MMTA: Multi Membership Temporal Attention for Fine-Grained Stroke Rehabilitation Assessment

Tailoring stroke rehabilitation requires assessing how movements are organized, not merely if they succeed. Currently, this assessment is a rate-limiting bottleneck. Instruments like the Action Research Arm Test (ARAT) compress rich behavioral observations into single ordinal endpoints, discarding the movement-quality details that distinguish recovery from compensation. Automated alternatives typically chase accuracy on noisy, single-observer labels to output opaque scores - a technology-centric approach that rarely reaches clinical practice. To address this, we present xAARA: an engine designed to augment rather than replace clinical judgment. From multi-view video, xAARA returns ARAT assessments with calibrated uncertainty and explanations across task, movement-phase, and movement-quality levels. Treating clinical scoring as an ill-posed inference problem, xAARA composes 692 calibrated multimodal models via a Dynamic Bayesian Network with entropy-based gating. It qualifies results against clinical validity rules and defers low-confidence cases. In 105 stroke survivors (788 exercises), xAARA achieved 94.2% task accuracy (Cohen's kappa=0.934) and 81.3% movement-phase accuracy (kappa=0.727), reducing predictive uncertainty by 96.1% compared to single-clinician scoring. For subjective cases, it matched at least one rater 100% of the time and never returned out-of-range scores. Four independent clinicians validated the assessments and indicated willingness to adopt the system. We argue that principled uncertainty quantification and clinician-aligned explainability are the critical bridges moving automated assessment from technical demonstration to a deployable clinical tool.

Recent progress in Temporal Action Segmentation (TAS) has increasingly relied on complex architectures, which can hinder practical deployment. We present a lightweight dual-loss training framework that improves fine-grained segmentation quality with only one additional output channel and two auxiliary loss terms, requiring minimal architectural modification. Our approach combines a boundary-regression loss that promotes accurate temporal localization via a single-channel boundary prediction and a CDF-based segment-level regularization loss that encourages coherent within-segment structure by matching cumulative distributions over predicted and ground-truth segments. The framework is architecture-agnostic and can be integrated into existing TAS models (e.g., MS-TCN, C2F-TCN, FACT) as a training-time loss function. Across three benchmark datasets, the proposed method improves segment-level consistency and boundary quality, yielding higher F1 and Edit scores across three different models. Frame-wise accuracy remains largely unchanged, highlighting that precise segmentation can be achieved through simple loss design rather than heavier architectures or inference-time refinements.

Temporal action segmentation (TAS) divides untrimmed videos into labeled action segments. While fully supervised methods have advanced the field, challenges such as action variability, ambiguous boundaries, and high annotation costs remain, especially in new or low-resource domains. Grammar-based approaches improve segmentation with structural priors but rely on complex parsing limiting scalability. In this work, we propose a lightweight, constraint-based refinement framework that enhances TAS predictions by integrating statistical structural priors such as transition confidence, action boundary sets, and per-class duration, that can be directly extracted from annotated data. These constraints are integrated into a modified Viterbi decoding algorithm, allowing inference-time refinement without retraining or added model complexity. Our approach improves both fully and semi-supervised TAS models by correcting structural prediction errors while maintaining high efficiency. Code is available at https://github.com/LUNAProject22/CAD