Quantifying impairment and disease severity using AI models trained on healthy subjects.

Automatic assessment of impairment and disease severity is a key challenge in data-driven medicine. We propose a framework to address this challenge, which leverages AI models trained exclusively on healthy individuals. The COnfidence-Based chaRacterization of Anomalies (COBRA) score exploits the decrease in confidence of these models when presented with impaired or diseased patients to quantify their deviation from the healthy population. We applied the COBRA score to address a key limitation of current clinical evaluation of upper-body impairment in stroke patients. The gold-standard Fugl-Meyer Assessment (FMA) requires in-person administration by a trained assessor for 30-45 minutes, which restricts monitoring frequency and precludes physicians from adapting rehabilitation protocols to the progress of each patient. The COBRA score, computed automatically in under one minute, is shown to be strongly correlated with the FMA on an independent test cohort for two different data modalities: wearable sensors (ρ = 0.814, 95% CI [0.700,0.888]) and video (ρ = 0.736, 95% C.I [0.584, 0.838]). To demonstrate the generalizability of the approach to other conditions, the COBRA score was also applied to quantify severity of knee osteoarthritis from magnetic-resonance imaging scans, again achieving significant correlation with an independent clinical assessment (ρ = 0.644, 95% C.I [0.585,0.696]).

Quantifying Impairment and Disease Severity Using AI Models Trained on Healthy Subjects.

Automatic assessment of impairment and disease severity is a key challenge in data-driven medicine. We propose a novel framework to address this challenge, which leverages AI models trained exclusively on healthy individuals. The COnfidence-Based chaRacterization of Anomalies (COBRA) score exploits the decrease in confidence of these models when presented with impaired or diseased patients to quantify their deviation from the healthy population. We applied the COBRA score to address a key limitation of current clinical evaluation of upper-body impairment in stroke patients. The gold-standard Fugl-Meyer Assessment (FMA) requires in-person administration by a trained assessor for 30-45 minutes, which restricts monitoring frequency and precludes physicians from adapting rehabilitation protocols to the progress of each patient. The COBRA score, computed automatically in under one minute, is shown to be strongly correlated with the FMA on an independent test cohort for two different data modalities: wearable sensors ($\rho = 0.845$, 95% CI [0.743,0.908]) and video ($\rho = 0.746$, 95% C.I [0.594, 0.847]). To demonstrate the generalizability of the approach to other conditions, the COBRA score was also applied to quantify severity of knee osteoarthritis from magnetic-resonance imaging scans, again achieving significant correlation with an independent clinical assessment ($\rho = 0.644$, 95% C.I [0.585,0.696]).

Data-Driven Quantitation of Movement Abnormality after Stroke.

Stroke commonly affects the ability of the upper extremities (UEs) to move normally. In clinical settings, identifying and measuring movement abnormality is challenging due to the imprecision and impracticality of available assessments. These challenges interfere with therapeutic tracking, communication, and treatment. We thus sought to develop an approach that blends precision and pragmatism, combining high-dimensional motion capture with out-of-distribution (OOD) detection. We used an array of wearable inertial measurement units to capture upper body motion in healthy and chronic stroke subjects performing a semi-structured, unconstrained 3D tabletop task. After data were labeled by human coders, we trained two deep learning models exclusively on healthy subject data to classify elemental movements (functional primitives). We tested these healthy subject-trained models on previously unseen healthy and stroke motion data. We found that model confidence, indexed by prediction probabilities, was generally high for healthy test data but significantly dropped when encountering OOD stroke data. Prediction probabilities worsened with more severe motor impairment categories and were directly correlated with individual impairment scores. Data inputs from the paretic UE, rather than trunk, most strongly influenced model confidence. We demonstrate for the first time that using OOD detection with high-dimensional motion data can reveal clinically meaningful movement abnormality in subjects with chronic stroke.

Dual-Tasking in Daily Activities Among Adults With and Without Stroke.

IMPORTANCE: In laboratory settings, dual-tasking is a performance strategy affected by dominance and stroke. However, the volitional use of dual-tasking has not been examined during naturalistic performance of activities of daily living (ADLs). OBJECTIVE: To examine dual-tasking in the context of ADLs and identify whether dominance and stroke influence its use. DESIGN: Cross-sectional, observational. SETTING: Academic medical center. PARTICIPANTS: Forty-three participants with chronic stroke and upper extremity (UE) motor impairment and 19 control participants without stroke. OUTCOMES AND MEASURES: We identified dual-tasking as the performance of dual-object primitives (DOPs), a functional strategy to manage two objects simultaneously. We videotaped participants performing feeding and toothbrushing tasks and identified the initiation and frequency of DOPs. We assessed whether these outcomes were influenced by UE dominance or paresis and whether among participants with stroke these outcomes were influenced by motor impairment (using the Fugl-Meyer Assessment) or cognitive impairment (using the Montreal Cognitive Assessment). RESULTS: DOP initiation was reduced on the nondominant side of control UEs and in the paretic UE of participants with stroke. After DOPs were initiated, however, their frequency was not significantly related to dominance or paresis. Among participants with stroke, DOP initiation but not DOP frequency was influenced by motor impairment, and neither were influenced by cognitive impairment. CONCLUSIONS AND RELEVANCE: The initiation of dual-tasking is curtailed in the nondominant and paretic UEs, extending previous laboratory-based findings to a more naturalistic setting. These results may reflect a demand on neural resources that is exceeded when these limbs are used. What This Article Adds: DOPs, a functional strategy to simultaneously engage two objects during ADLs, could serve as a behavioral marker of dual-tasking in real-world activities, supporting their investigation more broadly. Practicing DOPs in rehabilitation could also train the integration of dual-tasking strategies in activity execution.

PrimSeq: A deep learning-based pipeline to quantitate rehabilitation training.

Stroke rehabilitation seeks to accelerate motor recovery by training functional activities, but may have minimal impact because of insufficient training doses. In animals, training hundreds of functional motions in the first weeks after stroke can substantially boost upper extremity recovery. The optimal quantity of functional motions to boost recovery in humans is currently unknown, however, because no practical tools exist to measure them during rehabilitation training. Here, we present PrimSeq, a pipeline to classify and count functional motions trained in stroke rehabilitation. Our approach integrates wearable sensors to capture upper-body motion, a deep learning model to predict motion sequences, and an algorithm to tally motions. The trained model accurately decomposes rehabilitation activities into elemental functional motions, outperforming competitive machine learning methods. PrimSeq furthermore quantifies these motions at a fraction of the time and labor costs of human experts. We demonstrate the capabilities of PrimSeq in previously unseen stroke patients with a range of upper extremity motor impairment. We expect that our methodological advances will support the rigorous measurement required for quantitative dosing trials in stroke rehabilitation.

StrokeRehab: A Benchmark Dataset for Sub-second Action Identification.

Automatic action identification from video and kinematic data is an important machine learning problem with applications ranging from robotics to smart health. Most existing works focus on identifying coarse actions such as running, climbing, or cutting vegetables, which have relatively long durations and a complex series of motions. This is an important limitation for applications that require identification of more elemental motions at high temporal resolution. For example, in the rehabilitation of arm impairment after stroke, quantifying the training dose (number of repetitions) requires differentiating motions with sub-second durations. Our goal is to bridge this gap. To this end, we introduce a large-scale, multimodal dataset, StrokeRehab, as a new action-recognition benchmark that includes elemental short-duration actions labeled at a high temporal resolution. StrokeRehab consists of high-quality inertial measurement unit sensor and video data of 51 stroke-impaired patients and 20 healthy subjects performing activities of daily living like feeding, brushing teeth, etc. Because it contains data from both healthy and impaired individuals, StrokeRehab can be used to study the influence of distribution shift in action-recognition tasks. When evaluated on StrokeRehab, current state-of-the-art models for action segmentation produce noisy predictions, which reduces their accuracy in identifying the corresponding sequence of actions. To address this, we propose a novel approach for high-resolution action identification, inspired by speech-recognition techniques, which is based on a sequence-to-sequence model that directly predicts the sequence of actions. This approach outperforms current state-of-the-art methods on StrokeRehab, as well as on the standard benchmark datasets 50Salads, Breakfast, and Jigsaws.

Towards data-driven stroke rehabilitation via wearable sensors and deep learning.

Recovery after stroke is often incomplete, but rehabilitation training may potentiate recovery by engaging endogenous neuroplasticity. In preclinical models of stroke, high doses of rehabilitation training are required to restore functional movement to the affected limbs of animals. In humans, however, the necessary dose of training to potentiate recovery is not known. This ignorance stems from the lack of objective, pragmatic approaches for measuring training doses in rehabilitation activities. Here, to develop a measurement approach, we took the critical first step of automatically identifying functional primitives, the basic building block of activities. Forty-eight individuals with chronic stroke performed a variety of rehabilitation activities while wearing inertial measurement units (IMUs) to capture upper body motion. Primitives were identified by human labelers, who labeled and segmented the associated IMU data. We performed automatic classification of these primitives using machine learning. We designed a convolutional neural network model that outperformed existing methods. The model includes an initial module to compute separate embeddings of different physical quantities in the sensor data. In addition, it replaces batch normalization (which performs normalization based on statistics computed from the training data) with instance normalization (which uses statistics computed from the test data). This increases robustness to possible distributional shifts when applying the method to new patients. With this approach, we attained an average classification accuracy of 70%. Thus, using a combination of IMU-based motion capture and deep learning, we were able to identify primitives automatically. This approach builds towards objectively-measured rehabilitation training, enabling the identification and counting of functional primitives that accrues to a training dose.