The mortality burden of head and neck cancer (HNC) is increasing globally and disproportionately affects people in low-and middle-income countries with limited medical workforce. To address this issue, artificial intelligence (AI) algorithms are increasingly being explored to process medical imaging data, demonstrating competitive performance. However, the clinical adoption of AI remains challenging as clinicians struggle to understand how complex AI works and trust it to use in practice. In addition, AI may not perform well on varying data qualities of endoscopy videos for HNC screening and diagnosis from multiple sites. In this project, our international and interdisciplinary team will collaborate with clinicians from multiple sites (e.g. Singapore, the U.S., and Bangladesh) to collect a diverse, multi-site dataset. In addition, we aim to design and develop computational techniques and practices to improve collaborations between clinicians and AI for the triage and diagnosis of HNC. Specifically, these techniques include a YOLOv5-based glottis detector, a classifier of patient's status using clinical endoscopy videos, uncertainty quantification techniques, and interactive Vision Language Model-based AI explanations, which will enable clinicians to understand AI outputs and provide their inputs to improve AI. After developing our system, we will evaluate the effectiveness of these computational techniques in enabling AI-assisted point-of-care triage and decision-support for HNC, particularly in resource-limited settings.

A growing research explores the usage of AI explanations on user’s decision phases for human-AI collaborative decision-making. However, previous studies found the issues of overreliance on ‘wrong’ AI outputs. In this paper, we propose interactive example-based explanations to improve health professionals’ onboarding with AI for their better reliance on AI during AI-assisted decision-making. We implemented an AI-based decision support system that utilizes a neural network to assess the quality of post-stroke survivors’ exercises and interactive example-based explanations that systematically surface the nearest neighborhoods of a test/task sample from the training set of the AI model to assist users’ onboarding with the AI model. To investigate the effect of interactive example-based explanations, we conducted a study with domain experts, health professionals to evaluate their performance and reliance on AI. Our interactive example-based explanations during onboarding assisted health professionals in having a better reliance on AI and making a higher ratio of making ‘right’ decisions and a lower ratio of ‘wrong’ decisions than providing only feature-based explanations during the decision-support phase. Our study discusses new challenges of assisting user’s onboarding with AI for human-AI collaborative decision-making.

Older adult care technologies are increasingly explored to support the independent living of older adults by monitoring their abnormal activities and informing caregivers to provide intervention if necessary. However, the adoption of these technologies remains challenging due to several factors (e.g. lack of usability). In this work, we present a human-centered, intelligent system for older adult care. Our proposed designs of the system were created based on the findings from a focus group session with caregivers. This system monitors the abnormal activities of an older adult using wireless motion sensors and machine learning models. In addition, unlike previous work that only notifies an outcome of activity recognition and abnormal detection models to a caregiver, the system supports interactive dialogue responses to explain the abnormal activities of an older adult to a caregiver and allow the caregiver to elicit additional information about the older adult and the older adult to proactively share his/her status with the caregiver for an adequate intervention.

Artificial intelligence (AI) is increasingly being considered to assist human decision-making in high-stake domains (e.g. health). However, researchers have discussed an issue that humans can over-rely on wrong suggestions of the AI model instead of achieving human AI complementary performance. In this work, we utilized salient feature explanations along with what-if, counterfactual explanations to make humans review AI suggestions more analytically to reduce overreliance on AI and explored the effect of these explanations on trust and reliance on AI during clinical decision-making. We conducted an experiment with seven therapists and ten laypersons on the task of assessing post-stroke survivors' quality of motion, and analyzed their performance, agreement level on the task, and reliance on AI without and with two types of AI explanations. Our results showed that the AI model with both salient features and counterfactual explanations assisted therapists and laypersons to improve their performance and agreement level on the task when 'right' AI outputs are presented. While both therapists and laypersons over-relied on 'wrong' AI outputs, counterfactual explanations assisted both therapists and laypersons to reduce their over-reliance on 'wrong' AI outputs by 21% compared to salient feature explanations. Specifically, laypersons had higher performance degrades by 18.0 f1-score with salient feature explanations and 14.0 f1-score with counterfactual explanations than therapists with performance degrades of 8.6 and 2.8 f1-scores respectively. Our work discusses the potential of counterfactual explanations to better estimate the accuracy of an AI model and reduce over-reliance on 'wrong' AI outputs and implications for improving human-AI collaborative decision-making.

Artificial intelligence (AI) and machine learning (ML) algorithms are increasingly being explored to support various decision-making tasks in health (e.g. rehabilitation assessment). However, the development of such AI/ML-based decision support systems is challenging due to the expensive process to collect an annotated dataset. In this paper, we describe the development process of a human-AI collaborative, clinical decision support system that augments an ML model with a rule-based (RB) model from domain experts. We conducted its empirical evaluation in the context of assessing physical stroke rehabilitation with the dataset of three exercises from 15 post-stroke survivors and therapists. Our results bring new insights on the efficient development and annotations of a decision support system: when an annotated dataset is not available initially, the RB model can be used to assess post-stroke survivor’s quality of motion and identify samples with low confidence scores to support efficient annotations for training an ML model. Specifically, our system requires only 22 - 33% of annotations from therapists to train an ML model that achieves equally good performance with an ML model with all annotations from a therapist. Our work discusses the values of a human-AI collaborative approach for effectively collecting an annotated dataset and supporting a complex decision-making task.

Advances in artificial intelligence (AI) have made it increasingly applicable to supplement expert’s decision-making in the form of a decision support system on various tasks. For instance, an AI-based system can provide therapists quantitative analysis on patient’s status to improve practices of rehabilitation assessment. However, there is limited knowledge on the potential of these systems. In this paper, we present the development and evaluation of an interactive AI-based system that supports collaborative decision making with therapists for rehabilitation assessment. This system automatically identifies salient features of assessment to generate patient-specific analysis for therapists, and tunes with their feedback. In two evaluations with therapists, we found that our system supports therapists significantly higher agreement on assessment (0.71 average F1-score) than a traditional system without analysis (0.66 average F1-score, p < 0.05). After tuning with therapist’s feedback, our system significantly improves its performance from 0.8377 to 0.9116 average F1-scores (p < 0.01). This work discusses the potential of a human-AI collaborative system to support more accurate decision making while learning from each other’s strengths.

A robotic exercise coaching system requires the capability of automatically assessing a patient's exercise to interact with a patient and generate corrective feedback. However, even if patients have various physical conditions, most prior work on robotic exercise coaching systems has utilized generic, pre-defined feedback.This paper presents an interactive approach that combines machine learning and rule-based models to automatically assess a patient's rehabilitation exercise and tunes with patient's data to generate personalized corrective feedback. To generate feedback when an erroneous motion occurs, our approach applies an ensemble voting method that leverages predictions from multiple frames for frame-level assessment. According to the evaluation with the dataset of three stroke rehabilitation exercises from 15 post-stroke subjects, our interactive approach with an ensemble voting method supports more accurate frame-level assessment (p <; 0.01), but also can be tuned with held-out user's unaffected motions to significantly improve the performance of assessment from 0.7447 to 0.8235 average F1-scores over all exercises (p <; 0.01). This paper discusses the value of an interactive approach with an ensemble voting method for personalized interaction of a robotic exercise coaching system.

Technology-assisted systems to monitor and assess rehabilitation exercises have an opportunity of enhancing rehabilitation practices by automatically collecting patient's quantitative performance data. However, even if a complex algorithm (e.g. Neural Network) is applied, it is still challenging to develop such a system due to patients with various physical conditions. The system with a complex algorithm is limited to be a black-box system that cannot provide explanations on its predictions. To address these challenges, this paper presents a hybrid model that integrates a machine learning (ML) model with a rule-based (RB) model as an explainable artificial intelligence (AI) technique for quantitative assessment of stroke rehabilitation exercises. For evaluation, we collected therapist's knowledge on assessment as 15 rules from interviews with therapists and the dataset of three upper-limb stroke rehabilitation exercises from 15 post-stroke and 11 healthy subjects using a Kinect sensor. Experimental results show that a hybrid model can achieve comparable performance with a ML model using Neural Network, but also provide explanations on a model prediction with a RB model. The results indicate the potential of a hybrid model as an explainable AI technique to support the interpretation of a model and fine-tune a model with user-specific rules for personalization.

Clinical decision support systems have the potential to improve work flows of experts in practice (e.g. therapist's evidence-based rehabilitation assessment). However, the adoption of these systems is challenging, and the gains of these systems have not fully demonstrated yet. In this paper, we identified the needs of therapists to assess patient's functional abilities (e.g. alternative perspectives with quantitative information on patient's exercise motions). As a result, we co-designed and developed an intelligent decision support system that automatically identifies salient features of assessment using reinforcement learning to assess the quality of motion and generate patient-specific analysis. We evaluated this system with seven therapists using the dataset from 15 patients performing three exercises. The results show that therapists have higher usage intent on our system than a traditional system without patient-specific analysis ($p < 0.05$). While presenting richer information ($p < 0.10$), our system significantly reduces therapists' effort on assessment ($p < 0.10$) and improves their agreement on assessment from 0.66 to 0.71 F1-scores ($p < 0.01$). This work discusses the importance of human centered design and development of a machine learning-based decision support system that presents contextually relevant information and salient explanations on its prediction for better adoption in practice.

Assessment of rehabilitation exercises is important to determine an adequate rehabilitation intervention. However, this assessment is costly as it requires the presence of a therapist. This paper presents an interactive multimodal approach that automatically assesses exercise performance, identifies salient features of assessment, and iteratively present user-specific analysis to support therapist's decision making on personalized rehabilitation assessment. This approach can achieve good agreement level with therapist's evaluation (i.e. an average of 0.8565 F1-scores on three upper-limb exercises), which is higher than non-interactive, unimodal models.

Individualized rehabilitation sessions with a therapists are important to improve physical ability of a patient with neurological and musculoskeletal disorders. However, in-home rehabilitation regimens are often prescribed due to therapist’s limited availability. During in-home rehabilitation, patients might become confused whether they correctly follow rehabilitation regimens. To address this problem, this research aims to develop a Socially Assistive Robot that can interactively accommodate expert’s domain knowledge into a data-driven model to assess exercise performance and guide desirable joint positions for improvement.

Due to the limited number of therapists, task-oriented exercises are often prescribed for post-stroke survivors as in-home rehabilitation. During in-home rehabilitation, a patient may become unmotivated or confused to comply prescriptions without the feedback of a therapist. To address this challenge, this paper proposes an automated method that can achieve not only qualitative, but also quantitative assessment of stroke rehabilitation exercises. Specifically, we explored a threshold model that utilizes the outputs of binary classifiers to quantify the correctness of a movements into a performance score. We collected movements of 11 healthy subjects and 15 post-stroke survivors using a Kinect sensor and ground truth scores from primary and secondary therapists. The proposed method achieves the following agreement with the primary therapist: 0.8436, 0.8264, and 0.7976 F1-scores on three task-oriented exercises. Experimental results show that our approach performs equally well or better than multi-class classification, regression, or the evaluation of the secondary therapist. Furthermore, we found a strong correlation (R2 = 0.95) between the sum of computed exercise scores and the Fugl-Meyer Assessment scores, clinically validated motor impairment index of post-stroke survivors. Our results demonstrate a feasibility of automatically assessing stroke rehabilitation exercises with the decent agreement levels and clinical relevance.

Improving functional ability after a stroke requires task-oriented physical rehabilitation with the supervision of a therapist. However, with increasing medical costs and a shortage of rehabilitation specialists, post-stroke survivors sometimes receive a limited amount of individual treatment.\\ This paper proposes a low-cost computer-assisted rehabilitation system, called Virtual Coach that evaluates and guides a post-stroke survivor to engage in rehabilitation correctly at home with minimal supervision of a therapist. This system includes two major components: 1) motion analysis modules that evaluate exercise performance and guide a desirable joint trajectory and 2) a dialogue interface to provide feedback. The evaluation function of motion analysis modules computed exercise performance scores of 15 post-stroke survivors and achieved a 78% agreement with a practicing clinician. After developing a guidance function, the usability of the system will be evaluated with post-stroke survivors and therapists and iteratively improved.