Cross-view Multimodal Vision-Based Assessment Framework for Traditional Chinese Medicine Rehabilitation Training
Authors: Francis Xiatian Zhang, Hao Yao, Shengxuan Chen, Hong Zhu, Hongxiao Jia, Sisi Zheng, Hubert P. H. Shum
Organizations: Department of Computer Science, Durham University, UK · Institute for Regeneration and Repair, The University of Edinburgh, UK · Ningbo Hospital of Traditional Chinese Medicine, Ningbo, China · Department of Rehabilitation Medicine, The Gulou Hospital of Traditional Chinese Medicine, China · Beijing Key Laboratory of Intelligent Drug Research and Development for Mental Disorders; National Clinical Research Center for Mental Disorders; National Center for Mental Disorders; and Beijing Anding Hospital, Capital Medical University, Beijing, China
Vision-based assessment can provide convenient and cost-effective evaluation in Traditional Chinese Medicine (TCM) rehabilitation training, where action quality assessment (AQA) from computer vision offers a promising solution. Existing automatic AQA frameworks for physical therapy typically rely on skeletal data captured from a single viewpoint, which is inefficient for TCM techniques such as acupuncture or Tuina that involve dense hand self-occlusion and complex hand-object interactions. To address these challenges, we propose CME-AQA, a cross-view, multimodal vision-based assessment framework that integrates visual-pose fusion to enhance understanding of environmental context and leverages both first-person and third-person videos during training to improve inference robustness. We collected two dual-view datasets, TCM-AQA61-A (Acupuncture) and TCM-AQA61-T (Tuina), each containing synchronized first-person and third-person recordings of 61 subjects with expert annotations. Experimental results show that our approach achieves superior or comparable mean performance against competitive baselines, achieving over 10% relative improvement in weighted F1 over the best competing method on key rating tasks such as Needle Depth and Quick Needle Insertion, while also reducing mean absolute error in quantitative measures such as insertion time and manipulation frequency. Testing on a CPR dataset further demonstrates comparable performance on several posture-based criteria, suggesting applicability to related structured simulated clinical skill assessments where participant motion is central to evaluation. Overall, CME-AQA enhances assessment accuracy for structured TCM rehabilitation training and facilitates more convenient and effective training-oriented skill evaluation.
Traditional Chinese Medicine (TCM) diagnosis, particularly through tongue inspection, faces persistent challenges in subjectivity and reproducibility. The application of multimodal artificial intelligence to TCM clinical tasks, such as syndrome differentiation and prescription generation, is significantly hampered by the semantic gap between visual tongue features and textual reasoning, as well as the lack of large-scale, standardized datasets. To address these challenges, we introduce MMIR-TCM, a novel framework that emulates the diagnostic process of TCM experts by integrating multimodal large language model(MLLM) with memory-augmented segmentation and retrieval-augmented generation (RAG). Employing a three-stage architecture, MMIR-TCM integrates a training-free Memory-SAM module for robust tongue extraction, a fine-tuned Qwen3-VL model for structured tongue diagnosis generation, and a Qwen3-based RAG component for evidence-grounded clinical decision support generation. The framework was developed and validated using MedTCM, a new large-scale multimodal dataset that we introduce specifically for advanced TCM research. To properly evaluate our framework's clinical accuracy, which existing metrics fail to capture, we also developed TDEU, a domain-specific evaluation metric incorporating semantic understanding and diagnostic importance. Our comprehensive experiments demonstrate that MMIR-TCM significantly outperforms leading models, including GPT-4o and Gemini 2.5 Flash.
Though artificial intelligence (AI) increasingly transforms modern medicine, its integration into Traditional Chinese Medicine (TCM) has been relatively slow, primarily due to TCM's reliance on holistic, subjective diagnostic methods---namely Inspection, Auscultation and Olfaction, Inquiry, and Palpation(I-AOI-P)---which are difficult to align with quantitative, standardized medical systems. In this work, we introduce a Unification Framework for Multimodal Data (UFMD), which automatically processes tongue and pulse images into structured, clinically standard descriptions, integrating multi-source diagnostic information into a unified digital record of I-AOI-P process. Building on this structured data, we create LingLan-14B, a TCM-specific large language model fine-tuned via supervised learning to emulate the diagnostic logic and workflow of I-AOI-P process. Experimental results show that our method significantly enhances diagnostic accuracy, achieving a relative improvement of 103.5% over the baseline (62.72% vs. 30.82%) and reaching an F1-score of up to 82%.
Rehabilitation scoring systems are most useful when their outputs can be reviewed and interpreted within clinical workflows. This study presents PhaseAware, a compact framework for continuous rehabilitation quality assessment that combines a temporal backbone with phase- and body-group descriptors through a backbone-conditioned gated residual pathway. The model was evaluated on the UI-PRMD deep-squat protocol and further tested on the KIMORE squatting subset. On UI-PRMD, PhaseAware achieved an RMSE of 0.0230, corresponding to an 88.9% reduction relative to the accepted baseline. It also maintained favorable performance on KIMORE, suggesting that the phase-aware design transfers across related squatting protocols. In addition to score prediction, PhaseAware generates structured review cues based on phase- and body-level sensitivity, highlighting the movement stages and body regions most relevant to each prediction. The architecture employs a backbone-conditioned gated residual mechanism to stabilize feature representation, supporting use in resource-constrained settings. These cues are intended to support clinician review, boundary-case monitoring, and human-in-the-loop triage rather than autonomous decision-making. Overall, PhaseAware offers a practical and interpretable approach to rehabilitation scoring that may help integrate automated assessment into information systems while preserving clinician oversight.