archetype (adl_version=1.4; uid=52c3c495-8736-4e6d-85b9-613095d12883)
	openEHR-EHR-CLUSTER.exam_tendon_reflexes.v0

concept
	[at0000]	-- Examination of deep tendon reflexes
language
	original_language = <[ISO_639-1::en]>
description
	original_author = <
		["name"] = <"Heather Leslie">
		["organisation"] = <"Atomica Informatics">
		["email"] = <"heather.leslie@atomicainformatics.com">
		["date"] = <"2018-09-12">
	>
	details = <
		["en"] = <
			language = <[ISO_639-1::en]>
			purpose = <"For recording a description and clinical interpretation of the findings observed during the physical examination of deep tendon reflexes in the limbs.">
			use = <"Use to record a description of the overall findings observed during the physical examination of deep tendon reflexes. This initial draft archetype consists only of the core examination pattern data elements (as per CLUSTER.exam_pattern) and will likely be expanded further over time as specific clinical requirements are identified.

This archetype has been specifically designed to be used in the 'Examination findings' SLOT within the CLUSTER.exam_nervous_system archetype, but can also be used within the OBSERVATION.exam and other OBSERVATION or CLUSTER archetypes, where clinically appropriate.

The CLUSTER.exclusion_exam archetype can be nested within the 'Examination not done' SLOT to optionally record explicit details about the examination not being performed.

Use to incorporate the narrative descriptions of clinical findings within existing or legacy clinical systems into an archetyped format, using the 'Clinical Description' data element.">
			keywords = <"examination", "nervous system", "reflexes", "tendon">
			misuse = <"Not to be used for recording the clinical history about deep tendon reflexes - use specific OBSERVATION and CLUSTER archetypes. For example OBSERVATION.story and CLUSTER.symptom.

Not to be used to record the response to Masseter reflex (Jaw jerk). Use CLUSTER.exam_cranial_nerves for this purpose.

Not to be used to record the respons to the Plantar reflex (Babinski response/sign). Use CLUSTER.exam.foot for this purpose.">
			copyright = <"© openEHR Foundation">
		>
	>
	lifecycle_state = <"in_development">
	other_contributors = <"Silje Ljosland Bakke, Nasjonal IKT HF, Norway", "Ian McNicoll, freshEHR Clinical Informatics, United Kingdom", "John Tore Valand, Haukeland Universitetssjukehus, Norway">
	other_details = <
		["licence"] = <"This work is licensed under the Creative Commons Attribution-ShareAlike 3.0 License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/3.0/.">
		["custodian_organisation"] = <"openEHR Foundation">
		["current_contact"] = <"Heather Leslie, Atomica Informatics<heather.leslie@atomicainformatics.com>">
		["original_namespace"] = <"org.openehr">
		["original_publisher"] = <"openEHR Foundation">
		["custodian_namespace"] = <"org.openehr">
		["MD5-CAM-1.0.1"] = <"FC7BFEDDD82A0939EDDC8FC78A4DB367">
		["build_uid"] = <"195b369e-9c21-4b82-91d7-853b1b1f5ec0">
		["revision"] = <"0.0.2-alpha">
	>

definition
	CLUSTER[at0000] matches {	-- Examination of deep tendon reflexes
		items cardinality matches {1..*; unordered} matches {
			ELEMENT[at0002] occurrences matches {0..1} matches {	-- No abnormality detected
				value matches {
					DV_BOOLEAN matches {
						value matches {True}
					}
				}
			}
			ELEMENT[at0003] occurrences matches {0..1} matches {	-- Clinical description
				value matches {
					DV_TEXT matches {*}
				}
			}
			CLUSTER[at0012] occurrences matches {0..1} matches {	-- Per reflex
				name matches {
					DV_CODED_TEXT matches {
						defining_code matches {
							[local::
							at0017, 	-- Left biceps
							at0018, 	-- Left brachioradialis
							at0019, 	-- Left triceps
							at0020, 	-- Left patellar
							at0021, 	-- Left achilles
							at0029, 	-- Right biceps
							at0030, 	-- Right brachioradialis
							at0031, 	-- Right triceps
							at0032, 	-- Right patellar
							at0033]	-- Right achilles
						}
					}
				}
				items cardinality matches {1..*; unordered} matches {
					ELEMENT[at0013] occurrences matches {0..1} matches {	-- Response
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0022, 	-- Absent
									at0023, 	-- Equivocal
									at0024, 	-- Slight
									at0025, 	-- Normal
									at0026, 	-- Brisk
									at0027, 	-- Non-sustained clonus
									at0028]	-- Sustained clonus
								}
							}
						}
					}
					ELEMENT[at0014] occurrences matches {0..1} matches {	-- With recruitment?
						value matches {
							DV_BOOLEAN matches {
								value matches {True}
							}
						}
					}
					ELEMENT[at0015] occurrences matches {0..1} matches {	-- Comment
						value matches {
							DV_TEXT matches {*}
						}
					}
				}
			}
			allow_archetype CLUSTER[at0005] occurrences matches {0..*} matches {	-- Multimedia representation
				include
					archetype_id/value matches {/openEHR-EHR-CLUSTER\.multimedia(-[a-zA-Z0-9_]+)*\.v1/}
			}
			ELEMENT[at0006] occurrences matches {0..*} matches {	-- Clinical interpretation
				value matches {
					DV_TEXT matches {*}
				}
			}
			ELEMENT[at0007] occurrences matches {0..1} matches {	-- Comment
				value matches {
					DV_TEXT matches {*}
				}
			}
			allow_archetype CLUSTER[at0008] occurrences matches {0..*} matches {	-- Examination not done
				include
					archetype_id/value matches {/openEHR-EHR-CLUSTER\.exclusion_exam(-[a-zA-Z0-9_]+)*\.v1/}
			}
		}
	}


ontology
	term_definitions = <
		["en"] = <
			items = <
				["at0000"] = <
					text = <"Examination of deep tendon reflexes">
					description = <"Findings observed during the physical examination of deep tendon reflexes in the limbs.">
				>
				["at0002"] = <
					text = <"No abnormality detected">
					description = <"Statement that no abnormality was detected (NAD) on physical examination.">
					comment = <"Record as True if no abnormality was detected on examination. Specific statements about the examination can be included in the 'Clinical Interpretation' data element.">
				>
				["at0003"] = <
					text = <"Clinical description">
					description = <"Narrative description of the overall findings observed during the physical examination.">
				>
				["at0005"] = <
					text = <"Multimedia representation">
					description = <"Digital image, video or diagram representing the physical examination findings.">
				>
				["at0006"] = <
					text = <"Clinical interpretation">
					description = <"Single word, phrase or brief description that represents the clinical meaning and significance of the physical examination findings.">
				>
				["at0007"] = <
					text = <"Comment">
					description = <"Additional narrative about the physical examination findings, not captured in other fields.">
				>
				["at0008"] = <
					text = <"Examination not done">
					description = <"Details to explicitly record that this examination was not performed.">
				>
				["at0012"] = <
					text = <"Per reflex">
					description = <"Details per reflex.">
				>
				["at0013"] = <
					text = <"Response">
					description = <"Strength of the reflex response.">
				>
				["at0014"] = <
					text = <"With recruitment?">
					description = <"Record as true if muscle recruitment was used to accentuate the response.">
				>
				["at0015"] = <
					text = <"Comment">
					description = <"Additional narrative about the reflex response findings, not captured in other fields.">
				>
				["at0017"] = <
					text = <"Left biceps">
					description = <"Stretch reflex used to test the status of C5 & C6.">
				>
				["at0018"] = <
					text = <"Left brachioradialis">
					description = <"Stretch reflex used to test the status of C6. Also known as Supinator jerk.">
				>
				["at0019"] = <
					text = <"Left triceps">
					description = <"Stretch reflex used to test the status of C7.">
				>
				["at0020"] = <
					text = <"Left patellar">
					description = <"Stretch reflex used to test the status of L4. Also known as Knee jerk.">
				>
				["at0021"] = <
					text = <"Left achilles">
					description = <"Stretch reflex used to test the status of S1.">
				>
				["at0022"] = <
					text = <"Absent">
					description = <"Reflex not evident. May be recorded as '0'.">
				>
				["at0023"] = <
					text = <"Equivocal">
					description = <"Reflex possibly present. May be recorded as '+/-'.">
				>
				["at0024"] = <
					text = <"Slight">
					description = <"Reflex present but less than normal amplitude, or only seen with reinforcement. May be recorded as '+' or '1+'.">
				>
				["at0025"] = <
					text = <"Normal">
					description = <"Reflex present at normal amplitude. May be recorded as '++' or '2+'.">
				>
				["at0026"] = <
					text = <"Brisk">
					description = <"Reflex present at greater than normal amplitude. May be recorded as '+++' or '3+'.">
				>
				["at0027"] = <
					text = <"Non-sustained clonus">
					description = <"Reflex is repeating but not sustained. May be recorded as '++++' or '4+'.">
				>
				["at0028"] = <
					text = <"Sustained clonus">
					description = <"Reflex is repeating and sustained. May be recorded as '+++++' or '5+'.">
				>
				["at0029"] = <
					text = <"Right biceps">
					description = <"Stretch reflex used to test the status of C5 & C6.">
				>
				["at0030"] = <
					text = <"Right brachioradialis">
					description = <"Stretch reflex used to test the status of C6. Also known as Supinator jerk.">
				>
				["at0031"] = <
					text = <"Right triceps">
					description = <"Stretch reflex used to test the status of C7.">
				>
				["at0032"] = <
					text = <"Right patellar">
					description = <"Stretch reflex used to test the status of L4. Also known as Knee jerk.">
				>
				["at0033"] = <
					text = <"Right achilles">
					description = <"Stretch reflex used to test the status of S1.">
				>
			>
		>
	>