{ "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-12T10:47:00Z", "providers": [ "Codex" ], "breadth": "recalled by Codex without web access - no source was read", "missingProviders": [], "pass": 2, "cost": { "grok": { "seconds": 17.6, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a09539-1edc-75f2-b16a-b692d6432cd5\n--------\nuser\nDescribe what is already known about one registered thing. Answer as JSON only, no prose around it.\n\nThing: Klumpke paralysis\nSense to describe: (none recorded)\nDomain code: INF.KNW\nAlso known as: (none)\n\n\nContext for this batch of 1001 things:\n# Batch 043: 10", "usd": 0.0, "recall": true }, "codex": { "seconds": 76.9, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a09539-1edc-7140-bb17-83130064544d\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: Klumpke paralysis\nRegistry id: vr.tr.klumpke-paralysis\nPlane / domain: INF / INF.KNW\nRegistry definition: (none recorded)\nNames folded into this entr" } }, "enrichment": { "pass": 3, "engine": "claude", "producedAt": "2026-10-06T12:00:00Z", "ingestedAt": "2026-10-06T08:39:52+00:00", "fields": [ "agent_conduct", "ethics", "owners" ] }, "gate": { "passed": true, "version": "1.0", "at": "2026-10-07T10:10:28+00:00", "evidence": [ "completeness 1.00", "sense: Wikidata description", "2 live sources", "review by codex: pass" ] } }, "metaModel": { "id": "THING-Q2336817", "registryId": "vr.tr.klumpke-paralysis", "name": "Klumpke paralysis", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "INF.KNW" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q2336817/", "model": { "registry_id": "vr.tr.klumpke-paralysis", "name": "Klumpke paralysis", "purpose": "Enable an agent to recognise a documented Klumpke paralysis pattern, track hand function and recovery, and support clinician-directed assessment and care.", "definition": "Klumpke paralysis is a lower brachial plexus palsy involving predominantly C8-T1 nerve fibres, causing weakness or paralysis chiefly of the intrinsic hand muscles, often with sensory loss along the medial forearm and hand.", "scope_statement": "Own the clinical knowledge representation of Klumpke paralysis for vr.tr.klumpke-paralysis in INF / INF.KNW: a lower brachial plexus palsy associated with C8-T1 involvement, distinguished from its underlying injury event and from broader plexus disorders.", "in_scope": [ "Evidence for C8-T1 involvement and the anatomical extent of the palsy", "Affected-side hand weakness, sensory disturbance and functional limitations", "Onset, injury context and associated sympathetic signs", "Diagnostic confidence, competing localisations and investigation findings", "Recovery trajectory and clinician-directed rehabilitation or surgical assessment" ], "out_of_scope": [ "A complete model of all brachial plexus injuries", "Isolated ulnar or median neuropathy without evidence of lower plexus involvement", "Cervical spinal cord disease or radiculopathy as independent conditions", "Obstetric delivery events and adult trauma events themselves", "Standalone models of Horner syndrome, rehabilitation procedures or nerve reconstruction" ], "distinguishing_features": [ "Require evidence of a lower C8-T1 pattern rather than identifying the condition from hand weakness alone; this anatomical designation is described in [Texas Children's Hospital teaching material](https://www.texaschildrens.org/sites/default/files/uploads/Chris%20Pederson.pdf).", "Compare hand impairment with shoulder and elbow function: relative proximal preservation supports an isolated lower palsy, whereas proximal deficits require assessment for broader involvement. [Texas Children's Hospital](https://www.texaschildrens.org/sites/default/files/uploads/Chris%20Pederson.pdf).", "Check whether the motor and sensory findings extend beyond a single terminal nerve before distinguishing the palsy from an isolated ulnar or median neuropathy.", "Record associated Horner signs without requiring them for recognition or treating them alone as proof of root avulsion; sympathetic involvement can accompany the lower palsy. [Texas Children's Hospital](https://www.texaschildrens.org/sites/default/files/uploads/Chris%20Pederson.pdf).", "Distinguish a documented birth presentation from later acquired injury; neither the name nor the hand posture establishes the cause." ], "characteristics": [ { "name": "Diagnostic standing", "kind": "state", "unit_or_values": "suspected | clinician-diagnosed | disputed | excluded; assessor and date", "why_it_matters": "Separates recognition of a possible pattern from an established clinical diagnosis." }, { "name": "Affected side", "kind": "category", "unit_or_values": "left | right | bilateral | undocumented", "why_it_matters": "Anchors examination findings, functional comparisons and follow-up." }, { "name": "Anatomical localisation", "kind": "category", "unit_or_values": "C8/T1 root involvement | lower trunk involvement | mixed extent | unresolved; supporting evidence", "why_it_matters": "Preserves the distinction between the syndrome label and the demonstrated lesion." }, { "name": "Lesion continuity", "kind": "state", "unit_or_values": "unknown | continuity preserved | rupture documented | avulsion documented; structure and evidence", "why_it_matters": "Makes structural severity available for specialist interpretation without inferring it from weakness." }, { "name": "Onset and elapsed time", "kind": "measurement", "unit_or_values": "onset date or interval; days since onset; age at onset", "why_it_matters": "Allows investigations and recovery observations to be interpreted in their temporal context." }, { "name": "Hand muscle performance", "kind": "measurement", "unit_or_values": "muscle-specific strength using a named age-appropriate scale; examination date", "why_it_matters": "Avoids reducing differing finger and intrinsic-muscle deficits to a single paralysis flag." }, { "name": "Sensory distribution", "kind": "category", "unit_or_values": "mapped territory, tested modality and finding; untested explicitly recorded", "why_it_matters": "Supports localisation and identifies discrepancies between the reported and examined pattern." }, { "name": "Associated sympathetic findings", "kind": "state", "unit_or_values": "present | absent | uncertain | not assessed; individual signs and side", "why_it_matters": "Retains potentially relevant associated findings without making them diagnostic requirements." }, { "name": "Hand task performance", "kind": "measurement", "unit_or_values": "named grasp, pinch or manipulation task; assistance, success and age-appropriate instrument", "why_it_matters": "Connects neurological impairment to practical ability." }, { "name": "Recovery trajectory", "kind": "state", "unit_or_values": "improving | stable | worsening | indeterminate; observation interval and compared measures", "why_it_matters": "Supports review of progress using comparable observations." } ], "affordances": [ "Assemble a traceable lower plexus phenotype from examination and investigation records.", "Flag evidence inconsistent with an isolated Klumpke pattern for clinician review.", "Compare serial hand strength, sensation and task performance.", "Identify missing localisation evidence or overdue clinician-specified reassessment.", "Prepare a specialist handover linking lesion evidence, elapsed time, functional goals and unresolved questions." ], "agent_conduct": { "may": [ "Explain Klumpke paralysis and its causes, including birth injuries, citing medical sources.", "Advise parents to seek assessment when a newborn does not move a hand or arm normally." ], "must_not": [ "Diagnose the condition in a person or infant.", "Assign blame for a birth injury to a named clinician without evidence.", "Advise exercises or splints in place of a therapist's plan.", "Share a child's medical details without the parents' consent." ], "requires_human": [ "Any decision on surgery or therapy.", "Statements about fault in a birth-injury claim." ] }, "ethics": { "considerations": [ "Birth injuries affect children for life and raise hard questions of fault.", "Families deserve accurate information without false hope or blame." ], "affected_parties": [ "Affected infants and children", "Parents", "Birth attendants" ] }, "owners": { "steward": "Nobody owns the condition; clinicians answer for each patient's care.", "master_systems": [] }, "what_it_is_for": [ "Klumpke paralysis is encountered in neurological and rehabilitation assessment of lower brachial plexus injury.", "The term supports documentation of hand weakness, sensory changes and functional recovery in birth-related or later injuries." ], "standards_and_regulation": [ "The International Classification of Diseases, Tenth Revision, issued by the World Health Organization, includes P14.1 for Klumpke paralysis due to birth injury." ], "failure_modes_and_hazards": [ "Persistent hand weakness can limit grasp, fine movement and everyday activities.", "Sensory loss can increase the likelihood of unnoticed injury to the affected limb.", "Muscle imbalance and prolonged weakness can contribute to joint contractures and deformity.", "Incorrectly attributing symptoms to Klumpke paralysis can delay recognition of another neurological injury." ], "facets_not_applicable": { "recognition": "Klumpke paralysis is a neurological condition whose identity requires clinical assessment and cannot be established from visual appearance alone." } }, "sources": [ { "id": "wikidata", "title": "Wikidata item Q2336817: Klumpke paralysis", "url": "https://www.wikidata.org/wiki/Q2336817", "url_status": "live", "what_it_supports": "identity and sense of the item", "checked_by": "wikidata-api" }, { "id": "wikipedia-en", "title": "Wikipedia: Klumpke paralysis", "url": "https://en.wikipedia.org/wiki/Klumpke_paralysis", "url_status": "live", "what_it_supports": "general description of the item", "checked_by": "wikidata-api sitelink" } ], "structure": { "bundles": [ { "id": "lower-plexus-identity", "name": "Lower plexus identity", "description": "Establish what the Klumpke label denotes in this record and how well it fits the observed pattern.", "rationale": "The eponym must not substitute for anatomical localisation or conceal a broader palsy.", "layers": [ { "id": "syndrome-definition", "name": "Syndrome definition", "description": "Connect the registered concept with the recorded clinical diagnosis.", "findings": [ { "id": "diagnostic-label-and-authority", "name": "Diagnostic label and authority", "description": "Record the exact diagnostic wording, its author and whether it is provisional or established.", "questions": [ { "text": "What clinical meaning does the diagnosing source assign to Klumpke paralysis?", "kind": "definition", "id": "diagnostic-label-and-authority-q01" }, { "text": "Who applied the diagnosis, when, and on which examination or investigation evidence?", "kind": "provenance", "id": "diagnostic-label-and-authority-q02" } ] } ] }, { "id": "anatomical-boundaries", "name": "Anatomical boundaries", "description": "Separate an isolated lower pattern from wider plexus involvement and alternative localisations.", "findings": [ { "id": "localisation-and-extent", "name": "Localisation and extent", "description": "Retain the demonstrated distribution and contradictory findings instead of forcing every deficit into C8-T1.", "questions": [ { "text": "Which motor and sensory findings support lower plexus involvement, and which structures remain unlocalised?", "kind": "measurement", "id": "localisation-and-extent-q01" }, { "text": "What evidence distinguishes this presentation from upper or total plexus palsy, a terminal neuropathy, or a cervical lesion?", "kind": "boundary", "id": "localisation-and-extent-q02" } ] } ] } ] }, { "id": "onset-and-lesion-context", "name": "Onset and lesion context", "description": "Capture when the palsy began, the proposed mechanism and the structural injury evidence.", "rationale": "Birth and later acquired presentations require explicit context; mechanism alone cannot establish lesion severity.", "layers": [ { "id": "onset-and-mechanism", "name": "Onset and mechanism", "description": "Distinguish the recorded event from a retrospectively inferred cause.", "findings": [ { "id": "causal-evidence", "name": "Causal evidence", "description": "Record birth or later onset and any documented traction event; upward arm traction is a described lower plexus mechanism. [Texas Children's Hospital](https://www.texaschildrens.org/sites/default/files/uploads/Chris%20Pederson.pdf).", "questions": [ { "text": "When was weakness first observed, and was onset at birth, immediately after an event, or progressive?", "kind": "provenance", "id": "causal-evidence-q01" }, { "text": "Which account supports the proposed mechanism, and what alternative explanation remains unresolved?", "kind": "boundary", "id": "causal-evidence-q02" } ] } ] }, { "id": "structural-injury", "name": "Structural injury", "description": "Represent structural findings separately from the clinical palsy pattern.", "findings": [ { "id": "continuity-and-associated-signs", "name": "Continuity and associated signs", "description": "Keep suspected stretch injury, rupture and root avulsion distinct, recording associated sympathetic findings separately.", "questions": [ { "text": "What imaging, operative or specialist evidence establishes the affected structure and its continuity?", "kind": "provenance", "id": "continuity-and-associated-signs-q01" }, { "text": "Which sympathetic signs were assessed, on which side, and what interpretation did the clinician document?", "kind": "measurement", "id": "continuity-and-associated-signs-q02" } ] } ] } ] }, { "id": "hand-impairment-and-use", "name": "Hand impairment and use", "description": "Describe the specific hand deficits and their effect on daily activity.", "rationale": "A hand-paralysis label does not capture residual movement, sensory protection or meaningful function.", "layers": [ { "id": "motor-sensory-pattern", "name": "Motor and sensory pattern", "description": "Map tested muscles, movements and sensory territories.", "findings": [ { "id": "mapped-hand-deficits", "name": "Mapped hand deficits", "description": "Record intrinsic hand and finger movement findings alongside sensory testing, including spared functions and examination limitations.", "questions": [ { "text": "Which finger and intrinsic hand movements are weak, absent or preserved on an age-appropriate examination?", "kind": "measurement", "id": "mapped-hand-deficits-q01" }, { "text": "Where is sensation altered, which modalities were tested, and how reliable was the examination?", "kind": "measurement", "id": "mapped-hand-deficits-q02" } ] } ] }, { "id": "posture-and-task-performance", "name": "Posture and task performance", "description": "Connect hand posture and available motion with practical use.", "findings": [ { "id": "usable-hand-function", "name": "Usable hand function", "description": "Separate observed clawing, passive restriction and active weakness, then record their consequences for relevant tasks.", "questions": [ { "text": "Is abnormal finger posture passively correctable, and which joints have restricted active or passive motion?", "kind": "measurement", "id": "usable-hand-function-q01" }, { "text": "Which age-relevant grasp, pinch or manipulation tasks can the person perform, and with what assistance?", "kind": "measurement", "id": "usable-hand-function-q02" } ] } ] } ] }, { "id": "diagnostic-evidence-and-recovery", "name": "Diagnostic evidence and recovery", "description": "Organise investigation results and serial observations around localisation and change.", "rationale": "Investigation timing and inconsistent measurements can distort both diagnostic confidence and apparent recovery.", "layers": [ { "id": "investigation-interpretation", "name": "Investigation interpretation", "description": "Preserve what each investigation establishes and its stated limitations.", "findings": [ { "id": "time-anchored-test-evidence", "name": "Time-anchored test evidence", "description": "Link imaging and electrodiagnostic reports to the clinical question, age and interval since onset.", "questions": [ { "text": "When was each test performed relative to onset, and what question was it intended to resolve?", "kind": "provenance", "id": "time-anchored-test-evidence-q01" }, { "text": "Which conclusions about localisation or injury severity are explicit in the report, and which remain uncertain?", "kind": "boundary", "id": "time-anchored-test-evidence-q02" } ] } ] }, { "id": "serial-recovery", "name": "Serial recovery", "description": "Track changes in nerve-related impairment separately from changes in task performance.", "findings": [ { "id": "comparable-recovery-observations", "name": "Comparable recovery observations", "description": "Compare repeated assessments while retaining changes in method, assistance and compensatory movement.", "questions": [ { "text": "How have the same tested muscles, sensory territories and hand tasks changed between dated assessments?", "kind": "measurement", "id": "comparable-recovery-observations-q01" }, { "text": "Does improved task performance reflect documented motor recovery, compensation, assistance or an unresolved combination?", "kind": "boundary", "id": "comparable-recovery-observations-q02" } ] } ] } ] }, { "id": "care-decisions-and-review", "name": "Care decisions and review", "description": "Connect the documented palsy to individual functional goals and clinician-owned decision points.", "rationale": "An agent needs actionable review information without deriving treatment eligibility from the eponym alone.", "layers": [ { "id": "hand-protection-and-rehabilitation", "name": "Hand protection and rehabilitation", "description": "Represent the prescribed response to weakness, sensory impairment and movement restriction.", "findings": [ { "id": "individual-hand-care-plan", "name": "Individual hand care plan", "description": "Record clinician-selected therapy, positioning, orthoses or sensory-protection measures with their functional targets.", "questions": [ { "text": "Which documented hand deficit or activity goal does each prescribed measure address?", "kind": "action", "id": "individual-hand-care-plan-q01" }, { "text": "What precautions, assistance needs and reassessment criteria accompany the plan?", "kind": "action", "id": "individual-hand-care-plan-q02" } ] } ] }, { "id": "specialist-decision-points", "name": "Specialist decision points", "description": "Track referral and reconstruction assessment against the actual lesion evidence and recovery course.", "findings": [ { "id": "review-and-escalation-ownership", "name": "Review and escalation ownership", "description": "Store the responsible specialist, planned review date and explicit decision criteria without importing thresholds from other palsy patterns.", "questions": [ { "text": "Which clinician owns the next decision, by when, and what evidence must be available?", "kind": "action", "id": "review-and-escalation-ownership-q01" }, { "text": "What age-, lesion- and recovery-specific criteria justify continued observation or assessment for an intervention?", "kind": "action", "id": "review-and-escalation-ownership-q02" } ] } ] } ] }, { "id": "evidence-and-external-alignment", "name": "Evidence and external alignment", "description": "What the world already says about this thing, gathered so the model can be checked against it.", "rationale": "A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.", "layers": [ { "id": "reported-evidence", "name": "Reported evidence", "description": "Findings from the breadth pass, kept separate from the structural claims.", "findings": [ { "id": "evidence-confidence-notes", "name": "Check these first", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "This is a neurological condition, not a discipline or field of knowledge; the supplied domain classification should be reviewed.", "The eponym is used for lower-root or lower-trunk injury patterns; precise anatomical localization requires case-specific evidence.", "This description is recalled knowledge, not source-verified research; coding applicability and terminology should be checked before publication." ], "questions": [ { "id": "evidence-confidence-notes-q01", "text": "Which of these check these first hold for the sense of Klumpke paralysis this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-kinds", "name": "Kinds and varieties", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Obstetric Klumpke palsy associated with birth injury", "Acquired traumatic Klumpke palsy" ], "questions": [ { "id": "evidence-kinds-q01", "text": "Which of these kinds and varieties hold for the sense of Klumpke paralysis this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-identifiers", "name": "Identifiers and schemes", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "scheme": "ICD-10", "value_or_pattern": "P14.1", "note": "World Health Organization category for Klumpke paralysis due to birth injury; not a general code for acquired cases." } ], "questions": [ { "id": "evidence-identifiers-q01", "text": "Which of these identifiers and schemes hold for the sense of Klumpke paralysis this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-real-world-use", "name": "Real-world use", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Clinical localization of lower brachial plexus injury", "Assessment and documentation of birth-related or traumatic upper-limb nerve injury", "Planning rehabilitation and specialist evaluation of impaired hand function" ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of Klumpke paralysis this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-failure-modes-and-hazards", "name": "Failure modes and hazards", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Persistent weakness, muscle wasting and impaired fine hand movements", "Clawing of the fingers and secondary joint contractures", "Sensory loss and neuropathic pain", "Associated Horner syndrome when the injury also affects sympathetic pathways", "Misidentification as an isolated ulnar neuropathy" ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of Klumpke paralysis this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-neighbours", "name": "Neighbouring kinds and how to tell them apart", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "name": "Erb palsy", "difference": "Predominantly affects the upper brachial plexus, usually C5-C6, with shoulder and elbow weakness rather than predominantly intrinsic hand weakness." }, { "name": "Ulnar neuropathy", "difference": "Affects a single peripheral nerve; lower plexus injury can also affect C8-T1 functions carried by other nerves and sensation in the medial forearm." }, { "name": "C8 or T1 radiculopathy", "difference": "Localizes to a spinal nerve root rather than the lower plexus; examination and electrodiagnostic findings help distinguish them." }, { "name": "Total brachial plexus palsy", "difference": "Involves upper and lower plexus components, producing substantially broader upper-limb weakness." } ], "questions": [ { "id": "evidence-neighbours-q01", "text": "Which of these neighbouring kinds and how to tell them apart hold for the sense of Klumpke paralysis this model covers, and on what evidence?", "kind": "provenance" } ] } ] } ] } ] }, "openQuestions": [ "Which authoritative definition should govern inclusion of root-level injuries, lower-trunk lesions and mixed lower-predominant plexus injuries under this registry entry?", "Which existing Vercy world model, if any, already owns this concept and should receive the registry link?", "Which examination instruments and clinically meaningful change thresholds are validated specifically for isolated Klumpke presentations at different ages?", "What evidence supports referral timing and reconstructive decision criteria specifically for isolated lower palsy, separately from upper and total plexus injuries?", "How accurately do associated Horner signs and investigation findings predict structural severity and functional recovery in birth versus adult presentations?" ], "statistics": { "bundles": 6, "layers": 11, "findings": 16, "questions": 26 } }