Identification of distinct subtypes of post-stroke and neurotypical gait behaviors using neural network analysis of kinematic time series data.

Abstract

Heterogeneous types of gait impairment are common post-stroke. Studies used supervised and unsupervised machine learning on discrete biomechanical features to summarize the gait cycle and identify common patterns of gait behaviors. However, discrete features cannot account for temporal variations that occur during gait. Here, we propose a novel machine-learning pipeline to identify subgroups of gait behaviors post-stroke using kinematic time series data. We analyzed ankle and knee kinematic data during treadmill walking data in 39 individuals post- stroke and 28 neurotypical controls. The data were first input into a supervised dual-stage Convolutional Neural Network-Temporal Convolutional Network, trained to extract temporal and spatial gait features. Then, we used these features to find clusters of different gait behaviors using unsupervised time series k-means. We repeated the clustering process using 10,000 bootstrap training data samples and a Gaussian Mixture Model to identify stable clusters representative of our dataset. Finally, we assessed the kinematic differences between the identified clusters using 1D statistical parametric mapping ANOVA. We then compared gait spatiotemporal and clinical characteristics between clusters using one-way ANOVA. We obtained five clusters: two clusters of neurotypical individuals (C1 and C2) and three clusters of individuals post-stroke (S1, S2, S3). C1 had kinematics that resembled the normative gait pattern. Individuals in C2 had a shorter stride time than C1. Individuals in S1 had mild impairment and walked with increased bilateral knee flexion during the loading response. Individuals in S2 had moderate impairment, were the slowest among the clusters, took shorter steps, had increased knee flexion during stance bilaterally and reduced paretic knee flexion during swing. Individuals in S3 had mild impairment, asymmetric swing time, had increased ankle abduction during the gait cycle and reduced dorsiflexion bilaterally during loading response and stance. Every individual was assigned to a cluster with a cluster membership likelihood above 93%. Our results indicate that joint kinematics in individuals post-stroke are distinct from controls, even in those individuals with mild impairment. The three subgroups post-stroke showed distinct kinematic impairments during specific phases in the gait cycle, providing additional information to clinicians for gait retraining interventions.