PhysioAI: Clinical Knowledge-Guided Semantic Supervision for Skeleton-Based Physiotherapy Action Recognition
Authors: Jie Cao, Euijoon Ahn, Anwar Hassan, Jinman Kim
Abstract
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±1.34% on KiMoRe Overall, 94.64±7.36% on the Hard-67 stress test, and 87.44±7.69% 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.
Skeleton-based human action recognition is a powerful approach for understanding human behaviour from pose data, but collecting large-scale, diverse, and well-annotated 3D skeleton datasets is both expensive and labor-intensive. To address this challenge, we propose a conditional generative pipeline for data augmentation in skeleton action recognition. Our method learns the distribution of real skeleton sequences under the constraint of action labels, enabling the synthesis of diverse and high-fidelity data. Even with limited training samples, it can effectively generate skeleton sequences and achieve competitive recognition performance in low-data scenarios, demonstrating strong generalisation in downstream tasks. Specifically, we introduce a Transformer-based encoder-decoder architecture, combined with a generative refinement module and a dropout mechanism, to balance fidelity and diversity during sampling. Experiments on HumanAct12 and the refined NTU-RGBD (NTU-VIBE) dataset show that our approach consistently improves the accuracy of multiple skeleton-based action recognition models, validating its effectiveness in both few-shot and full-data settings. The source code can be found at here.
Skeleton-based action recognition models have recently shown strong performance on large-scale benchmarks with general actions. However, directly transferring them to domain-specific tasks e.g., healthcare monitoring, is often suboptimal, as such tasks are narrow in scope and may be relevant to only a subset of general motion priors. Moreover, not all pretrained motion patterns are equally useful for a specific task, and retaining less relevant components may hinder adaptation and increase computational cost. To address these challenges, we propose Prior-Adaptive Transfer of Skeletons (PATS), a framework that adapts general skeleton-based models by selectively retaining task-relevant motion priors while filtering redundant ones during transfer. PATS follows a standard pipeline that extracts skeleton signals from videos and employs a spatio-temporal backbone pre-trained on general actions. The key contribution lies in a novel Adaptive Prior Transfer module, which performs model compression as a prior selection mechanism through iterative pruning and refinement. Experiments on two specific action recognition tasks, Alzheimer's detection and fall detection, show consistent improvements in both performance and efficiency over competitive baselines. The code will be released upon acceptance.
Vision-language models such as CLIP have recently achieved strong performance on a wide range of visual understanding tasks. However, most existing models rely primarily on appearance-level supervision from images or videos, and do not explicitly model human motion, which is essential for fine-grained and human-centric action recognition task as actions are defined by temporally structured and physically grounded body movements. To address this problem, we propose Transferable skeleton MOtion Representation (T-MOR), a motion-aware framework that learns transferable action representations from skeleton sequences with the aid of video and language supervision during training. T-MOR adopts a multi-modal contrastive learning scheme that aligns skeleton motion with visual and textual representations, while performing inference using only lightweight skeleton inputs. To support large-scale pre-training, we construct PoseCap-1M, a new dataset that contains over one million synchronized video, skeleton, and text triplets covering diverse human activities. We evaluate T-MOR on a range of human-centric action recognition benchmarks, including action classification and frame-wise temporal detection. Experimental results show that T-MOR consistently improves performance across multiple datasets, such as Toyota Smarthome, Penn Action, UAV-Human, TSU, and Charades. In addition, T-MOR demonstrates strong generalization ability in few-shot and zero-shot settings, highlighting the effectiveness of motion-centric and embodied representations for transferable action understanding.