Explainable artificial intelligence for gait analysis: advances, pitfalls, and challenges - a systematic review
Bibliographic record
Abstract
Machine learning (ML) has emerged as a powerful tool to analyze gait data, yet the "black-box" nature of many ML models hinders their clinical application. Explainable artificial intelligence (XAI) promises to enhance the interpretability and transparency of ML models, making them more suitable for clinical decision-making. This systematic review, registered on PROSPERO (CRD42024622752), assessed the application of XAI in gait analysis by examining its methods, performance, and potential for clinical utility. A comprehensive search across four electronic databases yielded 3676 unique records, of which 31 studies met inclusion criteria. These studies were categorized into model-agnostic (n = 16), model-specific (n = 12), and hybrid (n = 3) interpretability approaches. Most applied local interpretation methods such as SHAP and LIME, while others used Grad-CAM, attention mechanisms, and Layer-wise Relevance Propagation. Clinical populations studied included Parkinson's disease, stroke, sarcopenia, cerebral palsy, and musculoskeletal disorders. Reported outcomes highlighted biomechanically relevant features such as stride length and joint angles as key discriminators of pathological gait. Overall, the findings demonstrate that XAI can bridge the gap between predictive performance and interpretability, but significant challenges remain in standardization, validation, and balancing accuracy with transparency. Future research should refine XAI frameworks and assess their real-world clinical applicability across diverse gait disorders.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".