValue == 0 && !s4_5.RightTouchImpairmentNotDueToSci
&& s4_5.RightPrickValue == 0 && !s4_5.RightPrickImpairmentNotDueToSci
&& s4_5.LeftTouchValue == 0 && !s4_5.LeftTouchImpairmentNotDueToSci
&& s4_5.LeftPrickValue == 0 && !s4_5.LeftPrickImpairmentNotDueToSci)
totals.AddAsiaImpairmentScaleValue("A");
if (couldNotBeMotorIncomplete && totals.MostRostralNeurologicalLevelOfInjury.Name != "S4_5")
totals.AddAsiaImpairmentScaleValue("B");
//// Not an ASIA E only
//// AND not an ASIA A only
if (totals.MostRostralNeurologicalLevelOfInjury.Name != "S4_5"
&& (isSensoryIncomplete || neurologyForm.AnalContraction == BinaryObservation.Yes || neurologyForm.AnalContraction == BinaryObservation.NT))
{
bool couldBeAsiaC;
bool couldBeAsiaD;
CouldBeAsiaCorD(neurologyForm, totals, out couldBeAsiaC, out couldBeAsiaD);
if (couldBeAsiaC)
totals.AddAsiaImpairmentScaleValue("C");
if (couldBeAsiaD)
totals.AddAsiaImpairmentScaleValue("D");
}
if (totals.RightSensoryContains("S4_5") && totals.LeftSensoryContains("S4_5")
&& totals.RightMotorContains("S4_5") && totals.LeftMotorContains("S4_5"))
totals.AddAsiaImpairmentScaleValue("E");
return totals;
}
/// <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>
/// Evaluates the specified form and totals to determine if any of the different
/// return conditions could produce a case where there could be motor function more
/// than 3 levels below the injury level.
/// </summary>
/// <param name="neurologyForm">Form that was used to produce the totals.</param>
/// <param name="totals">Totals retunred by the algorithm.</param>
/// <returns>Flag indicating if any combination in the totals could have a case with motor function more than 3 levels below the injury level.</returns>
private static bool CouldNotHaveMotorFunctionMoreThan3LevelsBelowMotorLevel(NeurologyForm neurologyForm, NeurologyFormTotals totals)
{
NeurologyFormLevel mostRostralRightLevelWithMotor = null;
NeurologyFormLevel mostRostralLeftLevelWithMotor = null;
var currentLevel = neurologyForm.GetLevelWithName("S1");
while ((mostRostralRightLevelWithMotor == null || mostRostralLeftLevelWithMotor == null)
&& currentLevel != null // Could happen if SNL is C1
&& currentLevel.Ordinal >= totals.MostCaudalNeurologicalLevelOfInjury.Ordinal)
{
if (mostRostralRightLevelWithMotor == null &&
(currentLevel.RightMotorImpairmentNotDueToSci || currentLevel.HasOtherRightMotorFunction || (currentLevel.RightMotorValue != 0 && currentLevel.IsKeyMuscle)))
mostRostralRightLevelWithMotor = currentLevel;
if (mostRostralLeftLevelWithMotor == null &&
(currentLevel.LeftMotorImpairmentNotDueToSci || currentLevel.HasOtherLeftMotorFunction || (currentLevel.LeftMotorValue != 0 && currentLevel.IsKeyMuscle)))
mostRostralLeftLevelWithMotor = currentLevel;
currentLevel = currentLevel.Previous;
}
return (mostRostralRightLevelWithMotor == null || mostRostralRightLevelWithMotor.Ordinal - totals.MostCaudalRightMotor.Ordinal <= 3)
&& (mostRostralLeftLevelWithMotor == null || mostRostralLeftLevelWithMotor.Ordinal - totals.MostCaudalLeftMotor.Ordinal <= 3);
}
/// <summary>
/// Evaluates the specified form and totals to determine if any of the different
/// return conditions could produce a case where the Asia Impairment Scale is C o D.
/// </summary>
/// <param name="neurologyForm">Form that was used to produce the totals.</param>
/// <param name="totals">Totals retunred by the algorithm.</param>
/// <param name="couldBeAsiaC">out variable use as flag indicating if this case is a possible ASIA C.</param>
/// <param name="couldBeAsiaD">out variable use as flag indicating if this case is a possible ASIA D.</param>
private static void CouldBeAsiaCorD(NeurologyForm neurologyForm, NeurologyFormTotals totals, out bool couldBeAsiaC, out bool couldBeAsiaD)
{
couldBeAsiaC = false;
couldBeAsiaD = false;
NeurologyFormLevel rightMotor = null;
NeurologyFormLevel leftMotor = null;
// Check if the patient could be motor incoplete via sphincter contraction
// Otherwise we need to check for motor function more than 3 levels below motor level.
var couldHaveAnalContraction = neurologyForm.AnalContraction == BinaryObservation.Yes || neurologyForm.AnalContraction == BinaryObservation.NT;
//var couldNotHaveAnalContraction = neurologyForm.AnalContraction == BinaryObservation.No || neurologyForm.AnalContraction == BinaryObservation.NT;
var nliEnum = totals.GetNeurologicalLevelsOfInjury().GetEnumerator();
while (nliEnum.MoveNext() && (!couldBeAsiaC || !couldBeAsiaD))
{
//var otherMotorIsMoreThanThreeLevelsBelowNli = (neurologyForm.)
// RIGHT MOTOR
// If not motor incomplete already, find the right motor level that correspond to this particular neurological level
if (!couldHaveAnalContraction && (rightMotor == null || rightMotor.Ordinal < nliEnum.Current.Ordinal))
{
var rightMotorValues = totals.GetRightMotorValues().GetEnumerator();
rightMotor = null;
while (rightMotor == null && rightMotorValues.MoveNext())
{
if (rightMotorValues.Current.Ordinal >= nliEnum.Current.Ordinal)
rightMotor = rightMotorValues.Current;
}
rightMotorValues.Dispose();
}
// LEFT MOTOR
// If not motor incomplete already, find the left motor level that correspond to this particular neurological level
if (!couldHaveAnalContraction && (leftMotor == null || leftMotor.Ordinal < nliEnum.Current.Ordinal))
{
var leftMotorValues = totals.GetLeftMotorValues().GetEnumerator();
leftMotor = null;
while (leftMotor == null && leftMotorValues.MoveNext())
{
if (leftMotorValues.Current.Ordinal >= nliEnum.Current.Ordinal)
leftMotor = leftMotorValues.Current;
}
leftMotorValues.Dispose();
}
//if (couldNotHaveAnalContraction
// && (rightMotor == null || totals.MostCaudalRightLevelWithMotorFunction.Ordinal - rightMotor.Ordinal <= 3)
// && (leftMotor == null || totals.MostCaudalLeftLevelWithMotorFunction.Ordinal - leftMotor.Ordinal <= 3))
// couldBeAsiaB = true;
// If the test is not motor incomplete at this level, do not continue to count motor levels, move to the next nli available.
if (!couldHaveAnalContraction
&& totals.MostCaudalRightLevelWithMotorFunction.Ordinal - rightMotor.Ordinal <= 3
&& totals.MostCaudalLeftLevelWithMotorFunction.Ordinal - leftMotor.Ordinal <= 3)
continue;
// When motor incomplete and the nli is S1 or more caudal, it is automatically D since there are no myotomes to count from.
// We can break the loop.
if (nliEnum.Current.Ordinal > 24) // Greater than L5 (24)
{
couldBeAsiaD = true;
break;
}
// If motor incomplete, count the motor levels with muscle grade greater than two
var levelsWithMuscleGradeGreaterThanTwo = 0;
var levelsWithMuscleGradeLessThanThree = 0;
var eligibleLevelCount = 0;
var currentLevel = nliEnum.Current.Next;
while (currentLevel != null)
{
if (currentLevel.IsKeyMuscle)
{
eligibleLevelCount += 2;
if (currentLevel.RightMotorValue > 2 || currentLevel.RightMotorImpairmentNotDueToSci || NtRegex.IsMatch(currentLevel.RightMotorName))
levelsWithMuscleGradeGreaterThanTwo++;
if ((currentLevel.RightMotorValue < 3 || NtRegex.IsMatch(currentLevel.RightMotorName)) && !currentLevel.RightMotorImpairmentNotDueToSci)
levelsWithMuscleGradeLessThanThree++;
if (currentLevel.LeftMotorValue > 2 || currentLevel.LeftMotorImpairmentNotDueToSci || NtRegex.IsMatch(currentLevel.LeftMotorName))
levelsWithMuscleGradeGreaterThanTwo++;
if ((currentLevel.LeftMotorValue < 3 || NtRegex.IsMatch(currentLevel.LeftMotorName)) && !currentLevel.LeftMotorImpairmentNotDueToSci)
levelsWithMuscleGradeLessThanThree++;
}
currentLevel = currentLevel.Next;
}
// If not more than half the myotomes contain values less to 3, this is an Asia C
if (levelsWithMuscleGradeLessThanThree > eligibleLevelCount / 2)
couldBeAsiaC = true;
// If at least half the myotomes below the current NLI containing values greater or equal to 3, hooray! it is ASIA D.
if (levelsWithMuscleGradeGreaterThanTwo >= eligibleLevelCount / 2)
couldBeAsiaD = true;
}
nliEnum.Dispose();
}
/// <summary>
/// Produces a summarized version of a NeurologyFormTotals object which can be used to be displayed in an interface or be stored in a database.
/// The values in the summary return will have ranges instead of lists of values.
/// </summary>
/// <param name="totals">The form totals object to be used to generate the summary.</param>
/// <returns>
/// Summarized version of the totals where the enumerations get replaced by ranges.
/// </returns>
public static NeurologyFormTotalsSummary GetTotalsSummaryFor(NeurologyFormTotals totals)
{
var ais = totals.GetAsiaImpairmentScaleValues();
var isAsiaA = ais.Contains("A");
var couldBeOtherThanAsiaA = !isAsiaA || ais.Length > 1;
var summary = new NeurologyFormTotalsSummary
{
AsiaImpairmentScale = ais,
Completeness = isAsiaA ? (couldBeOtherThanAsiaA ? "C,I" : "C") : "I",
LeftLowerMotorTotal = GetSummaryStringFor(totals.LeftLowerMotorTotal, totals.LeftLowerMotorTotalHasImpairmentNotDueToSci, totals.LeftLowerMotorContainsNt),
LeftMotor = GetLevelsRange(totals.GetLeftMotorValues(), false),
LeftMotorZpp = isAsiaA ? GetLevelsRange(totals.GetLeftMotorZppValues(), couldBeOtherThanAsiaA) : NotApplicable,
LeftMotorTotal = GetSummaryStringFor(totals.LeftUpperMotorTotal + totals.LeftLowerMotorTotal,
totals.LeftUpperMotorTotalHasImpairmentNotDueToSci || totals.LeftLowerMotorTotalHasImpairmentNotDueToSci,
totals.LeftUpperMotorContainsNt || totals.LeftLowerMotorContainsNt),
LeftPrickTotal = GetSummaryStringFor(totals.LeftPrickTotal, totals.LeftPrickTotalHasImpairmentNotDueToSci, totals.LeftPrickContainsNt),
LeftSensory = GetLevelsRange(totals.GetLeftSensoryValues(), false),
LeftSensoryZpp = isAsiaA ? GetLevelsRange(totals.GetLeftSensoryZppValues(), couldBeOtherThanAsiaA) : NotApplicable,
LeftTouchTotal = GetSummaryStringFor(totals.LeftTouchTotal, totals.LeftTouchTotalHasImpairmentNotDueToSci, totals.LeftTouchContainsNt),
LeftUpperMotorTotal = GetSummaryStringFor(totals.LeftUpperMotorTotal, totals.LeftUpperMotorTotalHasImpairmentNotDueToSci, totals.LeftUpperMotorContainsNt),
LowerMotorTotal = GetSummaryStringFor(totals.LowerMotorTotal,
totals.RightLowerMotorTotalHasImpairmentNotDueToSci || totals.LeftLowerMotorTotalHasImpairmentNotDueToSci,
totals.RightLowerMotorContainsNt || totals.LeftLowerMotorContainsNt),
NeurologicalLevelOfInjury = GetLevelsRange(totals.GetNeurologicalLevelsOfInjury(), false),
PrickTotal = GetSummaryStringFor(totals.RightPrickTotal + totals.LeftPrickTotal,
totals.RightPrickTotalHasImpairmentNotDueToSci || totals.LeftPrickTotalHasImpairmentNotDueToSci,
totals.RightPrickContainsNt || totals.LeftPrickContainsNt),
RightLowerMotorTotal = GetSummaryStringFor(totals.RightLowerMotorTotal, totals.RightLowerMotorTotalHasImpairmentNotDueToSci, totals.RightLowerMotorContainsNt),
RightMotor = GetLevelsRange(totals.GetRightMotorValues(), false),
RightMotorZpp = isAsiaA ? GetLevelsRange(totals.GetRightMotorZppValues(), couldBeOtherThanAsiaA) : NotApplicable,
RightMotorTotal = GetSummaryStringFor(totals.RightUpperMotorTotal + totals.RightLowerMotorTotal,
totals.RightUpperMotorTotalHasImpairmentNotDueToSci || totals.RightLowerMotorTotalHasImpairmentNotDueToSci,
totals.RightUpperMotorContainsNt || totals.RightLowerMotorContainsNt),
RightPrickTotal = GetSummaryStringFor(totals.RightPrickTotal, totals.RightPrickTotalHasImpairmentNotDueToSci, totals.RightPrickContainsNt),
RightSensory = GetLevelsRange(totals.GetRightSensoryValues(), false),
RightSensoryZpp = isAsiaA ? GetLevelsRange(totals.GetRightSensoryZppValues(), couldBeOtherThanAsiaA) : NotApplicable,
RightTouchTotal = GetSummaryStringFor(totals.RightTouchTotal, totals.RightTouchTotalHasImpairmentNotDueToSci, totals.RightTouchContainsNt),
RightUpperMotorTotal = GetSummaryStringFor(totals.RightUpperMotorTotal, totals.RightUpperMotorTotalHasImpairmentNotDueToSci, totals.RightUpperMotorContainsNt),
TouchTotal = GetSummaryStringFor(totals.RightTouchTotal + totals.LeftTouchTotal,
totals.RightTouchTotalHasImpairmentNotDueToSci || totals.LeftTouchTotalHasImpairmentNotDueToSci,
totals.RightTouchContainsNt || totals.LeftTouchContainsNt),
UpperMotorTotal = GetSummaryStringFor(totals.UpperMotorTotal,
totals.RightUpperMotorTotalHasImpairmentNotDueToSci || totals.LeftUpperMotorTotalHasImpairmentNotDueToSci,
totals.RightUpperMotorContainsNt || totals.LeftUpperMotorContainsNt)
};
return summary;
}
