Enhancing Clinician Decision-Making via Uncertainty-Aware Multi-Expert Fusion for Stroke Rehabilitation

Abstract

Tailoring stroke rehabilitation requires assessing how movements are organized, not merely if they succeed. Currently, this assessment is a rate-limiting bottleneck. Instruments like the Action Research Arm Test (ARAT) compress rich behavioral observations into single ordinal endpoints, discarding the movement-quality details that distinguish recovery from compensation. Automated alternatives typically chase accuracy on noisy, single-observer labels to output opaque scores - a technology-centric approach that rarely reaches clinical practice. To address this, we present xAARA: an engine designed to augment rather than replace clinical judgment. From multi-view video, xAARA returns ARAT assessments with calibrated uncertainty and explanations across task, movement-phase, and movement-quality levels. Treating clinical scoring as an ill-posed inference problem, xAARA composes 692 calibrated multimodal models via a Dynamic Bayesian Network with entropy-based gating. It qualifies results against clinical validity rules and defers low-confidence cases. In 105 stroke survivors (788 exercises), xAARA achieved 94.2% task accuracy (Cohen's kappa=0.934) and 81.3% movement-phase accuracy (kappa=0.727), reducing predictive uncertainty by 96.1% compared to single-clinician scoring. For subjective cases, it matched at least one rater 100% of the time and never returned out-of-range scores. Four independent clinicians validated the assessments and indicated willingness to adopt the system. We argue that principled uncertainty quantification and clinician-aligned explainability are the critical bridges moving automated assessment from technical demonstration to a deployable clinical tool.