Daily Papers

Effective rehabilitation assessment is essential for monitoring patient progress, particularly in home-based settings. Existing systems often face challenges such as data imbalance and difficulty detecting subtle movement errors. This paper introduces Error-Guided Pose Augmentation (EGPA), a method that generates synthetic skeleton data by simulating clinically relevant movement mistakes. Unlike standard augmentation techniques, EGPA targets biomechanical errors observed in rehabilitation. Combined with an attention-based graph convolutional network, EGPA improves performance across multiple evaluation metrics. Experiments demonstrate reductions in mean absolute error of up to 27.6 percent and gains in error classification accuracy of 45.8 percent. Attention visualizations show that the model learns to focus on clinically significant joints and movement phases, enhancing both accuracy and interpretability. EGPA offers a promising approach for improving automated movement quality assessment in both clinical and home-based rehabilitation contexts.

Pose estimation has promised to impact healthcare by enabling more practical methods to quantify nuances of human movement and biomechanics. However, despite the inherent connection between pose estimation and biomechanics, these disciplines have largely remained disparate. For example, most current pose estimation benchmarks use metrics such as Mean Per Joint Position Error, Percentage of Correct Keypoints, or mean Average Precision to assess performance, without quantifying kinematic and physiological correctness - key aspects for biomechanics. To alleviate this challenge, we develop OpenCapBench to offer an easy-to-use unified benchmark to assess common tasks in human pose estimation, evaluated under physiological constraints. OpenCapBench computes consistent kinematic metrics through joints angles provided by an open-source musculoskeletal modeling software (OpenSim). Through OpenCapBench, we demonstrate that current pose estimation models use keypoints that are too sparse for accurate biomechanics analysis. To mitigate this challenge, we introduce SynthPose, a new approach that enables finetuning of pre-trained 2D human pose models to predict an arbitrarily denser set of keypoints for accurate kinematic analysis through the use of synthetic data. Incorporating such finetuning on synthetic data of prior models leads to twofold reduced joint angle errors. Moreover, OpenCapBench allows users to benchmark their own developed models on our clinically relevant cohort. Overall, OpenCapBench bridges the computer vision and biomechanics communities, aiming to drive simultaneous advances in both areas.

Great progress has been made in estimating 3D human pose and shape from images and video by training neural networks to directly regress the parameters of parametric human models like SMPL. However, existing body models have simplified kinematic structures that do not correspond to the true joint locations and articulations in the human skeletal system, limiting their potential use in biomechanics. On the other hand, methods for estimating biomechanically accurate skeletal motion typically rely on complex motion capture systems and expensive optimization methods. What is needed is a parametric 3D human model with a biomechanically accurate skeletal structure that can be easily posed. To that end, we develop SKEL, which re-rigs the SMPL body model with a biomechanics skeleton. To enable this, we need training data of skeletons inside SMPL meshes in diverse poses. We build such a dataset by optimizing biomechanically accurate skeletons inside SMPL meshes from AMASS sequences. We then learn a regressor from SMPL mesh vertices to the optimized joint locations and bone rotations. Finally, we re-parametrize the SMPL mesh with the new kinematic parameters. The resulting SKEL model is animatable like SMPL but with fewer, and biomechanically-realistic, degrees of freedom. We show that SKEL has more biomechanically accurate joint locations than SMPL, and the bones fit inside the body surface better than previous methods. By fitting SKEL to SMPL meshes we are able to "upgrade" existing human pose and shape datasets to include biomechanical parameters. SKEL provides a new tool to enable biomechanics in the wild, while also providing vision and graphics researchers with a better constrained and more realistic model of human articulation. The model, code, and data are available for research at https://skel.is.tue.mpg.de..

Human motion generation holds significant promise in fields such as animation, film production, and robotics. However, existing methods often fail to produce physically plausible movements that adhere to biomechanical principles. While recent autoregressive and diffusion models have improved visual quality, they frequently overlook essential biodynamic features, such as muscle activation patterns and joint coordination, leading to motions that either violate physical laws or lack controllability. This paper introduces BioMoDiffuse, a novel biomechanics-aware diffusion framework that addresses these limitations. It features three key innovations: (1) A lightweight biodynamic network that integrates muscle electromyography (EMG) signals and kinematic features with acceleration constraints, (2) A physics-guided diffusion process that incorporates real-time biomechanical verification via modified Euler-Lagrange equations, and (3) A decoupled control mechanism that allows independent regulation of motion speed and semantic context. We also propose a set of comprehensive evaluation protocols that combines traditional metrics (FID, R-precision, etc.) with new biomechanical criteria (smoothness, foot sliding, floating, etc.). Our approach bridges the gap between data-driven motion synthesis and biomechanical authenticity, establishing new benchmarks for physically accurate motion generation.

Learning motor control for muscle-driven musculoskeletal models is hindered by the computational cost of biomechanically accurate simulation and the scarcity of validated, open full-body models. Here we present MuscleMimic, an open-source framework for scalable motion imitation learning with physiologically realistic, muscle-actuated humanoids. MuscleMimic provides two validated musculoskeletal embodiments - a fixed-root upper-body model (126 muscles) for bimanual manipulation and a full-body model (416 muscles) for locomotion - together with a retargeting pipeline that maps SMPL-format motion capture data onto musculoskeletal structures while preserving kinematic and dynamic consistency. Leveraging massively parallel GPU simulation, the framework achieves order-of-magnitude training speedups over prior CPU-based approaches while maintaining comprehensive collision handling, enabling a single generalist policy to be trained on hundreds of diverse motions within days. The resulting policy faithfully reproduces a broad repertoire of human movements under full muscular control and can be fine-tuned to novel motions within hours. Biomechanical validation against experimental walking and running data demonstrates strong agreement in joint kinematics (mean correlation r = 0.90), while muscle activation analysis reveals both the promise and fundamental challenges of achieving physiological fidelity through kinematic imitation alone. By lowering the computational and data barriers to musculoskeletal simulation, MuscleMimic enables systematic model validation across diverse dynamic movements and broader participation in neuromuscular control research. Code, models, checkpoints, and retargeted datasets are available at: https://github.com/amathislab/musclemimic

Modeling spinal motion is fundamental to understanding human biomechanics, yet remains underexplored in computer vision due to the spine's complex multi-joint kinematics and the lack of large-scale 3D annotations. We present a biomechanics-aware keypoint simulation framework that augments existing human pose datasets with anatomically consistent 3D spinal keypoints derived from musculoskeletal modeling. Using this framework, we create the first open dataset, named SIMSPINE, which provides sparse vertebra-level 3D spinal annotations for natural full-body motions in indoor multi-camera capture without external restraints. With 2.14 million frames, this enables data-driven learning of vertebral kinematics from subtle posture variations and bridges the gap between musculoskeletal simulation and computer vision. In addition, we release pretrained baselines covering fine-tuned 2D detectors, monocular 3D pose lifting models, and multi-view reconstruction pipelines, establishing a unified benchmark for biomechanically valid spine motion estimation. Specifically, our 2D spine baselines improve the state-of-the-art from 0.63 to 0.80 AUC in controlled environments, and from 0.91 to 0.93 AP for in-the-wild spine tracking. Together, the simulation framework and SIMSPINE dataset advance research in vision-based biomechanics, motion analysis, and digital human modeling by enabling reproducible, anatomically grounded 3D spine estimation under natural conditions.

Fatigue modeling is essential for motion synthesis tasks to model human motions under fatigued conditions and biomechanical engineering applications, such as investigating the variations in movement patterns and posture due to fatigue, defining injury risk mitigation and prevention strategies, formulating fatigue minimization schemes and creating improved ergonomic designs. Nevertheless, employing data-driven methods for synthesizing the impact of fatigue on motion, receives little to no attention in the literature. In this work, we present Fatigue-PINN, a deep learning framework based on Physics-Informed Neural Networks, for modeling fatigued human movements, while providing joint-specific fatigue configurations for adaptation and mitigation of motion artifacts on a joint level, resulting in more realistic animations. To account for muscle fatigue, we simulate the fatigue-induced fluctuations in the maximum exerted joint torques by leveraging a PINN adaptation of the Three-Compartment Controller model to exploit physics-domain knowledge for improving accuracy. This model also introduces parametric motion alignment with respect to joint-specific fatigue, hence avoiding sharp frame transitions. Our results indicate that Fatigue-PINN accurately simulates the effects of externally perceived fatigue on open-type human movements being consistent with findings from real-world experimental fatigue studies. Since fatigue is incorporated in torque space, Fatigue-PINN provides an end-to-end encoder-decoder-like architecture, to ensure transforming joint angles to joint torques and vice-versa, thus, being compatible with motion synthesis frameworks operating on joint angles.

Reconstructing biomechanically realistic 3D human motion - recovering both kinematics (motion) and kinetics (forces) - is a critical challenge. While marker-based systems are lab-bound and slow, popular monocular methods use oversimplified, anatomically inaccurate models (e.g., SMPL) and ignore physics, fundamentally limiting their biomechanical fidelity. In this work, we introduce MonoMSK, a hybrid framework that bridges data-driven learning and physics-based simulation for biomechanically realistic 3D human motion estimation from monocular video. MonoMSK jointly recovers both kinematics (motions) and kinetics (forces and torques) through an anatomically accurate musculoskeletal model. By integrating transformer-based inverse dynamics with differentiable forward kinematics and dynamics layers governed by ODE-based simulation, MonoMSK establishes a physics-regulated inverse-forward loop that enforces biomechanical causality and physical plausibility. A novel forward-inverse consistency loss further aligns motion reconstruction with the underlying kinetic reasoning. Experiments on BML-MoVi, BEDLAM, and OpenCap show that MonoMSK significantly outperforms state-of-the-art methods in kinematic accuracy, while for the first time enabling precise monocular kinetics estimation.

This study presents an automated lameness detection system that uses deep-learning image processing techniques to extract multiple locomotion traits associated with lameness. Using the T-LEAP pose estimation model, the motion of nine keypoints was extracted from videos of walking cows. The videos were recorded outdoors, with varying illumination conditions, and T-LEAP extracted 99.6% of correct keypoints. The trajectories of the keypoints were then used to compute six locomotion traits: back posture measurement, head bobbing, tracking distance, stride length, stance duration, and swing duration. The three most important traits were back posture measurement, head bobbing, and tracking distance. For the ground truth, we showed that a thoughtful merging of the scores of the observers could improve intra-observer reliability and agreement. We showed that including multiple locomotion traits improves the classification accuracy from 76.6% with only one trait to 79.9% with the three most important traits and to 80.1% with all six locomotion traits.

Injury to the cervical spinal cord can cause quadriplegia, impairing muscle function in all four limbs. People with impaired hand function and mobility encounter significant difficulties in carrying out essential self-care and household tasks. Despite the impairment of their neural drive, their volitional myoelectric activity is often partially preserved. High-density electromyography (HDEMG) can detect this myoelectric activity, which can serve as control inputs to assistive devices. Previous HDEMG-controlled robotic interfaces have primarily been limited to controlling table-mounted robot arms. These have constrained reach capabilities. Instead, the ability to control mobile manipulators, which have no such workspace constraints, could allow individuals with quadriplegia to perform a greater variety of assistive tasks, thus restoring independence and reducing caregiver workload. In this study, we introduce a non-invasive wearable HDEMG interface with real-time myoelectric hand gesture recognition, enabling both coarse and fine control over the intricate mobility and manipulation functionalities of an 8 degree-of-freedom mobile manipulator. Our evaluation, involving 13 participants engaging in challenging self-care and household activities, demonstrates the potential of our wearable HDEMG system to profoundly enhance user independence by enabling non-invasive control of a mobile manipulator.

The rising number of the elderly incurs growing concern about healthcare, and in particular rehabilitation healthcare. Assistive technology and assistive robotics in particular may help to improve this process. We develop a robot coach capable of demonstrating rehabilitation exercises to patients, watch a patient carry out the exercises and give him feedback so as to improve his performance and encourage him. The HRI of the system is based on our study with a team of rehabilitation therapists and with the target population.The system relies on human motion analysis. We develop a method for learning a probabilistic representation of ideal movements from expert demonstrations. A Gaussian Mixture Model is employed from position and orientation features captured using a Microsoft Kinect v2. For assessing patients' movements, we propose a real-time multi-level analysis to both temporally and spatially identify and explain body part errors. This analysis combined with a classification algorithm allows the robot to provide coaching advice to make the patient improve his movements. The evaluation on three rehabilitation exercises shows the potential of the proposed approach for learning and assessing kinaesthetic movements.

Introduction: Mechanical thrombectomy can cause vessel deformation and procedure-related injury. Benchtop models are widely used for device testing, but time-resolved, full-field 3D vessel-motion measurements remain limited. Methods: We developed a nine-camera, low-cost multi-view workflow for benchtop thrombectomy in silicone middle cerebral artery phantoms (2160p, 20 fps). Multi-view videos were calibrated, segmented, and reconstructed with 4D Gaussian Splatting. Reconstructed point clouds were converted to fixed-connectivity edge graphs for region-of-interest (ROI) displacement tracking and a relative surface-based stress proxy. Stress-proxy values were derived from edge stretch using a Neo-Hookean mapping and reported as comparative surface metrics. A synthetic Blender pipeline with known deformation provided geometric and temporal validation. Results: In synthetic bulk translation, the stress proxy remained near zero for most edges (median approx 0 MPa; 90th percentile 0.028 MPa), with sparse outliers. In synthetic pulling (1-5 mm), reconstruction showed close geometric and temporal agreement with ground truth, with symmetric Chamfer distance of 1.714-1.815 mm and precision of 0.964-0.972 at τ= 1 mm. In preliminary benchtop comparative trials (one trial per condition), cervical aspiration catheter placement showed higher max-median ROI displacement and stress-proxy values than internal carotid artery terminus placement. Conclusion: The proposed protocol provides standardized, time-resolved surface kinematics and comparative relative displacement and stress proxy measurements for thrombectomy benchtop studies. The framework supports condition-to-condition comparisons and methods validation, while remaining distinct from absolute wall-stress estimation. Implementation code and example data are available at https://ethanuser.github.io/vessel4D

In sports analytics, accurately capturing both the 3D locations and rotations of body joints is essential for understanding an athlete's biomechanics. While Human Mesh Recovery (HMR) models can estimate joint rotations, they often exhibit lower accuracy in joint localization compared to 3D Human Pose Estimation (HPE) models. Recent work addressed this limitation by combining a 3D HPE model with inverse kinematics (IK) to estimate both joint locations and rotations. However, IK is computationally expensive. To overcome this, we propose a novel 2D-to-3D uplifting model that directly estimates 3D human poses, including joint rotations, in a single forward pass. We investigate multiple rotation representations, loss functions, and training strategies - both with and without access to ground truth rotations. Our models achieve state-of-the-art accuracy in rotation estimation, are 150 times faster than the IK-based approach, and surpass HMR models in joint localization precision.

In this paper, we introduce a method for reconstructing 3D humans from a single image using a biomechanically accurate skeleton model. To achieve this, we train a transformer that takes an image as input and estimates the parameters of the model. Due to the lack of training data for this task, we build a pipeline to produce pseudo ground truth model parameters for single images and implement a training procedure that iteratively refines these pseudo labels. Compared to state-of-the-art methods for 3D human mesh recovery, our model achieves competitive performance on standard benchmarks, while it significantly outperforms them in settings with extreme 3D poses and viewpoints. Additionally, we show that previous reconstruction methods frequently violate joint angle limits, leading to unnatural rotations. In contrast, our approach leverages the biomechanically plausible degrees of freedom making more realistic joint rotation estimates. We validate our approach across multiple human pose estimation benchmarks. We make the code, models and data available at: https://isshikihugh.github.io/HSMR/

With the increasing awareness of health and the growing desire for aesthetic physique, fitness has become a prevailing trend. However, the potential risks associated with fitness training, especially with weight-loaded fitness actions, cannot be overlooked. Action Quality Assessment (AQA), a technology that quantifies the quality of human action and provides feedback, holds the potential to assist fitness enthusiasts of varying skill levels in achieving better training outcomes. Nevertheless, current AQA methodologies and datasets are limited to single-view competitive sports scenarios and RGB modality and lack professional assessment and guidance of fitness actions. To address this gap, we propose the FLEX dataset, the first multi-modal, multi-action, large-scale dataset that incorporates surface electromyography (sEMG) signals into AQA. FLEX utilizes high-precision MoCap to collect 20 different weight-loaded actions performed by 38 subjects across 3 different skill levels for 10 repetitions each, containing 5 different views of the RGB video, 3D pose, sEMG, and physiological information. Additionally, FLEX incorporates knowledge graphs into AQA, constructing annotation rules in the form of penalty functions that map weight-loaded actions, action keysteps, error types, and feedback. We conducted various baseline methodologies on FLEX, demonstrating that multimodal data, multiview data, and fine-grained annotations significantly enhance model performance. FLEX not only advances AQA methodologies and datasets towards multi-modal and multi-action scenarios but also fosters the integration of artificial intelligence within the fitness domain. Dataset and code are available at https://haoyin116.github.io/FLEX_Dataset.

Increased effort during use of the paretic arm and hand can provoke involuntary abnormal synergy patterns and amplify stiffness effects of muscle tone for individuals after stroke, which can add difficulty for user-controlled devices to assist hand movement during functional tasks. We study how volitional effort, exerted in an attempt to open or close the hand, affects resistance to robot-assisted movement at the finger level. We perform experiments with three chronic stroke survivors to measure changes in stiffness when the user is actively exerting effort to activate ipsilateral EMG-controlled robot-assisted hand movements, compared with when the fingers are passively stretched, as well as overall effects from sustained active engagement and use. Our results suggest that active engagement of the upper extremity increases muscle tone in the finger to a much greater degree than through passive-stretch or sustained exertion over time. Potential design implications of this work suggest that developers should anticipate higher levels of finger stiffness when relying on user-driven ipsilateral control methods for assistive or rehabilitative devices for stroke.

While automatic monitoring and coaching of exercises are showing encouraging results in non-medical applications, they still have limitations such as errors and limited use contexts. To allow the development and assessment of physical rehabilitation by an intelligent tutoring system, we identify in this article four challenges to address and propose a medical dataset of clinical patients carrying out low back-pain rehabilitation exercises. The dataset includes 3D Kinect skeleton positions and orientations, RGB videos, 2D skeleton data, and medical annotations to assess the correctness, and error classification and localisation of body part and timespan. Along this dataset, we perform a complete research path, from data collection to processing, and finally a small benchmark. We evaluated on the dataset two baseline movement recognition algorithms, pertaining to two different approaches: the probabilistic approach with a Gaussian Mixture Model (GMM), and the deep learning approach with a Long-Short Term Memory (LSTM). This dataset is valuable because it includes rehabilitation relevant motions in a clinical setting with patients in their rehabilitation program, using a cost-effective, portable, and convenient sensor, and because it shows the potential for improvement on these challenges.

Large language models (LLMs) show increasing promise in medical applications, but their ability to detect and correct errors in clinical texts -- a prerequisite for safe deployment -- remains under-evaluated, particularly beyond English. We introduce MedRECT, a cross-lingual benchmark (Japanese/English) that formulates medical error handling as three subtasks: error detection, error localization (sentence extraction), and error correction. MedRECT is built with a scalable, automated pipeline from the Japanese Medical Licensing Examinations (JMLE) and a curated English counterpart, yielding MedRECT-ja (663 texts) and MedRECT-en (458 texts) with comparable error/no-error balance. We evaluate 9 contemporary LLMs spanning proprietary, open-weight, and reasoning families. Key findings: (i) reasoning models substantially outperform standard architectures, with up to 13.5% relative improvement in error detection and 51.0% in sentence extraction; (ii) cross-lingual evaluation reveals 5-10% performance gaps from English to Japanese, with smaller disparities for reasoning models; (iii) targeted LoRA fine-tuning yields asymmetric improvements in error correction performance (Japanese: +0.078, English: +0.168) while preserving reasoning capabilities; and (iv) our fine-tuned model exceeds human expert performance on structured medical error correction tasks. To our knowledge, MedRECT is the first comprehensive cross-lingual benchmark for medical error correction, providing a reproducible framework and resources for developing safer medical LLMs across languages.

The meaningful use of electronic health records (EHR) continues to progress in the digital era with clinical decision support systems augmented by artificial intelligence. A priority in improving provider experience is to overcome information overload and reduce the cognitive burden so fewer medical errors and cognitive biases are introduced during patient care. One major type of medical error is diagnostic error due to systematic or predictable errors in judgment that rely on heuristics. The potential for clinical natural language processing (cNLP) to model diagnostic reasoning in humans with forward reasoning from data to diagnosis and potentially reduce the cognitive burden and medical error has not been investigated. Existing tasks to advance the science in cNLP have largely focused on information extraction and named entity recognition through classification tasks. We introduce a novel suite of tasks coined as Diagnostic Reasoning Benchmarks, DR.BENCH, as a new benchmark for developing and evaluating cNLP models with clinical diagnostic reasoning ability. The suite includes six tasks from ten publicly available datasets addressing clinical text understanding, medical knowledge reasoning, and diagnosis generation. DR.BENCH is the first clinical suite of tasks designed to be a natural language generation framework to evaluate pre-trained language models. Experiments with state-of-the-art pre-trained generative language models using large general domain models and models that were continually trained on a medical corpus demonstrate opportunities for improvement when evaluated in DR. BENCH. We share DR. BENCH as a publicly available GitLab repository with a systematic approach to load and evaluate models for the cNLP community.

Learning spatial-temporal correspondences in cardiac motion from images is important for understanding the underlying dynamics of cardiac anatomical structures. Many methods explicitly impose smoothness constraints such as the L_2 norm on the displacement vector field (DVF), while usually ignoring biomechanical feasibility in the transformation. Other geometric constraints either regularize specific regions of interest such as imposing incompressibility on the myocardium or introduce additional steps such as training a separate network-based regularizer on physically simulated datasets. In this work, we propose an explicit biomechanics-informed prior as regularization on the predicted DVF in modeling a more generic biomechanically plausible transformation within all cardiac structures without introducing additional training complexity. We validate our methods on two publicly available datasets in the context of 2D MRI data and perform extensive experiments to illustrate the effectiveness and robustness of our proposed methods compared to other competing regularization schemes. Our proposed methods better preserve biomechanical properties by visual assessment and show advantages in segmentation performance using quantitative evaluation metrics. The code is publicly available at https://github.com/Voldemort108X/bioinformed_reg.

This paper proposes one of the first clinical applications of multimodal large language models (LLMs) as an assistant for radiologists to check errors in their reports. We created an evaluation dataset from two real-world radiology datasets (MIMIC-CXR and IU-Xray), with 1,000 subsampled reports each. A subset of original reports was modified to contain synthetic errors by introducing various type of mistakes. The evaluation contained two difficulty levels: SIMPLE for binary error-checking and COMPLEX for identifying error types. LLaVA (Large Language and Visual Assistant) variant models, including our instruction-tuned model, were used for the evaluation. Additionally, a domain expert evaluation was conducted on a small test set. At the SIMPLE level, the LLaVA v1.5 model outperformed other publicly available models. Instruction tuning significantly enhanced performance by 47.4% and 25.4% on MIMIC-CXR and IU-Xray data, respectively. The model also surpassed the domain experts accuracy in the MIMIC-CXR dataset by 1.67%. Notably, among the subsets (N=21) of the test set where a clinician did not achieve the correct conclusion, the LLaVA ensemble mode correctly identified 71.4% of these cases. This study marks a promising step toward utilizing multi-modal LLMs to enhance diagnostic accuracy in radiology. The ensemble model demonstrated comparable performance to clinicians, even capturing errors overlooked by humans. Nevertheless, future work is needed to improve the model ability to identify the types of inconsistency.

Ergonomics and human comfort are essential concerns in physical human-robot interaction applications. Defining an accurate and easy-to-use ergonomic assessment model stands as an important step in providing feedback for postural correction to improve operator health and comfort. Common practical methods in the area suffer from inaccurate ergonomics models in performing postural optimization. In order to retain assessment quality, while improving computational considerations, we propose a novel framework for postural assessment and optimization for ergonomically intelligent physical human-robot interaction. We introduce DULA and DEBA, differentiable and continuous ergonomics models learned to replicate the popular and scientifically validated RULA and REBA assessments with more than 99% accuracy. We show that DULA and DEBA provide assessment comparable to RULA and REBA while providing computational benefits when being used in postural optimization. We evaluate our framework through human and simulation experiments. We highlight DULA and DEBA's strength in a demonstration of postural optimization for a simulated pHRI task.

Sexual dimorphism is a critical factor in many biological and medical research fields. In biomechanics and bioengineering, understanding sex differences is crucial for studying musculoskeletal conditions such as temporomandibular disorder (TMD). This paper focuses on the association between the craniofacial skeletal morphology and temporomandibular joint (TMJ) related masticatory muscle attachments to discern sex differences. Data were collected from 10 male and 11 female cadaver heads to investigate sex-specific relationships between the skull and muscles. We propose a conditional cross-covariance reduction (CCR) model, designed to examine the dynamic association between two sets of random variables conditioned on a third binary variable (e.g., sex), highlighting the most distinctive sex-related relationships between skull and muscle attachments in the human cadaver data. Under the CCR model, we employ a sparse singular value decomposition algorithm and introduce a sequential permutation for selecting sparsity (SPSS) method to select important variables and to determine the optimal number of selected variables.

While large language models (LLMs) have demonstrated remarkable versatility across a wide range of general tasks, their effectiveness often diminishes in domain-specific applications due to inherent knowledge gaps. Moreover, their performance typically declines when addressing complex problems that require multi-step reasoning and analysis. In response to these challenges, we propose leveraging both LLMs and AI agents to develop education assistants aimed at enhancing undergraduate learning in biomechanics courses that focus on analyzing the force and moment in the musculoskeletal system of the human body. To achieve our goal, we construct a dual-module framework to enhance LLM performance in biomechanics educational tasks: 1) we apply Retrieval-Augmented Generation (RAG) to improve the specificity and logical consistency of LLM's responses to the conceptual true/false questions; 2) we build a Multi-Agent System (MAS) to solve calculation-oriented problems involving multi-step reasoning and code execution. Specifically, we evaluate the performance of several LLMs, i.e., Qwen-1.0-32B, Qwen-2.5-32B, and Llama-70B, on a biomechanics dataset comprising 100 true/false conceptual questions and problems requiring equation derivation and calculation. Our results demonstrate that RAG significantly enhances the performance and stability of LLMs in answering conceptual questions, surpassing those of vanilla models. On the other hand, the MAS constructed using multiple LLMs demonstrates its ability to perform multi-step reasoning, derive equations, execute code, and generate explainable solutions for tasks that require calculation. These findings demonstrate the potential of applying RAG and MAS to enhance LLM performance for specialized courses in engineering curricula, providing a promising direction for developing intelligent tutoring in engineering education.

Several studies showed that Large Language Models (LLMs) can answer medical questions correctly, even outperforming the average human score in some medical exams. However, to our knowledge, no study has been conducted to assess the ability of language models to validate existing or generated medical text for correctness and consistency. In this paper, we introduce MEDEC (https://github.com/abachaa/MEDEC), the first publicly available benchmark for medical error detection and correction in clinical notes, covering five types of errors (Diagnosis, Management, Treatment, Pharmacotherapy, and Causal Organism). MEDEC consists of 3,848 clinical texts, including 488 clinical notes from three US hospital systems that were not previously seen by any LLM. The dataset has been used for the MEDIQA-CORR shared task to evaluate seventeen participating systems [Ben Abacha et al., 2024]. In this paper, we describe the data creation methods and we evaluate recent LLMs (e.g., o1-preview, GPT-4, Claude 3.5 Sonnet, and Gemini 2.0 Flash) for the tasks of detecting and correcting medical errors requiring both medical knowledge and reasoning capabilities. We also conducted a comparative study where two medical doctors performed the same task on the MEDEC test set. The results showed that MEDEC is a sufficiently challenging benchmark to assess the ability of models to validate existing or generated notes and to correct medical errors. We also found that although recent LLMs have a good performance in error detection and correction, they are still outperformed by medical doctors in these tasks. We discuss the potential factors behind this gap, the insights from our experiments, the limitations of current evaluation metrics, and share potential pointers for future research.

Operating robots precisely and at high speeds has been a long-standing goal of robotics research. Balancing these competing demands is key to enabling the seamless collaboration of robots and humans and increasing task performance. However, traditional motor-driven systems often fall short in this balancing act. Due to their rigid and often heavy design exacerbated by positioning the motors into the joints, faster motions of such robots transfer high forces at impact. To enable precise and safe dynamic motions, we introduce a four degree-of-freedom~(DoF) tendon-driven robot arm. Tendons allow placing the actuation at the base to reduce the robot's inertia, which we show significantly reduces peak collision forces compared to conventional robots with motors placed near the joints. Pairing our robot with pneumatic muscles allows generating high forces and highly accelerated motions, while benefiting from impact resilience through passive compliance. Since tendons are subject to additional friction and hence prone to wear and tear, we validate the reliability of our robotic arm on various experiments, including long-term dynamic motions. We also demonstrate its ease of control by quantifying the nonlinearities of the system and the performance on a challenging dynamic table tennis task learned from scratch using reinforcement learning. We open-source the entire hardware design, which can be largely 3D printed, the control software, and a proprioceptive dataset of 25 days of diverse robot motions at webdav.tuebingen.mpg.de/pamy2.

We introduce UbiPhysio, a milestone framework that delivers fine-grained action description and feedback in natural language to support people's daily functioning, fitness, and rehabilitation activities. This expert-like capability assists users in properly executing actions and maintaining engagement in remote fitness and rehabilitation programs. Specifically, the proposed UbiPhysio framework comprises a fine-grained action descriptor and a knowledge retrieval-enhanced feedback module. The action descriptor translates action data, represented by a set of biomechanical movement features we designed based on clinical priors, into textual descriptions of action types and potential movement patterns. Building on physiotherapeutic domain knowledge, the feedback module provides clear and engaging expert feedback. We evaluated UbiPhysio's performance through extensive experiments with data from 104 diverse participants, collected in a home-like setting during 25 types of everyday activities and exercises. We assessed the quality of the language output under different tuning strategies using standard benchmarks. We conducted a user study to gather insights from clinical physiotherapists and potential users about our framework. Our initial tests show promise for deploying UbiPhysio in real-life settings without specialized devices.

Physical therapy (PT) is crucial for patients to restore and maintain mobility, function, and well-being. Many on-site activities and body exercises are performed under the supervision of therapists or clinicians. However, the postures of some exercises at home cannot be performed accurately due to the lack of supervision, quality assessment, and self-correction. Therefore, in this paper, we design a new framework, PhysiQ, that continuously tracks and quantitatively measures people's off-site exercise activity through passive sensory detection. In the framework, we create a novel multi-task spatio-temporal Siamese Neural Network that measures the absolute quality through classification and relative quality based on an individual's PT progress through similarity comparison. PhysiQ digitizes and evaluates exercises in three different metrics: range of motions, stability, and repetition.

Precise tracking of the jaw kinematics is crucial for diagnosing various musculoskeletal and neuromuscular diseases affecting the masticatory system and for advancing rehabilitative devices such as jaw exoskeletons, a hardly explored research field, to treat these disorders. We introduce an open-source, low-cost, precise, non-invasive, and biocompatible jaw tracking system based on optical motion capture technology to address the need for accessible and adaptable research tools. The system encompasses a complete pipeline from data acquisition, processing, and kinematic analysis to filtering, visualization, and data storage. We evaluated its performance and feasibility in experiments with four participants executing various jaw movements. The system demonstrated reliable kinematic tracking with an estimated precision of (182 pm 47) {mu}m and (0.126 pm 0.034) {deg}. Therefore, the open-source nature of the system and its utility comparable to commercial systems make it suitable for many research and development contexts, especially for applications such as the integration and design of jaw exoskeletons and customized diagnostic protocols. The complete system is available at GitHub with the aim of promoting innovation in temporomandibular disorders research and jaw assistive technology.

Gait disorders are commonly observed in older adults, who frequently experience various issues related to walking. Additionally, researchers and clinicians extensively investigate mobility related to gait in typically and atypically developing children, athletes, and individuals with orthopedic and neurological disorders. Effective gait analysis enables the understanding of the causal mechanisms of mobility and balance control of patients, the development of tailored treatment plans to improve mobility, the reduction of fall risk, and the tracking of rehabilitation progress. However, analyzing gait data is a complex task due to the multivariate nature of the data, the large volume of information to be interpreted, and the technical skills required. Existing tools for gait analysis are often limited to specific patient groups (e.g., cerebral palsy), only handle a specific subset of tasks in the entire workflow, and are not openly accessible. To address these shortcomings, we conducted a requirements assessment with gait practitioners (e.g., researchers, clinicians) via surveys and identified key components of the workflow, including (1) data processing and (2) data analysis and visualization. Based on the findings, we designed VIGMA, an open-access visual analytics framework integrated with computational notebooks and a Python library, to meet the identified requirements. Notably, the framework supports analytical capabilities for assessing disease progression and for comparing multiple patient groups. We validated the framework through usage scenarios with experts specializing in gait and mobility rehabilitation. VIGMA is available at https://github.com/komar41/VIGMA.

Poor sitting posture can lead to various work-related musculoskeletal disorders (WMSDs). Office employees spend approximately 81.8% of their working time seated, and sedentary behavior can result in chronic diseases such as cervical spondylosis and cardiovascular diseases. To address these health concerns, we present SitPose, a sitting posture and sedentary detection system utilizing the latest Kinect depth camera. The system tracks 3D coordinates of bone joint points in real-time and calculates the angle values of related joints. We established a dataset containing six different sitting postures and one standing posture, totaling 33,409 data points, by recruiting 36 participants. We applied several state-of-the-art machine learning algorithms to the dataset and compared their performance in recognizing the sitting poses. Our results show that the ensemble learning model based on the soft voting mechanism achieves the highest F1 score of 98.1%. Finally, we deployed the SitPose system based on this ensemble model to encourage better sitting posture and to reduce sedentary habits.

Esports are a mostly sedentary activity. There is a growing need for investigation into how biomechanical and physical abilities can be optimized for esports through training. One such research avenue concerns the ability of esports players to perform balance tasks due to the prolonged sedentary states that are required to reach the top echelon of performance. Our aim for this work is to describe and compare physical abilities (balance, grip strength, and self-reported training habits) of top Polish StarCraft~2 tournament players. Esports players differed significantly from the reference group in their ability to balance on one leg. Additionally, in a grip strength test, the esports group fared worse than the reference group in all consecutive attempts. Despite self-reported physical activity in the esports group, player fitness requires further research. Training optimization could offset the issues arising from sedentary activity, and intensifying esports training so it could take less time overall.

Reliable fall recovery is critical for humanoids operating in cluttered environments. Unlike quadrupeds or wheeled robots, humanoids experience high-energy impacts, complex whole-body contact, and large viewpoint changes during a fall, making recovery essential for continued operation. Existing methods fragment fall safety into separate problems such as fall avoidance, impact mitigation, and stand-up recovery, or rely on end-to-end policies trained without vision through reinforcement learning or imitation learning, often on flat terrain. At a deeper level, fall safety is treated as monolithic data complexity, coupling pose, dynamics, and terrain and requiring exhaustive coverage, limiting scalability and generalization. We present a unified fall safety approach that spans all phases of fall recovery. It builds on two insights: 1) Natural human fall and recovery poses are highly constrained and transferable from flat to complex terrain through alignment, and 2) Fast whole-body reactions require integrated perceptual-motor representations. We train a privileged teacher using sparse human demonstrations on flat terrain and simulated complex terrains, and distill it into a deployable student that relies only on egocentric depth and proprioception. The student learns how to react by matching the teacher's goal-in-context latent representation, which combines the next target pose with the local terrain, rather than separately encoding what it must perceive and how it must act. Results in simulation and on a real Unitree G1 humanoid demonstrate robust, zero-shot fall safety across diverse non-flat environments without real-world fine-tuning. The project page is available at https://vigor2026.github.io/

Motion artefacts in magnetic resonance brain images can have a strong impact on diagnostic confidence. The assessment of MR image quality is fundamental before proceeding with the clinical diagnosis. Motion artefacts can alter the delineation of structures such as the brain, lesions or tumours and may require a repeat scan. Otherwise, an inaccurate (e.g. correct pathology but wrong severity) or incorrect diagnosis (e.g. wrong pathology) may occur. "Image quality assessment" as a fast, automated step right after scanning can assist in deciding if the acquired images are diagnostically sufficient. An automated image quality assessment based on the structural similarity index (SSIM) regression through a residual neural network is proposed in this work. Additionally, a classification into different groups - by subdividing with SSIM ranges - is evaluated. Importantly, this method predicts SSIM values of an input image in the absence of a reference ground truth image. The networks were able to detect motion artefacts, and the best performance for the regression and classification task has always been achieved with ResNet-18 with contrast augmentation. The mean and standard deviation of residuals' distribution were mu=-0.0009 and sigma=0.0139, respectively. Whilst for the classification task in 3, 5 and 10 classes, the best accuracies were 97, 95 and 89\%, respectively. The results show that the proposed method could be a tool for supporting neuro-radiologists and radiographers in evaluating image quality quickly.

Falling is an inherent risk of humanoid mobility. Maintaining stability is thus a primary safety focus in robot control and learning, yet no existing approach fully averts loss of balance. When instability does occur, prior work addresses only isolated aspects of falling: avoiding falls, choreographing a controlled descent, or standing up afterward. Consequently, humanoid robots lack integrated strategies for impact mitigation and prompt recovery when real falls defy these scripts. We aim to go beyond keeping balance to make the entire fall-and-recovery process safe and autonomous: prevent falls when possible, reduce impact when unavoidable, and stand up when fallen. By fusing sparse human demonstrations with reinforcement learning and an adaptive diffusion-based memory of safe reactions, we learn adaptive whole-body behaviors that unify fall prevention, impact mitigation, and rapid recovery in one policy. Experiments in simulation and on a Unitree G1 demonstrate robust sim-to-real transfer, lower impact forces, and consistently fast recovery across diverse disturbances, pointing towards safer, more resilient humanoids in real environments. Videos are available at https://firm2025.github.io/.

A vast number of applications for legged robots entail tasks in complex, dynamic environments. But these environments put legged robots at high risk for limb damage. This paper presents an empirical study of fault tolerant dynamic gaits designed for a quadrupedal robot suffering from a single, known "missing" limb. Preliminary data suggests that the featured gait controller successfully anchors a previously developed planar monopedal hopping template in the three-legged spatial machine. This compositional approach offers a useful and generalizable guide to the development of a wider range of tripedal recovery gaits for damaged quadrupedal machines.

Motion instruction is a crucial task that helps athletes refine their technique by analyzing movements and providing corrective guidance. Although recent advances in multimodal models have improved motion understanding, generating precise and sport-specific instruction remains challenging due to the highly domain-specific nature of sports and the need for informative guidance. We propose CoachMe, a reference-based model that analyzes the differences between a learner's motion and a reference under temporal and physical aspects. This approach enables both domain-knowledge learning and the acquisition of a coach-like thinking process that identifies movement errors effectively and provides feedback to explain how to improve. In this paper, we illustrate how CoachMe adapts well to specific sports such as skating and boxing by learning from general movements and then leveraging limited data. Experiments show that CoachMe provides high-quality instructions instead of directions merely in the tone of a coach but without critical information. CoachMe outperforms GPT-4o by 31.6% in G-Eval on figure skating and by 58.3% on boxing. Analysis further confirms that it elaborates on errors and their corresponding improvement methods in the generated instructions. You can find CoachMe here: https://motionxperts.github.io/

We explore whether surgical manipulation tasks can be learned on the da Vinci robot via imitation learning. However, the da Vinci system presents unique challenges which hinder straight-forward implementation of imitation learning. Notably, its forward kinematics is inconsistent due to imprecise joint measurements, and naively training a policy using such approximate kinematics data often leads to task failure. To overcome this limitation, we introduce a relative action formulation which enables successful policy training and deployment using its approximate kinematics data. A promising outcome of this approach is that the large repository of clinical data, which contains approximate kinematics, may be directly utilized for robot learning without further corrections. We demonstrate our findings through successful execution of three fundamental surgical tasks, including tissue manipulation, needle handling, and knot-tying.

Human shape estimation has become increasingly important both theoretically and practically, for instance, in 3D mesh estimation, distance garment production and computational forensics, to mention just a few examples. As a further specialization, Human Body Dimensions Estimation (HBDE) focuses on estimating human body measurements like shoulder width or chest circumference from images or 3D meshes usually using supervised learning approaches. The main obstacle in this context is the data scarcity problem, as collecting this ground truth requires expensive and difficult procedures. This obstacle can be overcome by obtaining realistic human measurements from 3D human meshes. However, a) there are no well established methods to calculate HBDs from 3D meshes and b) there are no benchmarks to fairly compare results on the HBDE task. Our contribution is twofold. On the one hand, we present a method to calculate right and left arm length, shoulder width, and inseam (crotch height) from 3D meshes with focus on potential medical, virtual try-on and distance tailoring applications. On the other hand, we use four additional body dimensions calculated using recently published methods to assemble a set of eight body dimensions which we use as a supervision signal to our Neural Anthropometer: a convolutional neural network capable of estimating these dimensions. To assess the estimation, we train the Neural Anthropometer with synthetic images of 3D meshes, from which we calculated the HBDs and observed that the network's overall mean estimate error is 20.89 mm (relative error of 2.84\%). The results we present are fully reproducible and establish a fair baseline for research on the task of HBDE, therefore enabling the community with a valuable method.

Human motion is created by, and constrained by, our muscles. We take a first step at building computer vision methods that represent the internal muscle activity that causes motion. We present a new dataset, Muscles in Action (MIA), to learn to incorporate muscle activity into human motion representations. The dataset consists of 12.5 hours of synchronized video and surface electromyography (sEMG) data of 10 subjects performing various exercises. Using this dataset, we learn a bidirectional representation that predicts muscle activation from video, and conversely, reconstructs motion from muscle activation. We evaluate our model on in-distribution subjects and exercises, as well as on out-of-distribution subjects and exercises. We demonstrate how advances in modeling both modalities jointly can serve as conditioning for muscularly consistent motion generation. Putting muscles into computer vision systems will enable richer models of virtual humans, with applications in sports, fitness, and AR/VR.

We introduce MURA, a large dataset of musculoskeletal radiographs containing 40,561 images from 14,863 studies, where each study is manually labeled by radiologists as either normal or abnormal. To evaluate models robustly and to get an estimate of radiologist performance, we collect additional labels from six board-certified Stanford radiologists on the test set, consisting of 207 musculoskeletal studies. On this test set, the majority vote of a group of three radiologists serves as gold standard. We train a 169-layer DenseNet baseline model to detect and localize abnormalities. Our model achieves an AUROC of 0.929, with an operating point of 0.815 sensitivity and 0.887 specificity. We compare our model and radiologists on the Cohen's kappa statistic, which expresses the agreement of our model and of each radiologist with the gold standard. Model performance is comparable to the best radiologist performance in detecting abnormalities on finger and wrist studies. However, model performance is lower than best radiologist performance in detecting abnormalities on elbow, forearm, hand, humerus, and shoulder studies. We believe that the task is a good challenge for future research. To encourage advances, we have made our dataset freely available at https://stanfordmlgroup.github.io/competitions/mura .

Reliable odometry for legged robots without cameras or LiDAR remains challenging due to IMU drift and noisy joint velocity sensing. This paper presents a purely proprioceptive state estimator that uses only IMU and motor measurements to jointly estimate body pose and velocity, with a unified formulation applicable to biped, quadruped, and wheel-legged robots. The key idea is to treat each contacting leg as a kinematic anchor: joint-torque--based foot wrench estimation selects reliable contacts, and the corresponding footfall positions provide intermittent world-frame constraints that suppress long-term drift. To prevent elevation drift during extended traversal, we introduce a lightweight height clustering and time-decay correction that snaps newly recorded footfall heights to previously observed support planes. To improve foot velocity observations under encoder quantization, we apply an inverse-kinematics cubature Kalman filter that directly filters foot-end velocities from joint angles and velocities. The implementation further mitigates yaw drift through multi-contact geometric consistency and degrades gracefully to a kinematics-derived heading reference when IMU yaw constraints are unavailable or unreliable. We evaluate the method on four quadruped platforms (three Astrall robots and a Unitree Go2 EDU) using closed-loop trajectories. On Astrall point-foot robot~A, a sim200\,m horizontal loop and a sim15\,m vertical loop return with 0.1638\,m and 0.219\,m error, respectively; on wheel-legged robot~B, the corresponding errors are 0.2264\,m and 0.199\,m. On wheel-legged robot~C, a sim700\,m horizontal loop yields 7.68\,m error and a sim20\,m vertical loop yields 0.540\,m error. Unitree Go2 EDU closes a sim120\,m horizontal loop with 2.2138\,m error and a sim8\,m vertical loop with less than 0.1\,m vertical error. github.com/ShineMinxing/Ros2Go2Estimator.git

In MRI, motion artefacts are among the most common types of artefacts. They can degrade images and render them unusable for accurate diagnosis. Traditional methods, such as prospective or retrospective motion correction, have been proposed to avoid or alleviate motion artefacts. Recently, several other methods based on deep learning approaches have been proposed to solve this problem. This work proposes to enhance the performance of existing deep learning models by the inclusion of additional information present as image priors. The proposed approach has shown promising results and will be further investigated for clinical validity.

Biomedical Foundation Models (FMs) are rapidly transforming AI-enabled healthcare research and entering clinical validation. However, their susceptibility to learning non-biological technical features -- including variations in surgical/endoscopic techniques, laboratory procedures, and scanner hardware -- poses risks for clinical deployment. We present the first systematic investigation of pathology FM robustness to non-biological features. Our work (i) introduces measures to quantify FM robustness, (ii) demonstrates the consequences of limited robustness, and (iii) proposes a framework for FM robustification to mitigate these issues. Specifically, we developed PathoROB, a robustness benchmark with three novel metrics, including the robustness index, and four datasets covering 28 biological classes from 34 medical centers. Our experiments reveal robustness deficits across all 20 evaluated FMs, and substantial robustness differences between them. We found that non-robust FM representations can cause major diagnostic downstream errors and clinical blunders that prevent safe clinical adoption. Using more robust FMs and post-hoc robustification considerably reduced (but did not yet eliminate) the risk of such errors. This work establishes that robustness evaluation is essential for validating pathology FMs before clinical adoption and demonstrates that future FM development must integrate robustness as a core design principle. PathoROB provides a blueprint for assessing robustness across biomedical domains, guiding FM improvement efforts towards more robust, representative, and clinically deployable AI systems that prioritize biological information over technical artifacts.

This paper investigates the use of deep learning approaches to estimate the femur caput-collum-diaphyseal (CCD) angle from X-ray images. The CCD angle is an important measurement in the diagnosis of hip problems, and correct prediction can help in the planning of surgical procedures. Manual measurement of this angle, on the other hand, can be time-intensive and vulnerable to inter-observer variability. In this paper, we present a deep-learning algorithm that can reliably estimate the femur CCD angle from X-ray images. To train and test the performance of our model, we employed an X-ray image dataset with associated femur CCD angle measurements. Furthermore, we built a prototype to display the resulting predictions and to allow the user to interact with the predictions. As this is happening in a sterile setting during surgery, we expanded our interface to the possibility of being used only by voice commands. Our results show that our deep learning model predicts the femur CCD angle on X-ray images with great accuracy, with a mean absolute error of 4.3 degrees on the left femur and 4.9 degrees on the right femur on the test dataset. Our results suggest that deep learning has the potential to give a more efficient and accurate technique for predicting the femur CCD angle, which might have substantial therapeutic implications for the diagnosis and management of hip problems.

Tagged magnetic resonance imaging (tMRI) has been employed for decades to measure the motion of tissue undergoing deformation. However, registration-based motion estimation from tMRI is difficult due to the periodic patterns in these images, particularly when the motion is large. With a larger motion the registration approach gets trapped in a local optima, leading to motion estimation errors. We introduce a novel "momenta, shooting, and correction" framework for Lagrangian motion estimation in the presence of repetitive patterns and large motion. This framework, grounded in Lie algebra and Lie group principles, accumulates momenta in the tangent vector space and employs exponential mapping in the diffeomorphic space for rapid approximation towards true optima, circumventing local optima. A subsequent correction step ensures convergence to true optima. The results on a 2D synthetic dataset and a real 3D tMRI dataset demonstrate our method's efficiency in estimating accurate, dense, and diffeomorphic 2D/3D motion fields amidst large motion and repetitive patterns.

There is a growing body of studies on applying deep learning to biometrics analysis. Certain circumstances, however, could impair the objective measures and accuracy of the proposed biometric data analysis methods. For instance, people with chronic pain (CP) unconsciously adapt specific body movements to protect themselves from injury or additional pain. Because there is no dedicated benchmark database to analyse this correlation, we considered one of the specific circumstances that potentially influence a person's biometrics during daily activities in this study and classified pain level and pain-related behaviour in the EmoPain database. To achieve this, we proposed a sparsely-connected recurrent neural networks (s-RNNs) ensemble with the gated recurrent unit (GRU) that incorporates multiple autoencoders using a shared training framework. This architecture is fed by multidimensional data collected from inertial measurement unit (IMU) and surface electromyography (sEMG) sensors. Furthermore, to compensate for variations in the temporal dimension that may not be perfectly represented in the latent space of s-RNNs, we fused hand-crafted features derived from information-theoretic approaches with represented features in the shared hidden state. We conducted several experiments which indicate that the proposed method outperforms the state-of-the-art approaches in classifying both pain level and pain-related behaviour.