Explaining Deep Learning Models for Age-related Gait Classification based on time series acceleration

Gait analysis holds significant importance in monitoring daily health, particularly among older adults. Advancements in sensor technology enable the capture of movement in real-life environments and generate big data. Machine learning, notably deep learning (DL), shows promise to use these big data in gait analysis. However, the inherent black-box nature of these models poses challenges for their clinical application. This study aims to enhance transparency in DL-based gait classification for aged-related gait patterns using Explainable Artificial Intelligence, such as SHAP. A total of 244 subjects, comprising 129 adults and 115 older adults (age>65), were included. They performed a 3-minute walking task while accelerometers were affixed to the lumbar segment L3. DL models, convolutional neural network (CNN) and gated recurrent unit (GRU), were trained using 1-stride and 8-stride accelerations, respectively, to classify adult and older adult groups. SHAP was employed to explain the models' predictions. CNN achieved a satisfactory performance with an accuracy of 81.4% and an AUC of 0.89, and GRU demonstrated promising results with an accuracy of 84.5% and an AUC of 0.94. SHAP analysis revealed that both CNN and GRU assigned higher SHAP values to the data from vertical and walking directions, particularly emphasizing data around heel contact, spanning from the terminal swing to loading response phases. Furthermore, SHAP values indicated that GRU did not treat every stride equally. CNN accurately distinguished between adults and older adults based on the characteristics of a single stride's data. GRU achieved accurate classification by considering the relationships and subtle differences between strides. In both models, data around heel contact emerged as most critical, suggesting differences in acceleration and deceleration patterns during walking between different age groups.

Establishing Central Sensitization Inventory Cut-off Values in patients with Chronic Low Back Pain by Unsupervised Machine Learning

Human Assumed Central Sensitization is involved in the development and maintenance of chronic low back pain (CLBP). The Central Sensitization Inventory (CSI) was developed to evaluate the presence of HACS, with a cut-off value of 40/100 based on patients with chronic pain. However, various factors including pain conditions (e.g., CLBP), and gender may influence this cut-off value. For chronic pain condition such as CLBP, unsupervised clustering approaches can take these factors into consideration and automatically learn the HACS-related patterns. Therefore, this study aimed to determine the cut-off values for a Dutch-speaking population with CLBP, considering the total group and stratified by gender based on unsupervised machine learning. In this study, questionnaire data covering pain, physical, and psychological aspects were collected from patients with CLBP and aged-matched pain-free adults (referred to as healthy controls, HC). Four clustering approaches were applied to identify HACS-related clusters based on the questionnaire data and gender. The clustering performance was assessed using internal and external indicators. Subsequently, receiver operating characteristic analysis was conducted on the best clustering results to determine the optimal cut-off values. The study included 151 subjects, consisting of 63 HCs and 88 patients with CLBP. Hierarchical clustering yielded the best results, identifying three clusters: healthy group, CLBP with low HACS level, and CLBP with high HACS level groups. Based on the low HACS levels group (including HC and CLBP with low HACS level) and high HACS level group, the cut-off value for the overall groups were 35, 34 for females, and 35 for. The findings suggest that the optimal cut-off values for CLBP is 35. The gender-related cut-off values should be interpreted with caution due to the unbalanced gender distribution in the sample.