A Causal Framework for Precision Rehabilitation

Precision rehabilitation offers the promise of an evidence-based approach for optimizing individual rehabilitation to improve long-term functional outcomes. Emerging techniques, including those driven by artificial intelligence, are rapidly expanding our ability to quantify the different domains of function during rehabilitation, other encounters with healthcare, and in the community. While this seems poised to usher rehabilitation into the era of big data and should be a powerful driver of precision rehabilitation, our field lacks a coherent framework to utilize these data and deliver on this promise. We propose a framework that builds upon multiple existing pillars to fill this gap. Our framework aims to identify the Optimal Dynamic Treatment Regimens (ODTR), or the decision-making strategy that takes in the range of available measurements and biomarkers to identify interventions likely to maximize long-term function. This is achieved by designing and fitting causal models, which extend the Computational Neurorehabilitation framework using tools from causal inference. These causal models can learn from heterogeneous data from different silos, which must include detailed documentation of interventions, such as using the Rehabilitation Treatment Specification System. The models then serve as digital twins of patient recovery trajectories, which can be used to learn the ODTR. Our causal modeling framework also emphasizes quantitatively linking changes across levels of the functioning to ensure that interventions can be precisely selected based on careful measurement of impairments while also being selected to maximize outcomes that are meaningful to patients and stakeholders. We believe this approach can provide a unifying framework to leverage growing big rehabilitation data and AI-powered measurements to produce precision rehabilitation treatments that can improve clinical outcomes.

Fusing uncalibrated IMUs and handheld smartphone video to reconstruct knee kinematics

Video and wearable sensor data provide complementary information about human movement. Video provides a holistic understanding of the entire body in the world while wearable sensors provide high-resolution measurements of specific body segments. A robust method to fuse these modalities and obtain biomechanically accurate kinematics would have substantial utility for clinical assessment and monitoring. While multiple video-sensor fusion methods exist, most assume that a time-intensive, and often brittle, sensor-body calibration process has already been performed. In this work, we present a method to combine handheld smartphone video and uncalibrated wearable sensor data at their full temporal resolution. Our monocular, video-only, biomechanical reconstruction already performs well, with only several degrees of error at the knee during walking compared to markerless motion capture. Reconstructing from a fusion of video and wearable sensor data further reduces this error. We validate this in a mixture of people with no gait impairments, lower limb prosthesis users, and individuals with a history of stroke. We also show that sensor data allows tracking through periods of visual occlusion.

Platypose: Calibrated Zero-Shot Multi-Hypothesis 3D Human Motion Estimation

Single camera 3D pose estimation is an ill-defined problem due to inherent ambiguities from depth, occlusion or keypoint noise. Multi-hypothesis pose estimation accounts for this uncertainty by providing multiple 3D poses consistent with the 2D measurements. Current research has predominantly concentrated on generating multiple hypotheses for single frame static pose estimation. In this study we focus on the new task of multi-hypothesis motion estimation. Motion estimation is not simply pose estimation applied to multiple frames, which would ignore temporal correlation across frames. Instead, it requires distributions which are capable of generating temporally consistent samples, which is significantly more challenging. To this end, we introduce Platypose, a framework that uses a diffusion model pretrained on 3D human motion sequences for zero-shot 3D pose sequence estimation. Platypose outperforms baseline methods on multiple hypotheses for motion estimation. Additionally, Platypose also achieves state-of-the-art calibration and competitive joint error when tested on static poses from Human3.6M, MPI-INF-3DHP and 3DPW. Finally, because it is zero-shot, our method generalizes flexibly to different settings such as multi-camera inference.

Differentiable Biomechanics Unlocks Opportunities for Markerless Motion Capture

Recent developments have created differentiable physics simulators designed for machine learning pipelines that can be accelerated on a GPU. While these can simulate biomechanical models, these opportunities have not been exploited for biomechanics research or markerless motion capture. We show that these simulators can be used to fit inverse kinematics to markerless motion capture data, including scaling the model to fit the anthropomorphic measurements of an individual. This is performed end-to-end with an implicit representation of the movement trajectory, which is propagated through the forward kinematic model to minimize the error from the 3D markers reprojected into the images. The differential optimizer yields other opportunities, such as adding bundle adjustment during trajectory optimization to refine the extrinsic camera parameters or meta-optimization to improve the base model jointly over trajectories from multiple participants. This approach improves the reprojection error from markerless motion capture over prior methods and produces accurate spatial step parameters compared to an instrumented walkway for control and clinical populations.

Advancing Monocular Video-Based Gait Analysis Using Motion Imitation with Physics-Based Simulation

Gait analysis from videos obtained from a smartphone would open up many clinical opportunities for detecting and quantifying gait impairments. However, existing approaches for estimating gait parameters from videos can produce physically implausible results. To overcome this, we train a policy using reinforcement learning to control a physics simulation of human movement to replicate the movement seen in video. This forces the inferred movements to be physically plausible, while improving the accuracy of the inferred step length and walking velocity.

Generalization properties of contrastive world models

Recent work on object-centric world models aim to factorize representations in terms of objects in a completely unsupervised or self-supervised manner. Such world models are hypothesized to be a key component to address the generalization problem. While self-supervision has shown improved performance however, OOD generalization has not been systematically and explicitly tested. In this paper, we conduct an extensive study on the generalization properties of contrastive world model. We systematically test the model under a number of different OOD generalization scenarios such as extrapolation to new object attributes, introducing new conjunctions or new attributes. Our experiments show that the contrastive world model fails to generalize under the different OOD tests and the drop in performance depends on the extent to which the samples are OOD. When visualizing the transition updates and convolutional feature maps, we observe that any changes in object attributes (such as previously unseen colors, shapes, or conjunctions of color and shape) breaks down the factorization of object representations. Overall, our work highlights the importance of object-centric representations for generalization and current models are limited in their capacity to learn such representations required for human-level generalization.

Dynamic Gaussian Splatting from Markerless Motion Capture can Reconstruct Infants Movements

Easy access to precise 3D tracking of movement could benefit many aspects of rehabilitation. A challenge to achieving this goal is that while there are many datasets and pretrained algorithms for able-bodied adults, algorithms trained on these datasets often fail to generalize to clinical populations including people with disabilities, infants, and neonates. Reliable movement analysis of infants and neonates is important as spontaneous movement behavior is an important indicator of neurological function and neurodevelopmental disability, which can help guide early interventions. We explored the application of dynamic Gaussian splatting to sparse markerless motion capture (MMC) data. Our approach leverages semantic segmentation masks to focus on the infant, significantly improving the initialization of the scene. Our results demonstrate the potential of this method in rendering novel views of scenes and tracking infant movements. This work paves the way for advanced movement analysis tools that can be applied to diverse clinical populations, with a particular emphasis on early detection in infants.

Self-Supervised Learning of Gait-Based Biomarkers

Markerless motion capture (MMC) is revolutionizing gait analysis in clinical settings by making it more accessible, raising the question of how to extract the most clinically meaningful information from gait data. In multiple fields ranging from image processing to natural language processing, self-supervised learning (SSL) from large amounts of unannotated data produces very effective representations for downstream tasks. However, there has only been limited use of SSL to learn effective representations of gait and movement, and it has not been applied to gait analysis with MMC. One SSL objective that has not been applied to gait is contrastive learning, which finds representations that place similar samples closer together in the learned space. If the learned similarity metric captures clinically meaningful differences, this could produce a useful representation for many downstream clinical tasks. Contrastive learning can also be combined with causal masking to predict future timesteps, which is an appealing SSL objective given the dynamical nature of gait. We applied these techniques to gait analyses performed with MMC in a rehabilitation hospital from a diverse clinical population. We find that contrastive learning on unannotated gait data learns a representation that captures clinically meaningful information. We probe this learned representation using the framework of biomarkers and show it holds promise as both a diagnostic and response biomarker, by showing it can accurately classify diagnosis from gait and is responsive to inpatient therapy, respectively. We ultimately hope these learned representations will enable predictive and prognostic gait-based biomarkers that can facilitate precision rehabilitation through greater use of MMC to quantify movement in rehabilitation.

Markerless Motion Capture and Biomechanical Analysis Pipeline

Markerless motion capture using computer vision and human pose estimation (HPE) has the potential to expand access to precise movement analysis. This could greatly benefit rehabilitation by enabling more accurate tracking of outcomes and providing more sensitive tools for research. There are numerous steps between obtaining videos to extracting accurate biomechanical results and limited research to guide many critical design decisions in these pipelines. In this work, we analyze several of these steps including the algorithm used to detect keypoints and the keypoint set, the approach to reconstructing trajectories for biomechanical inverse kinematics and optimizing the IK process. Several features we find important are: 1) using a recent algorithm trained on many datasets that produces a dense set of biomechanically-motivated keypoints, 2) using an implicit representation to reconstruct smooth, anatomically constrained marker trajectories for IK, 3) iteratively optimizing the biomechanical model to match the dense markers, 4) appropriate regularization of the IK process. Our pipeline makes it easy to obtain accurate biomechanical estimates of movement in a rehabilitation hospital.

Improved Trajectory Reconstruction for Markerless Pose Estimation

Markerless pose estimation allows reconstructing human movement from multiple synchronized and calibrated views, and has the potential to make movement analysis easy and quick, including gait analysis. This could enable much more frequent and quantitative characterization of gait impairments, allowing better monitoring of outcomes and responses to interventions. However, the impact of different keypoint detectors and reconstruction algorithms on markerless pose estimation accuracy has not been thoroughly evaluated. We tested these algorithmic choices on data acquired from a multicamera system from a heterogeneous sample of 25 individuals seen in a rehabilitation hospital. We found that using a top-down keypoint detector and reconstructing trajectories with an implicit function enabled accurate, smooth and anatomically plausible trajectories, with a noise in the step width estimates compared to a GaitRite walkway of only 8mm.