{
  "resourceType": "StructureDefinition",
  "id": "logicalmodel-Neurologicassessmentinneuro-oncology_nano_scale-R4",
  "url": "http://linkehr.com/fhir/logicalmodel-neurologicassessmentinneuro-oncology_nano_scale-R4",
  "identifier": [
    {
      "system": "openEHR-CKM",
      "value": "openEHR-EHR-OBSERVATION.neurologic_assessment_in_neuro_oncology_scale.v0"
    }
  ],
  "version": "0",
  "name": "Neurologicassessmentinneuro-oncology_nano_scale",
  "title": "Neurologic Assessment in Neuro-Oncology (NANO) scale",
  "status": "draft",
  "date": "2024-06-18",
  "publisher": "openEHR",
  "contact": [
    {
      "telecom": [
        {
          "system": "url",
          "value": "http://www.veratech.es"
        }
      ]
    }
  ],
  "description": "The NANO scale is a tool for assessing neurologic function in patients with brain tumor.",
  "purpose": "To record the result for each component parameter for the NANO-scale and to calculate the total score.",
  "fhirVersion": "4.0.0",
  "mapping": [
    {
      "identity": "openEHR",
      "uri": "http://openehr.org",
      "name": "openEHR Mapping"
    },
    {
      "identity": "openEHR-natural",
      "uri": "http://openehr.org",
      "name": "openEHR natural path"
    }
  ],
  "kind": "logical",
  "abstract": false,
  "type": "StructureDefinition",
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Element",
  "snapshot": {
    "element": [
      {
        "id": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale",
        "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale",
        "short": "Neurologic Assessment in Neuro-Oncology (NANO) scale",
        "definition": "The NANO scale is a tool for assessing neurologic function in patients with brain tumor.",
        "min": 1,
        "max": "1",
        "base": {
          "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale",
          "min": 1,
          "max": "1"
        },
        "type": [
          {
            "code": "BackboneElement"
          }
        ],
        "mustSupport": true,
        "isModifier": false,
        "isSummary": true
      },
      {
        "id": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.protocol",
        "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.protocol",
        "definition": "ITEM_TREE",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.protocol",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "BackboneElement"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": true
      },
      {
        "id": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History",
        "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History",
        "short": "History",
        "definition": "@ internal @",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "BackboneElement"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": true
      },
      {
        "id": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event",
        "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event",
        "short": "Any event",
        "definition": "Default, unspecified point in time or interval event which may be explicitly defined in a template or at run-time.",
        "min": 0,
        "max": "*",
        "base": {
          "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event",
          "min": 0,
          "max": "*"
        },
        "type": [
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            "code": "BackboneElement"
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        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": true
      },
      {
        "id": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data",
        "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data",
        "short": "Tree",
        "definition": "@ internal @",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "BackboneElement"
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        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": true
      },
      {
        "id": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Gait",
        "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Gait",
        "short": "Gait",
        "definition": "Walking is ideally assessed by at least 10 steps.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Gait",
          "min": 0,
          "max": "1"
        }
      },
      {
        "id": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Gait.value",
        "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Gait.value",
        "short": "Gait",
        "definition": "Walking is ideally assessed by at least 10 steps.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Gait.value",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": true
      },
      {
        "id": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Strength",
        "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Strength",
        "short": "Strength",
        "definition": "Test each limb separately. Recommend assess proximal (above knee or elbow) and distal (below knee or elbow) major muscle groups. Score should reflect worse performing area. Patients with baseline level 3 function in one major muscle group/limb can be scored based on assessment of other major muscle group/limbs.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Strength",
          "min": 0,
          "max": "1"
        }
      },
      {
        "id": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Strength.value",
        "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Strength.value",
        "short": "Strength",
        "definition": "Test each limb separately. Recommend assess proximal (above knee or elbow) and distal (below knee or elbow) major muscle groups. Score should reflect worse performing area. Patients with baseline level 3 function in one major muscle group/limb can be scored based on assessment of other major muscle group/limbs.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Strength.value",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": true
      },
      {
        "id": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Ataxia(upper_extremity)",
        "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Ataxia(upper_extremity)",
        "short": "Ataxia(upper extremity)",
        "definition": "Non-evaluable if strength is compromised. Trunk/lower extermities assessed by gait domain. Particulary important for patients with brainstem and cerebellar tumors. Score based on test respons of at least 3 attempts.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Ataxia(upper_extremity)",
          "min": 0,
          "max": "1"
        }
      },
      {
        "id": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Ataxia(upper_extremity).value",
        "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Ataxia(upper_extremity).value",
        "short": "Ataxia(upper extremity)",
        "definition": "Non-evaluable if strength is compromised. Trunk/lower extermities assessed by gait domain. Particulary important for patients with brainstem and cerebellar tumors. Score based on test respons of at least 3 attempts.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Ataxia(upper_extremity).value",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": true
      },
      {
        "id": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Sensation",
        "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Sensation",
        "short": "Sensation",
        "definition": "Recommend evaluating major body areas separately (face, limbs, trunk). Score should reflect worse performing area. Sensory modality includes but not limited to light touch, pinprick, temperature and proprioception. Patients with baseline level 2 function in one major body area can be scored based on assessment of other major body areas.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Sensation",
          "min": 0,
          "max": "1"
        }
      },
      {
        "id": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Sensation.value",
        "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Sensation.value",
        "short": "Sensation",
        "definition": "Recommend evaluating major body areas separately (face, limbs, trunk). Score should reflect worse performing area. Sensory modality includes but not limited to light touch, pinprick, temperature and proprioception. Patients with baseline level 2 function in one major body area can be scored based on assessment of other major body areas.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Sensation.value",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": true
      },
      {
        "id": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Visual_fields",
        "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Visual_fields",
        "short": "Visual fields",
        "definition": "Patients who require corrective lenses should be evaluated while wearing corrective lenses. Each eye should be evaluated and score should reflect the worst performing eye.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Visual_fields",
          "min": 0,
          "max": "1"
        }
      },
      {
        "id": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Visual_fields.value",
        "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Visual_fields.value",
        "short": "Visual fields",
        "definition": "Patients who require corrective lenses should be evaluated while wearing corrective lenses. Each eye should be evaluated and score should reflect the worst performing eye.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Visual_fields.value",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": true
      },
      {
        "id": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Facial_strength",
        "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Facial_strength",
        "short": "Facial strength",
        "definition": "Particularly important for brainstem tumors. Weakness includes nasolabial fold flattening, asymmetric smile and difficulty elevating eyebrows.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Facial_strength",
          "min": 0,
          "max": "1"
        }
      },
      {
        "id": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Facial_strength.value",
        "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Facial_strength.value",
        "short": "Facial strength",
        "definition": "Particularly important for brainstem tumors. Weakness includes nasolabial fold flattening, asymmetric smile and difficulty elevating eyebrows.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Facial_strength.value",
          "min": 0,
          "max": "1"
        },
        "type": [
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            "code": "CodeableConcept"
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        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": true
      },
      {
        "id": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Language",
        "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Language",
        "short": "Language",
        "definition": "Asses based on spoken speech. Non-verbal cues or writing should not be included.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Language",
          "min": 0,
          "max": "1"
        }
      },
      {
        "id": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Language.value",
        "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Language.value",
        "short": "Language",
        "definition": "Asses based on spoken speech. Non-verbal cues or writing should not be included.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Language.value",
          "min": 0,
          "max": "1"
        },
        "type": [
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            "code": "CodeableConcept"
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        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": true
      },
      {
        "id": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Level_of_consciousness",
        "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Level_of_consciousness",
        "short": "Level of consciousness",
        "definition": "ELEMENT",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Level_of_consciousness",
          "min": 0,
          "max": "1"
        }
      },
      {
        "id": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Level_of_consciousness.value",
        "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Level_of_consciousness.value",
        "short": "Level of consciousness",
        "definition": "DvOrdinal",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Level_of_consciousness.value",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept"
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        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": true
      },
      {
        "id": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Behavior",
        "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Behavior",
        "short": "Behavior",
        "definition": "Particulary important for frontal lobe tumors. Alteration includes but is not limited to apathy, disinhibition and confusion. Consider subclinical seizures for significant alteration.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Behavior",
          "min": 0,
          "max": "1"
        }
      },
      {
        "id": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Behavior.value",
        "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Behavior.value",
        "short": "Behavior",
        "definition": "Particulary important for frontal lobe tumors. Alteration includes but is not limited to apathy, disinhibition and confusion. Consider subclinical seizures for significant alteration.",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Behavior.value",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": true
      },
      {
        "id": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Total_sum_of_score",
        "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Total_sum_of_score",
        "short": "Total sum of score",
        "definition": "ELEMENT",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Total_sum_of_score",
          "min": 0,
          "max": "1"
        }
      },
      {
        "id": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Total_sum_of_score.value",
        "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Total_sum_of_score.value",
        "short": "Total sum of score",
        "definition": "DV_COUNT",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Neurologic_Assessment_in_Neuro_Oncology_(NANO)_scale.History.Any_event.data.Total_sum_of_score.value",
          "min": 0,
          "max": "1"
        },
        "type": [
          {
            "code": "Quantity"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "isSummary": true
      }
    ]
  }
}