Abstract
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.
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Jul 28, 2026cs.HC
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Jul 22, 2026cs.LG
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The Action Research Arm Test (ARAT) is a widely-used upper limb outcome measure in neurorehabilitation, but its ordinal scoring is subjective and suffers from limited sensitivity and specificity. We evaluated whether artificial-intelligence (AI)-based markerless motion capture (MMC), embedded into ARAT assessments during clinical routine, accurately reconstructs upper limb movement and yields valid, objective kinematic metrics carrying clinically meaningful information beyond the ordinal score. Across 47 sessions from 20 mixed-neurological patients (1,174 ARAT tasks), biomechanical reconstruction was accurate and robust across impairment levels, and kinematic metrics showed the discrimination pattern expected of a construct-valid measure. In longitudinal case studies, the metrics added the specificity and sensitivity the ordinal score lacks: a domain decomposition exposed patient-specific recovery profiles underlying equal ARAT gains (specificity), and kinematic improvement continued to be detected after the ARAT had saturated (sensitivity). MMC in clinical routine can thus provide valid, objective, sensitive, and specific kinematic measurement complementing ordinal scoring.
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