/// <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;
}
