Adaptive Gait Biofeedback With Participant-Held-Out Modeling and Participant-Specific Updating in Chronic Ankle Instability

Understanding adaptive biomechanical systems requires distinguishing observable performance, static multivariate representation, longitudinal displacement, and internal approximation of observed change. This study introduces Level 5, which examines whether the M1-M2 transformation observed in a single-subject gait dataset can be approximated within a selected PCA representation. Gait was recorded with instrumented insoles in a participant with Parkinson's disease under six occlusal observational probes during two sessions eleven weeks apart. A simplified feed-forward neural network was trained to approximate M2 PC1-PC2 coordinates from M1 coordinates, occlusal-probe descriptors, and the longitudinal-transition indicator. In the core analysis aligned with Level 4, the model preserved the Euclidean centroid-displacement hierarchy dOC3 < dONL < dOC2.5. In the extended six-probe analysis, it preserved the broad structure of the exploratory ordering. Held-out M2 and leave-condition-out analyses provided internal tests beyond the full-dataset fit, while a within-session analysis described probe positions relative to ONL. The term predictive is used only in a restricted methodological sense. The model does not provide prospective clinical prediction, patient-level forecasting, or generalization to unseen individuals. Occlusal conditions are treated as observational probes applied during measurement, not as continuous causal drivers of longitudinal evolution. The findings are exploratory, retrospective, representation dependent, and non causal. They do not establish causal occlusal effects, validated viability thresholds, therapeutic superiority, distinct physiological states, or generalizable predictive validity.

Cerebral Palsy (CP) is a neurological disorder of movement and the most common cause of lifelong physical disability in childhood. Approximately 75% of children with CP are ambulatory, and accurate gait assessment is central to preserving walking function, which deteriorates by mid-adulthood in a quarter to half of adults with CP. The Rodda and Graham classification system quantifies sagittal-plane gait deviations using ankle and knee z-scores derived from 3D Instrumented Gait Analysis (3D-IGA), but 3D-IGA is expensive and limited to specialized centers, while observational assessment shows only moderate inter-rater agreement. We developed a markerless gait analysis pipeline that quantifies Rodda and Graham knee and ankle z-scores directly from single-view clinical gait videos. Across 1,058 bilateral limb samples from 529 trials of 152 children (88 male, 63 female; age 12.1 $\pm$ 4.0 years; 60 distinct primary diagnoses, cerebral palsy the most common at $n=54$), the sagittal-view model achieved $R^2 = 0.80 \pm 0.02$ and CCC $= 0.89 \pm 0.02$ for knee z-scores and $R^2 = 0.57 \pm 0.02$ and CCC $= 0.72 \pm 0.02$ for ankle z-scores against 3D-IGA. Binary screening for excess knee flexion achieves AUROC $= 0.88$, correctly identifying 83% of affected children, and applying Rodda and Graham rules yields $43 \pm 1$% 7-class accuracy with macro-AUROC $= 0.78 \pm 0.01$, ankle prediction error remaining the primary bottleneck. Beyond cross-sectional screening, continuous z-scores support longitudinal trajectory tracking across visits, providing a quantitative substrate for monitoring disease progression and treatment response unavailable from observational scales. These results demonstrate the feasibility of video-based z-score estimation, excess-flexion screening, and longitudinal trajectory tracking as a path toward scalable, objective gait assessment in low-resource clinical settings.

This study evaluated personalized gait phase estimation for stroke survivors using functional inertial measurement unit (IMU) alignment and two-stage sequential adaptation of models pre-trained on healthy gait. The estimator used signals from a thigh-mounted IMU. Heel force-sensitive resistor measurements provided reference phase labels for offline adaptation and evaluation. Stage 1 established a distillation-regularized participant-specific model, and Stage 2 performed conditional refinement using low-rank adaptation. Long Short-Term Memory (LSTM), Temporal Convolutional Network (TCN), and Transformer models were evaluated in five stroke survivors walking with a powered knee exoskeleton using leave-one-subject-out hyperparameter selection and sequential test-then-adapt Stage 2 replay. Relative to the non-adapted baselines, Stage 1+2 reduced the mean participant-wise phase root mean square error by 84.2%, 77.0%, and 60.7%, respectively. The Transformer achieved the lowest final error (2.90 +- 1.13$% of the gait cycle) and heel-strike timing error (23.7 +- 4.5ms). Policy-specific ablations showed that every-cycle updates generally produced the lowest or near-lowest error, whereas conditional updating reduced the update frequency with small accuracy differences. After personalization, alignment produced model-dependent changes in phase error while preserving or improving heel-strike detection and reducing heel-strike timing error for the LSTM and Transformer. Concurrent embedded tests showed that the TCN and Transformer maintained 100-Hz inference during Stage 2 updates without deadline misses, whereas the LSTM missed the 10-ms deadline in 6.6% of inferences. All updates completed within 0.8s. These results support the offline feasibility and embedded computational timing of the proposed framework for exoskeleton-assisted walking.