An Exploratory Analysis of Pain Localization via Explainable Computational Modeling

Automatic pain localization, which involves identifying the anatomical origin of pain from peripheral physiological signals without patient self-report, is a clinically critical but largely unaddressed problem, particularly for non-verbal patients. This paper presents a systematic comparison of classical feature engineering and deep sequence learning for subject-independent three-class pain localization using the AI4Pain 2026 Challenge dataset, which comprises four synchronously recorded wearable modalities: electrodermal activity, blood volume pulse, respiration, and peripheral oxygen saturation recorded from 65 participants under controlled TENS-induced pain. A 115-dimensional hand-crafted feature set spanning time-domain, frequency-domain, modality-specific, and cross-modal descriptors is benchmarked against end-to-end deep architectures. Extremely Randomized Trees achieves the highest macro-F1 of 0.539, outperforming the best deep model by 7.4 percentage points, with EDA spectral features emerging as the dominant discriminators. A consistent 26-point gap between pain detection (F1\,=\,0.815) and localization (F1\,=\,0.552) across all models points to a fundamental ceiling imposed by the anatomical diffuseness of peripheral autonomic pathways at 10-second resolution.

Frailty Estimation in Elderly Oncology Patients Using Multimodal Wearable Data and Multi-Instance Learning

Frailty and functional decline strongly influence treatment tolerance and outcomes in older patients with cancer, yet assessment is typically limited to infrequent clinic visits. We propose a multimodal wearable framework to estimate frailty-related functional change between visits in elderly breast cancer patients enrolled in the multicenter CARDIOCARE study. Free-living smartwatch physical activity and sleep features are combined with ECG-derived heart rate variability (HRV) features from a chest strap and organized into patient-horizon bags aligned to month 3 (M3) and month 6 (M6) follow-ups. Our innovation is an attention-based multiple instance learning (MIL) formulation that fuses irregular, multimodal wearable instances under real-world missingness and weak supervision. An attention-based MIL model with modality-specific multilayer perceptron (MLP) encoders with embedding dimension 128 aggregates variable-length and partially missing longitudinal instances to predict discretized change-from-baseline classes (worsened, stable, improved) for FACIT-F and handgrip strength. Under subject-independent leave-one-subject-out (LOSO) evaluation, the full multimodal model achieved balanced accuracy/F1 of 0.68 +/- 0.08/0.67 +/- 0.09 at M3 and 0.70 +/- 0.10/0.69 +/- 0.08 at M6 for handgrip, and 0.59 +/- 0.04/0.58 +/- 0.06 at M3 and 0.64 +/- 0.05/0.63 +/- 0.07 at M6 for FACIT-F. Ablation results indicated that smartwatch activity and sleep provide the strongest predictive information for frailty-related functional changes, while HRV contributes complementary information when fused with smartwatch streams.

Stress Estimation in Elderly Oncology Patients Using Visual Wearable Representations and Multi-Instance Learning

Psychological stress is clinically relevant in cardio-oncology, yet it is typically assessed only through patient-reported outcome measures (PROMs) and is rarely integrated into continuous cardiotoxicity surveillance. We estimate perceived stress in an elderly, multicenter breast cancer cohort (CARDIOCARE) using multimodal wearable data from a smartwatch (physical activity and sleep) and a chest-worn ECG sensor. Wearable streams are transformed into heterogeneous visual representations, yielding a weakly supervised setting in which a single Perceived Stress Scale (PSS) score corresponds to many unlabeled windows. A lightweight pretrained mixture-of-experts backbone (Tiny-BioMoE) embeds each representation into 192-dimensional vectors, which are aggregated via attention-based multiple instance learning (MIL) to predict PSS at month 3 (M3) and month 6 (M6). Under leave-one-subject-out (LOSO) evaluation, predictions showed moderate agreement with questionnaire scores (M3: R^2=0.24, Pearson r=0.42, Spearman rho=0.48; M6: R^2=0.28, Pearson r=0.49, Spearman rho=0.52), with global RMSE/MAE of 6.62/6.07 at M3 and 6.13/5.54 at M6.

Multi-Representation Diagrams for Pain Recognition: Integrating Various Electrodermal Activity Signals into a Single Image

Pain is a multifaceted phenomenon that affects a substantial portion of the population. Reliable and consistent evaluation benefits those experiencing pain and underpins the development of effective and advanced management strategies. Automatic pain-assessment systems deliver continuous monitoring, inform clinical decision-making, and aim to reduce distress while preventing functional decline. By incorporating physiological signals, these systems provide objective, accurate insights into an individual's condition. This study has been submitted to the \textit{Second Multimodal Sensing Grand Challenge for Next-Gen Pain Assessment (AI4PAIN)}. The proposed method introduces a pipeline that leverages electrodermal activity signals as input modality. Multiple representations of the signal are created and visualized as waveforms, and they are jointly visualized within a single multi-representation diagram. Extensive experiments incorporating various processing and filtering techniques, along with multiple representation combinations, demonstrate the effectiveness of the proposed approach. It consistently yields comparable, and in several cases superior, results to traditional fusion methods, establishing it as a robust alternative for integrating different signal representations or modalities.

Tiny-BioMoE: a Lightweight Embedding Model for Biosignal Analysis

Pain is a complex and pervasive condition that affects a significant portion of the population. Accurate and consistent assessment is essential for individuals suffering from pain, as well as for developing effective management strategies in a healthcare system. Automatic pain assessment systems enable continuous monitoring, support clinical decision-making, and help minimize patient distress while mitigating the risk of functional deterioration. Leveraging physiological signals offers objective and precise insights into a person's state, and their integration in a multimodal framework can further enhance system performance. This study has been submitted to the \textit{Second Multimodal Sensing Grand Challenge for Next-Gen Pain Assessment (AI4PAIN)}. The proposed approach introduces \textit{Tiny-BioMoE}, a lightweight pretrained embedding model for biosignal analysis. Trained on $4.4$ million biosignal image representations and consisting of only $7.3$ million parameters, it serves as an effective tool for extracting high-quality embeddings for downstream tasks. Extensive experiments involving electrodermal activity, blood volume pulse, respiratory signals, peripheral oxygen saturation, and their combinations highlight the model's effectiveness across diverse modalities in automatic pain recognition tasks. \textit{\textcolor{blue}{The model's architecture (code) and weights are available at https://github.com/GkikasStefanos/Tiny-BioMoE.

Efficient Pain Recognition via Respiration Signals: A Single Cross-Attention Transformer Multi-Window Fusion Pipeline

Pain is a complex condition affecting a large portion of the population. Accurate and consistent evaluation is essential for individuals experiencing pain, and it supports the development of effective and advanced management strategies. Automatic pain assessment systems provide continuous monitoring and support clinical decision-making, aiming to reduce distress and prevent functional decline. This study has been submitted to the \textit{Second Multimodal Sensing Grand Challenge for Next-Gen Pain Assessment (AI4PAIN)}. The proposed method introduces a pipeline that leverages respiration as the input signal and incorporates a highly efficient cross-attention transformer alongside a multi-windowing strategy. Extensive experiments demonstrate that respiration is a valuable physiological modality for pain assessment. Moreover, experiments revealed that compact and efficient models, when properly optimized, can achieve strong performance, often surpassing larger counterparts. The proposed multi-window approach effectively captures both short-term and long-term features, as well as global characteristics, thereby enhancing the model's representational capacity.

A Deep Learning approach for Depressive Symptoms assessment in Parkinson's disease patients using facial videos

Parkinson's disease (PD) is a neurodegenerative disorder, manifesting with motor and non-motor symptoms. Depressive symptoms are prevalent in PD, affecting up to 45% of patients. They are often underdiagnosed due to overlapping motor features, such as hypomimia. This study explores deep learning (DL) models-ViViT, Video Swin Tiny, and 3D CNN-LSTM with attention layers-to assess the presence and severity of depressive symptoms, as detected by the Geriatric Depression Scale (GDS), in PD patients through facial video analysis. The same parameters were assessed in a secondary analysis taking into account whether patients were one hour after (ON-medication state) or 12 hours without (OFF-medication state) dopaminergic medication. Using a dataset of 1,875 videos from 178 patients, the Video Swin Tiny model achieved the highest performance, with up to 94% accuracy and 93.7% F1-score in binary classification (presence of absence of depressive symptoms), and 87.1% accuracy with an 85.4% F1-score in multiclass tasks (absence or mild or severe depressive symptoms).