Pragmatic classification of movement primitives for stroke rehabilitation

Rehabilitation training is the primary intervention to improve motor recovery after stroke, but a tool to measure functional training does not currently exist. To bridge this gap, we previously developed an approach to classify functional movement primitives using wearable sensors and a machine learning (ML) algorithm. We found that this approach had encouraging classification performance but had computational and practical limitations, such as training time, sensor cost, and magnetic drift. Here, we sought to refine this approach and determine the algorithm, sensor configurations, and data requirements needed to maximize computational and practical performance. Motion data had been previously collected from 6 stroke patients wearing 11 inertial measurement units (IMUs) as they moved objects on a target array. To identify optimal ML performance, we evaluated 4 algorithms that are commonly used in activity recognition (linear discriminant analysis (LDA), na\"ive Bayes, support vector machine, and k-nearest neighbors). We compared their classification accuracy, computational complexity, and tuning requirements. To identify optimal sensor configuration, we progressively sampled fewer sensors and compared classification accuracy. To identify optimal data requirements, we compared accuracy using data from IMUs versus accelerometers. We found that LDA had the highest classification accuracy (92%) of the algorithms tested. It also was the most pragmatic, with low training and testing times and modest tuning requirements. We found that 7 sensors on the paretic arm and back resulted in the best accuracy. Using this array, accelerometers had a lower accuracy (84%). We refined strategies to accurately and pragmatically quantify functional movement primitives in stroke patients. We propose that this optimized ML-sensor approach could be a means to quantify training dose after stroke.