Interactive Example-based Explanations to Improve Health Professionals' Onboarding with AI for Human-AI Collaborative Decision Making

A growing research explores the usage of AI explanations on user's decision phases for human-AI collaborative decision-making. However, previous studies found the issues of overreliance on `wrong' AI outputs. In this paper, we propose interactive example-based explanations to improve health professionals' onboarding with AI for their better reliance on AI during AI-assisted decision-making. We implemented an AI-based decision support system that utilizes a neural network to assess the quality of post-stroke survivors' exercises and interactive example-based explanations that systematically surface the nearest neighborhoods of a test/task sample from the training set of the AI model to assist users' onboarding with the AI model. To investigate the effect of interactive example-based explanations, we conducted a study with domain experts, health professionals to evaluate their performance and reliance on AI. Our interactive example-based explanations during onboarding assisted health professionals in having a better reliance on AI and making a higher ratio of making `right' decisions and a lower ratio of `wrong' decisions than providing only feature-based explanations during the decision-support phase. Our study discusses new challenges of assisting user's onboarding with AI for human-AI collaborative decision-making.

Improving Health Professionals' Onboarding with AI and XAI for Trustworthy Human-AI Collaborative Decision Making

With advanced AI/ML, there has been growing research on explainable AI (XAI) and studies on how humans interact with AI and XAI for effective human-AI collaborative decision-making. However, we still have a lack of understanding of how AI systems and XAI should be first presented to users without technical backgrounds. In this paper, we present the findings of semi-structured interviews with health professionals (n=12) and students (n=4) majoring in medicine and health to study how to improve onboarding with AI and XAI. For the interviews, we built upon human-AI interaction guidelines to create onboarding materials of an AI system for stroke rehabilitation assessment and AI explanations and introduce them to the participants. Our findings reveal that beyond presenting traditional performance metrics on AI, participants desired benchmark information, the practical benefits of AI, and interaction trials to better contextualize AI performance, and refine the objectives and performance of AI. Based on these findings, we highlight directions for improving onboarding with AI and XAI and human-AI collaborative decision-making.

Exploring a Multimodal Fusion-based Deep Learning Network for Detecting Facial Palsy

Algorithmic detection of facial palsy offers the potential to improve current practices, which usually involve labor-intensive and subjective assessment by clinicians. In this paper, we present a multimodal fusion-based deep learning model that utilizes unstructured data (i.e. an image frame with facial line segments) and structured data (i.e. features of facial expressions) to detect facial palsy. We then contribute to a study to analyze the effect of different data modalities and the benefits of a multimodal fusion-based approach using videos of 21 facial palsy patients. Our experimental results show that among various data modalities (i.e. unstructured data - RGB images and images of facial line segments and structured data - coordinates of facial landmarks and features of facial expressions), the feed-forward neural network using features of facial expression achieved the highest precision of 76.22 while the ResNet-based model using images of facial line segments achieved the highest recall of 83.47. When we leveraged both images of facial line segments and features of facial expressions, our multimodal fusion-based deep learning model slightly improved the precision score to 77.05 at the expense of a decrease in the recall score.

Understanding the Effect of Counterfactual Explanations on Trust and Reliance on AI for Human-AI Collaborative Clinical Decision Making

Artificial intelligence (AI) is increasingly being considered to assist human decision-making in high-stake domains (e.g. health). However, researchers have discussed an issue that humans can over-rely on wrong suggestions of the AI model instead of achieving human AI complementary performance. In this work, we utilized salient feature explanations along with what-if, counterfactual explanations to make humans review AI suggestions more analytically to reduce overreliance on AI and explored the effect of these explanations on trust and reliance on AI during clinical decision-making. We conducted an experiment with seven therapists and ten laypersons on the task of assessing post-stroke survivors' quality of motion, and analyzed their performance, agreement level on the task, and reliance on AI without and with two types of AI explanations. Our results showed that the AI model with both salient features and counterfactual explanations assisted therapists and laypersons to improve their performance and agreement level on the task when `right' AI outputs are presented. While both therapists and laypersons over-relied on `wrong' AI outputs, counterfactual explanations assisted both therapists and laypersons to reduce their over-reliance on `wrong' AI outputs by 21\% compared to salient feature explanations. Specifically, laypersons had higher performance degrades by 18.0 f1-score with salient feature explanations and 14.0 f1-score with counterfactual explanations than therapists with performance degrades of 8.6 and 2.8 f1-scores respectively. Our work discusses the potential of counterfactual explanations to better estimate the accuracy of an AI model and reduce over-reliance on `wrong' AI outputs and implications for improving human-AI collaborative decision-making.

Design, Development, and Evaluation of an Interactive Personalized Social Robot to Monitor and Coach Post-Stroke Rehabilitation Exercises

Socially assistive robots are increasingly being explored to improve the engagement of older adults and people with disability in health and well-being-related exercises. However, even if people have various physical conditions, most prior work on social robot exercise coaching systems has utilized generic, predefined feedback. The deployment of these systems still remains a challenge. In this paper, we present our work of iteratively engaging therapists and post-stroke survivors to design, develop, and evaluate a social robot exercise coaching system for personalized rehabilitation. Through interviews with therapists, we designed how this system interacts with the user and then developed an interactive social robot exercise coaching system. This system integrates a neural network model with a rule-based model to automatically monitor and assess patients' rehabilitation exercises and can be tuned with individual patient's data to generate real-time, personalized corrective feedback for improvement. With the dataset of rehabilitation exercises from 15 post-stroke survivors, we demonstrated our system significantly improves its performance to assess patients' exercises while tuning with held-out patient's data. In addition, our real-world evaluation study showed that our system can adapt to new participants and achieved 0.81 average performance to assess their exercises, which is comparable to the experts' agreement level. We further discuss the potential benefits and limitations of our system in practice.

Exploring a Gradient-based Explainable AI Technique for Time-Series Data: A Case Study of Assessing Stroke Rehabilitation Exercises

Explainable artificial intelligence (AI) techniques are increasingly being explored to provide insights into why AI and machine learning (ML) models provide a certain outcome in various applications. However, there has been limited exploration of explainable AI techniques on time-series data, especially in the healthcare context. In this paper, we describe a threshold-based method that utilizes a weakly supervised model and a gradient-based explainable AI technique (i.e. saliency map) and explore its feasibility to identify salient frames of time-series data. Using the dataset from 15 post-stroke survivors performing three upper-limb exercises and labels on whether a compensatory motion is observed or not, we implemented a feed-forward neural network model and utilized gradients of each input on model outcomes to identify salient frames that involve compensatory motions. According to the evaluation using frame-level annotations, our approach achieved a recall of 0.96 and an F2-score of 0.91. Our results demonstrated the potential of a gradient-based explainable AI technique (e.g. saliency map) for time-series data, such as highlighting the frames of a video that therapists should focus on reviewing and reducing the efforts on frame-level labeling for model training.

Imagining new futures beyond predictive systems in child welfare: A qualitative study with impacted stakeholders

Child welfare agencies across the United States are turning to data-driven predictive technologies (commonly called predictive analytics) which use government administrative data to assist workers' decision-making. While some prior work has explored impacted stakeholders' concerns with current uses of data-driven predictive risk models (PRMs), less work has asked stakeholders whether such tools ought to be used in the first place. In this work, we conducted a set of seven design workshops with 35 stakeholders who have been impacted by the child welfare system or who work in it to understand their beliefs and concerns around PRMs, and to engage them in imagining new uses of data and technologies in the child welfare system. We found that participants worried current PRMs perpetuate or exacerbate existing problems in child welfare. Participants suggested new ways to use data and data-driven tools to better support impacted communities and suggested paths to mitigate possible harms of these tools. Participants also suggested low-tech or no-tech alternatives to PRMs to address problems in child welfare. Our study sheds light on how researchers and designers can work in solidarity with impacted communities, possibly to circumvent or oppose child welfare agencies.

Enabling AI and Robotic Coaches for Physical Rehabilitation Therapy: Iterative Design and Evaluation with Therapists and Post-Stroke Survivors

Artificial intelligence (AI) and robotic coaches promise the improved engagement of patients on rehabilitation exercises through social interaction. While previous work explored the potential of automatically monitoring exercises for AI and robotic coaches, the deployment of these systems remains a challenge. Previous work described the lack of involving stakeholders to design such functionalities as one of the major causes. In this paper, we present our efforts on eliciting the detailed design specifications on how AI and robotic coaches could interact with and guide patient's exercises in an effective and acceptable way with four therapists and five post-stroke survivors. Through iterative questionnaires and interviews, we found that both post-stroke survivors and therapists appreciated the potential benefits of AI and robotic coaches to achieve more systematic management and improve their self-efficacy and motivation on rehabilitation therapy. In addition, our evaluation sheds light on several practical concerns (e.g. a possible difficulty with the interaction for people with cognitive impairment, system failures, etc.). We discuss the value of early involvement of stakeholders and interactive techniques that complement system failures, but also support a personalized therapy session for the better deployment of AI and robotic exercise coaches.

Designing Personalized Interaction of a Socially Assistive Robot for Stroke Rehabilitation Therapy

The research of a socially assistive robot has a potential to augment and assist physical therapy sessions for patients with neurological and musculoskeletal problems (e.g. stroke). During a physical therapy session, generating personalized feedback is critical to improve patient's engagement. However, prior work on socially assistive robotics for physical therapy has mainly utilized pre-defined corrective feedback even if patients have various physical and functional abilities. This paper presents an interactive approach of a socially assistive robot that can dynamically select kinematic features of assessment on individual patient's exercises to predict the quality of motion and provide patient-specific corrective feedback for personalized interaction of a robot exercise coach.

Opportunities of a Machine Learning-based Decision Support System for Stroke Rehabilitation Assessment

Rehabilitation assessment is critical to determine an adequate intervention for a patient. However, the current practices of assessment mainly rely on therapist's experience, and assessment is infrequently executed due to the limited availability of a therapist. In this paper, we identified the needs of therapists to assess patient's functional abilities (e.g. alternative perspective on assessment with quantitative information on patient's exercise motions). As a result, we developed an intelligent decision support system that can identify salient features of assessment using reinforcement learning to assess the quality of motion and summarize patient specific analysis. We evaluated this system with seven therapists using the dataset from 15 patient performing three exercises. The evaluation demonstrates that our system is preferred over a traditional system without analysis while presenting more useful information and significantly increasing the agreement over therapists' evaluation from 0.6600 to 0.7108 F1-scores ($p <0.05$). We discuss the importance of presenting contextually relevant and salient information and adaptation to develop a human and machine collaborative decision making system.