An explainable hierarchical self attention-based approach for tremor detection in the time domain
Authors: Timothy Odonga, Jeanne M. Powell, Mark Saad, Richa Tripathi, Christine D. Esper, Stewart A. Factor, Hyeokhyen Kwon, J. Lucas Mckay
Organizations: Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, USA · Jean and Paul Amos Parkinson’s Disease and Movement Disorders Program, Department of Neurology, School of Medicine, Emory University, Atlanta, GA, USA · Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
Abstract
Tremor is a common movement disorder associated with conditions like Parkinson's disease and Essential tremor, traditionally diagnosed through expert clinician assessment. Current automated detection methods rely on frequency-domain features informed by clinical expertise. In this work, we present an explainable, two-stage hierarchical framework for tremor detection in the time domain that learns tremor patterns directly from 3D kinematic marker time-series data across entire tremor-provoking trials. Our framework combined a deep convolutional and long short-term memory network to learn tremor representations from short, discrete, non-overlapping time segments of kinematic time series data from trials, which are then processed by a vision transformer that models their long-term temporal dynamics of time segment features for trial (session) level classification. Evaluated across nine body parts, the framework achieved F1-scores of 0.594 - 0.947 depending on body parts (average: 0.765), falling short of the frequency-domain state-of-the-art performance (0.909) while requiring minimal preprocessing. Attention weights and gradient-based class activation maps (Grad-CAM) identified time-domain features of tremor across body parts. This proof of concept demonstrated the feasibility of data-driven time-domain modeling for tremor detection across anatomically diverse body parts, while reducing reliance on expert-engineered spectral features and providing posthoc interpretability of temporal and anatomical patterns of tremor.
Deep learning models have been increasingly applied to Time Series Forecasting (TSF) in recent years. Transformer-based and MLP-based models have both been used effectively on many real-world TSF regression benchmarks, and there is ongoing debate as to which family of methods is best. While these benchmarks have drawn much attention, it is also worth noting that many current datasets and methods assume approximate periodicity in the time series. In this work, we focus on a new TSF task without periodicity: anticipating falls during humanoid locomotion, on the basis of egocentric vision and proprioception. When the locomotion trajectories are sufficiently diverse, periodicity is violated. We contribute two new benchmark datasets (one from simulation, one from real hardware), showing that periodicity is violated and recent deep TSF methods struggle on these benchmarks. We also propose a novel deep learning architecture that exploits both endogenous and exogenous variables and a training process that rigorously enforces i.i.d sampling of training examples. Our results show statistically significant improvement over prior art in multiple experimental conditions, by 12.73% or more on the real data and 10.40% or more on the simulation data. Code and datasets will be available upon acceptance.
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.
Ioannis Kyprakis, Stefanos Gkikas, Eric Nichols +2
Deep learning on physiological time series is interpreted through domain-specific features -- oscillatory rhythms in EEG, morphological complexes in ECG -- yet these signals sit atop a broadband aperiodic 1/f-like envelope that covaries with arousal, age, and pathology. We introduce a spectral audit framework combining aperiodic/periodic decomposition, phase-preserving Fourier interventions, sham controls, and simulation validation. Aperiodic reliance was task-dependent and architecture-general: across six neural architectures, flattening drops exceeded 0.42 balanced-accuracy points for sleep-wake classification, reached 0.07-0.13 for clinical abnormality detection, and remained minimal for motor imagery. Six of seven EEG foundation models showed FDR-significant aperiodic reliance on clinical EEG; age/sex and recording-era controls reduced but did not eliminate the effect. Applying the audit to PTB-XL ECG revealed neural drops of 0.32--0.36 persisting after demographic matching, confirming this confound class extends beyond EEG. Aperiodic controls should become standard for interpretable physiological time-series deep learning.