Representing and Detecting Label Ambiguity in IMU-Based Exercise Evaluation

Automated evaluation of movement quality can enhance physiotherapeutic treatment and sports training by providing objective, real-time feedback. However, deep learning models that assess movements captured by inertial measurement units (IMUs) are often limited by data scarcity, class imbalance, and label ambiguity. We present a data augmentation method that generates IMU data using musculoskeletal simulations integrated with systematic modifications of movement trajectories. The approach enforces anatomically plausible kinematic constraints and enables automatic labeling by combining inverse kinematic parameters with a knowledge-based evaluation strategy. Across four datasets of varying complexity, augmented variants closely resemble real-world data and contribute to gains in classification accuracy, generalization to unseen subjects, and patient-specific fine-tuning from few examples. The magnitude of these gains varies with dataset properties, in particular class balance and label ambiguity. These findings indicate that musculoskeletal simulation-based augmentation can address common challenges faced by deep learning applications in physiotherapeutic exercise evaluation.

Deep neural networks have become a promising approach for IMU-based sensing, but their scalability is fundamentally limited by costly labeled data and poor robustness to heterogeneous devices, placements, and users. Existing unsupervised and self-supervised methods reduce but do not remove this dependence, still requiring labeled data for domain adaptation and largely ignoring known physical structure. We propose physical self-supervised learning, an autoencoder-style paradigm for label-free IMU sensing. We replace the conventional neural decoder with an auto-adaptive physics decoder, a learnable family of kinematic equations that enforces explicit physical structure while adapting across environments, and adopt a hybrid two-stage IMU encoder with reconstruction in a structured latent space to mitigate sensor noise. Our framework further introduces probabilistic frequency-spatial constraints to disentangle sensor and object motion, a multi-view kinematic tree to exploit sparse physical self-supervised signals, and an uncertainty-aware formulation to handle the inherent ambiguity of IMU inference. Evaluated on inertial tracking and full-body motion capture over public datasets and realistic deployments, physical self-supervised learning reduces errors by up to 5x for tracking and 4x for motion capture in challenging generalization scenarios, consistently outperforming state-of-the-art supervised and self-supervised baselines without any labels. Our code is available at https://github.com/YuyangLeng/physical-ssl-imu-label-free

Skeleton-based action recognition can support automated tracking of physiotherapy exercises, particularly in remote rehabilitation settings where continuous in-person supervision is impractical. However, most existing methods are developed for large-scale daily-action benchmarks rather than rehabilitation scenarios. Public rehabilitation exercise datasets are typically small, with only subtle kinematic differences between exercise classes. For participants with motor impairments, exercise execution may also deviate from standard movement patterns in amplitude, speed, and coordination, increasing intra-class variability and making reliable recognition more difficult for skeleton-based models. We propose PhysioAI, a clinical knowledge-guided semantic supervision framework that injects structured physiotherapy knowledge into skeleton representation learning. PhysioAI combines graph-based spatiotemporal modelling of human movement with training-time semantic anchors derived from a structured Clinical Knowledge Dictionary (CKD). The CKD descriptions are encoded using a frozen Contrastive Language-Image Pre-training (CLIP) model and projected into an anchor space, where they provide class-specific semantic targets for skeleton representation learning. The resulting CKD-derived anchors are used only during skeleton-model training; inference requires only skeleton inputs. Under subject-disjoint evaluation, PhysioAI achieves $99.03\pm1.34\%$ on KiMoRe Overall, $94.64\pm7.36\%$ on the Hard-67 stress test, and $87.44\pm7.69\%$ on UI-PRMD Overall. These results exceed the strongest comparator for each endpoint by $0.27$, $2.87$, and $1.33$ percentage points (pp), respectively. These findings demonstrate that structured clinical knowledge can serve as an effective source of training-time supervision for physiotherapy action recognition.