public static NeurologyForm LoadNeurologyFormFrom(XDocument xmlDocument)
{
var formXml = xmlDocument.Root.Element("NeurologyForm");
var neurologyForm = new NeurologyForm()
{
AnalContraction = GetBinaryObservationFrom(formXml.Element("AnalContraction")),
AnalSensation = GetBinaryObservationFrom(formXml.Element("AnalSensation"))
};
neurologyForm.SetRightLowestNonKeyMuscleWithMotorFunction(formXml.Element("RightLowestNonKeyMuscleWithMotorFunction").Value);
neurologyForm.SetLeftLowestNonKeyMuscleWithMotorFunction(formXml.Element("LeftLowestNonKeyMuscleWithMotorFunction").Value);
foreach (var dermatomeElement in formXml.Descendants("Dermatome"))
AddValuesFromDermatomeToForm(dermatomeElement, neurologyForm);
return neurologyForm;
}
public NeurologyFormTotalsSummary Post(NeurologyFormModel formModel)
{
var neurologyForm = new NeurologyForm();
formModel.BindTo(neurologyForm);
return Algorithm.GetTotalsSummaryFor(neurologyForm);
}
public void BindTo(NeurologyForm neurologyForm)
{
neurologyForm.AnalContraction = AnalContraction;
neurologyForm.AnalSensation = AnalSensation;
if (!string.IsNullOrEmpty(RightLowestNonKeyMuscleWithMotorFunction))
neurologyForm.SetRightLowestNonKeyMuscleWithMotorFunction(RightLowestNonKeyMuscleWithMotorFunction);
if (!string.IsNullOrEmpty(LeftLowestNonKeyMuscleWithMotorFunction))
neurologyForm.SetLeftLowestNonKeyMuscleWithMotorFunction(LeftLowestNonKeyMuscleWithMotorFunction);
neurologyForm.UpdateLevelAt("C2", C2RightTouch, C2LeftTouch, C2RightPrick, C2LeftPrick, "0", "0");
neurologyForm.UpdateLevelAt("C3", C3RightTouch, C3LeftTouch, C3RightPrick, C3LeftPrick, "0", "0");
neurologyForm.UpdateLevelAt("C4", C4RightTouch, C4LeftTouch, C4RightPrick, C4LeftPrick, "0", "0");
neurologyForm.UpdateLevelAt("C5", C5RightTouch, C5LeftTouch, C5RightPrick, C5LeftPrick, C5RightMotor, C5LeftMotor);
neurologyForm.UpdateLevelAt("C6", C6RightTouch, C6LeftTouch, C6RightPrick, C6LeftPrick, C6RightMotor, C6LeftMotor);
neurologyForm.UpdateLevelAt("C7", C7RightTouch, C7LeftTouch, C7RightPrick, C7LeftPrick, C7RightMotor, C7LeftMotor);
neurologyForm.UpdateLevelAt("C8", C8RightTouch, C8LeftTouch, C8RightPrick, C8LeftPrick, C8RightMotor, C8LeftMotor);
neurologyForm.UpdateLevelAt("T1", T1RightTouch, T1LeftTouch, T1RightPrick, T1LeftPrick, T1RightMotor, T1LeftMotor);
neurologyForm.UpdateLevelAt("T2", T2RightTouch, T2LeftTouch, T2RightPrick, T2LeftPrick, "0", "0");
neurologyForm.UpdateLevelAt("T3", T3RightTouch, T3LeftTouch, T3RightPrick, T3LeftPrick, "0", "0");
neurologyForm.UpdateLevelAt("T4", T4RightTouch, T4LeftTouch, T4RightPrick, T4LeftPrick, "0", "0");
neurologyForm.UpdateLevelAt("T5", T5RightTouch, T5LeftTouch, T5RightPrick, T5LeftPrick, "0", "0");
neurologyForm.UpdateLevelAt("T6", T6RightTouch, T6LeftTouch, T6RightPrick, T6LeftPrick, "0", "0");
neurologyForm.UpdateLevelAt("T7", T7RightTouch, T7LeftTouch, T7RightPrick, T7LeftPrick, "0", "0");
neurologyForm.UpdateLevelAt("T8", T8RightTouch, T8LeftTouch, T8RightPrick, T8LeftPrick, "0", "0");
neurologyForm.UpdateLevelAt("T9", T9RightTouch, T9LeftTouch, T9RightPrick, T9LeftPrick, "0", "0");
neurologyForm.UpdateLevelAt("T10", T10RightTouch, T10LeftTouch, T10RightPrick, T10LeftPrick, "0", "0");
neurologyForm.UpdateLevelAt("T11", T11RightTouch, T11LeftTouch, T11RightPrick, T11LeftPrick, "0", "0");
neurologyForm.UpdateLevelAt("T12", T12RightTouch, T12LeftTouch, T12RightPrick, T12LeftPrick, "0", "0");
neurologyForm.UpdateLevelAt("L1", L1RightTouch, L1LeftTouch, L1RightPrick, L1LeftPrick, "0", "0");
neurologyForm.UpdateLevelAt("L2", L2RightTouch, L2LeftTouch, L2RightPrick, L2LeftPrick, L2RightMotor, L2LeftMotor);
neurologyForm.UpdateLevelAt("L3", L3RightTouch, L3LeftTouch, L3RightPrick, L3LeftPrick, L3RightMotor, L3LeftMotor);
neurologyForm.UpdateLevelAt("L4", L4RightTouch, L4LeftTouch, L4RightPrick, L4LeftPrick, L4RightMotor, L4LeftMotor);
neurologyForm.UpdateLevelAt("L5", L5RightTouch, L5LeftTouch, L5RightPrick, L5LeftPrick, L5RightMotor, L5LeftMotor);
neurologyForm.UpdateLevelAt("S1", S1RightTouch, S1LeftTouch, S1RightPrick, S1LeftPrick, S1RightMotor, S1LeftMotor);
neurologyForm.UpdateLevelAt("S2", S2RightTouch, S2LeftTouch, S2RightPrick, S2LeftPrick, "0", "0");
neurologyForm.UpdateLevelAt("S3", S3RightTouch, S3LeftTouch, S3RightPrick, S3LeftPrick, "0", "0");
neurologyForm.UpdateLevelAt("S4_5", S4_5RightTouch, S4_5LeftTouch, S4_5RightPrick, S4_5LeftPrick, "0", "0");
}
public void GetTotalsForNeurologyForm()
{
// Arrange
var neurologyForm = new NeurologyForm()
{
AnalContraction = BinaryObservation.No,
AnalSensation = BinaryObservation.Yes
};
neurologyForm.UpdateLevelAt("C2", "2", "2", "2", "2", "0", "0");
neurologyForm.UpdateLevelAt("C3", "2", "2", "2", "2", "0", "0");
neurologyForm.UpdateLevelAt("C4", "2", "2", "2", "2", "0", "0");
neurologyForm.UpdateLevelAt("C5", "2", "2", "2", "2", "5", "5");
neurologyForm.UpdateLevelAt("C6", "1", "1", "1", "0", "1", "1");
neurologyForm.UpdateLevelAt("C7", "1", "0", "1", "0", "0", "0");
neurologyForm.UpdateLevelAt("C8", "1", "0", "1", "0", "0", "0");
neurologyForm.UpdateLevelAt("T1", "1", "0", "1", "0", "0", "0");
neurologyForm.UpdateLevelAt("T2", "NT", "NT", "NT", "NT", "0", "0");
neurologyForm.UpdateLevelAt("T3", "NT", "NT", "NT", "NT", "0", "0");
neurologyForm.UpdateLevelAt("T4", "NT", "NT", "NT", "NT", "0", "0");
neurologyForm.UpdateLevelAt("T5", "NT", "NT", "NT", "NT", "0", "0");
neurologyForm.UpdateLevelAt("T6", "NT", "NT", "NT", "NT", "0", "0");
neurologyForm.UpdateLevelAt("T7", "NT", "NT", "NT", "NT", "0", "0");
neurologyForm.UpdateLevelAt("T8", "NT", "NT", "NT", "NT", "0", "0");
neurologyForm.UpdateLevelAt("T9", "NT", "NT", "NT", "NT", "0", "0");
neurologyForm.UpdateLevelAt("T10", "NT", "NT", "NT", "NT", "0", "0");
neurologyForm.UpdateLevelAt("T11", "NT", "NT", "NT", "NT", "0", "0");
neurologyForm.UpdateLevelAt("T12", "NT", "NT", "NT", "NT", "0", "0");
neurologyForm.UpdateLevelAt("L1", "NT", "NT", "NT", "NT", "0", "0");
neurologyForm.UpdateLevelAt("L2", "NT", "NT", "NT", "NT", "NT", "NT");
neurologyForm.UpdateLevelAt("L3", "NT", "NT", "NT", "NT", "NT", "NT");
neurologyForm.UpdateLevelAt("L4", "NT", "NT", "NT", "NT", "NT", "NT");
neurologyForm.UpdateLevelAt("L5", "NT", "NT", "NT", "NT", "NT", "NT");
neurologyForm.UpdateLevelAt("S1", "NT", "NT", "NT", "NT", "NT", "NT");
neurologyForm.UpdateLevelAt("S2", "NT", "NT", "NT", "NT", "0", "0");
neurologyForm.UpdateLevelAt("S3", "NT", "NT", "NT", "NT", "0", "0");
neurologyForm.UpdateLevelAt("S4_5", "NT", "NT", "NT", "NT", "0", "0");
// Act
var summary = Algorithm.GetTotalsSummaryFor(neurologyForm);
// Assert
Assert.AreEqual("B,C,D", summary.AsiaImpairmentScale);
Assert.AreEqual("I", summary.Completeness);
Assert.AreEqual("UTD", summary.LeftLowerMotorTotal);
Assert.AreEqual("C5", summary.LeftMotor);
Assert.AreEqual("UTD", summary.LeftMotorTotal);
Assert.AreEqual("NA", summary.LeftMotorZpp);
Assert.AreEqual("UTD", summary.LeftPrickTotal);
Assert.AreEqual("C5", summary.LeftSensory);
Assert.AreEqual("NA", summary.LeftSensoryZpp);
Assert.AreEqual("UTD", summary.LeftTouchTotal);
Assert.AreEqual("6", summary.LeftUpperMotorTotal);
Assert.AreEqual("UTD", summary.LowerMotorTotal);
Assert.AreEqual("C5", summary.NeurologicalLevelOfInjury);
Assert.AreEqual("UTD", summary.PrickTotal);
Assert.AreEqual("UTD", summary.RightLowerMotorTotal);
Assert.AreEqual("C5", summary.RightMotor);
Assert.AreEqual("UTD", summary.RightMotorTotal);
Assert.AreEqual("NA", summary.RightMotorZpp);
Assert.AreEqual("UTD", summary.RightPrickTotal);
Assert.AreEqual("C5", summary.RightSensory);
Assert.AreEqual("NA", summary.RightSensoryZpp);
Assert.AreEqual("UTD", summary.RightTouchTotal);
Assert.AreEqual("6", summary.RightUpperMotorTotal);
Assert.AreEqual("UTD", summary.TouchTotal);
Assert.AreEqual("12", summary.UpperMotorTotal);
}
private static void AddValuesFromDermatomeToForm(XElement dermatomeElement, NeurologyForm neurologyForm)
{
// Right Touch
var rightTouchName = dermatomeElement.Element("RightTouch").Value;
var rightPrickName = dermatomeElement.Element("RightPrick").Value;
var leftTouchName = dermatomeElement.Element("LeftTouch").Value;
var leftPrickName = dermatomeElement.Element("LeftPrick").Value;
var rightMotorElement = dermatomeElement.Element("RightMotor");
var rightMotorName = rightMotorElement == null ? "0" : rightMotorElement.Value;
var leftMotorElement = dermatomeElement.Element("LeftMotor");
var leftMotorName = leftMotorElement == null ? "0" : leftMotorElement.Value;
neurologyForm.UpdateLevelAt(dermatomeElement.Attribute("name").Value,
rightTouchName, leftTouchName,
rightPrickName, leftPrickName,
rightMotorName, leftMotorName);
}
/// <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="neurologyForm">Neurology form that has been populated with the values to be used in the algorithm calculations.</param>
/// <returns>
/// Summarized version of the totals which presents the results as ranges, rather than lists containing every possible value for every field.
/// </returns>
public static NeurologyFormTotalsSummary GetTotalsSummaryFor(NeurologyForm neurologyForm)
{
return GetTotalsSummaryFor(GetTotalsFor(neurologyForm));
}
