Medicine in Novel Technology and Devices 22 (2024) 100297

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Medicine in Novel Technology and Devices

journal homepage: www.journals.elsevier.com/medicine-in-novel-technology-and-devices/

An efficient tool for Parkinson's disease detection and severity grading based
on time-frequency and fuzzy features of cumulative gait signals through
improved LSTM networks
Farhad Abedinzadeh Torghabeh a, Yeganeh Modaresnia a, Seyyed Abed Hosseini b, *
a
Department of Biomedical Engineering, Mashhad Branch, Islamic Azad University, Mashhad, Iran
b
Department of Electrical Engineering, Mashhad Branch, Islamic Azad University, Mashhad, Iran

A R T I C L E I N F O A B S T R A C T

Keywords: Parkinson's disease (PD) is a widespread neurodegenerative condition that affects many individuals annually.
Parkinson's disease grading Early identification and monitoring of disease progression are crucial to effectively managing symptoms and
Cumulative gait signal preventing motor complications. This research proposes an automated PD diagnosis and severity-grading model
Vertical ground reaction force
based on time-frequency and fuzzy features using improved uni-directional and bi-directional long short-term
fuzzy feature
Bayesian optimization
memory networks with sensitive hyperparameters optimization. We utilize vertical ground reaction force sig-
Long short-term memory nals collected from Physionet's publicly available dataset recorded during regular and dual-task clinical trials of
walking measurements. Only the cumulative signal of both feet was then utilized and segmented into 30-s
windows without further pre-processing. Subsequently, we extracted only four key time-frequency and fuzzy
features from each segment, effectively capturing the signal's inherent uncertainty. Bayesian optimization is
employed in both detection and grading approaches to fine-tune the two critical hyperparameters: the initial
learning rate and the number of hidden units in the network. The detection phase yields an exceptional accuracy
of 99.19%, surpassing state-of-the-art studies with the same dataset. In the grading phase, classification based on
the unified PD rating scale values achieves an accuracy of 92.28%. The proposed study delves into the potential of
cumulative gait signals as a powerful diagnostic tool for PD, aiming to extract precise and intricate information by
implementing straightforward and minimal processing endeavors. This method demonstrates significant effi-
ciency in terms of complexity, cost, and energy consumption by utilizing a single-dimensional signal, eliminating
the need for pre-processing steps, and limiting the features used for training.

1. Introduction higher variations in gait, and instances of gait freezing [3].

Neurodegeneration refers to the progressive deterioration of neurons'
structure and function, which might lead to the demise of these cells. This
condition, also known as a neurodegenerative disease (NDD), encom-
passes a range of ailments, such as amyotrophic lateral sclerosis (ALS),
multiple sclerosis (MS), Parkinson's disease (PD), Alzheimer's disease
(AD), Huntington's disease (HD), multiple system atrophy (MSA), and
prion diseases [1]. PD is the second most frequent NDD, which causes a
wide range of life-changing symptoms, including tremors in the upper
extremities [2]. Motor function frequently declines in individuals with
moderate to severe PD, as indicated by a hunched upper body position,
short and shuffling steps, a displacement of the body's center of mass
towards the front, reduced walking pace, compromised equilibrium,
According to the Parkinson's Foundation “Parkinson's Prevalence
Project,” nearly one million Americans live with PD. It is anticipated that
by 2030, the total number of individuals affected will reach 1.2 million.
Annually, over 90,000 individuals receive a diagnosis of PD in the United
States [4] Furthermore, the prevalence of PD tends to increase with age
and is more prevalent in males [5]. The following motor symptoms often
characterize PD: trembling, bradykinesia (slowed movement), rest
tremor (rhythmic shaking), rigidity, reduced postural reflexes, impaired
balance, dysarthria (speech impairments) [6,7]. The prompt highlights
the criticality of early detection of PD in improving patient care.
Currently, medical practitioners evaluate symptoms that include
tremors, bradykinesia, akinesia, and gait issues. Several rating scales
were developed by medical societies to assess the severity of motor

* Corresponding author.
E-mail address: abed_hosseyni@yahoo.com (S.A. Hosseini).

https://doi.org/10.1016/j.medntd.2024.100297
Received 4 November 2023; Received in revised form 19 February 2024; Accepted 17 March 2024
2590-0935/© 2024 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-
nc-nd/4.0/).
F. Abedinzadeh Torghabeh et al.
symptom impairments. The unified PD rating scale (UPDRS) is a widely
utilized tool in the clinical evaluation of PD. This scale includes 42
questions/criteria that assess various aspects of PD, encompassing motor
symptoms such as gait, behavioral characteristics, and daily activities.
Moreover, it has the capability to differentiate postural instability, mild
and severe PD, and assess the quality of life (QoL) of patients who have
moderate to severe PD.
There is evidence that tremors and abnormal gait are prior symptoms
of PD in the literature [8]. These walking patterns can differ among in-
dividuals. Some of the common gait disturbances in PD include shuffling
gait, festinating gait, freezing of gait, wide-based gait, stooped posture,
and reduced arm swing [8]. These patterns can adversely affect balance,
mobility, and QoL, increasing the risk of falls and injuries. However,
physical therapy and other interventions can be beneficial in enhancing
gait and mobility in individuals with PD. Thus, analyzing gait movements
can be an efficient approach for an early diagnosis of PD. Apart from
detecting PD, analyzing gait movements can also provide insight into the
advancement of the disease and its severity, as they include periodic and
rhythmic foot movements. It has also been documented that gait ab-
normalities often occur during the early phases of PD [9].
Several characteristics of Parkinsonian gait include reduced step
length, a slower cycle, greater variability in stride length, shorter dura-
tion for the swing, longer stance phases, and a flat-footed stride rather
than a toe-to-heel strike [10]. PD is diagnosed by examining these fea-
tures as part of the diagnosis process. Performing gait analysis can be
challenging as it can be impacted by multiple factors, including but not
limited to age and physical fitness. Additionally, physicians do not have
an objective tool to assist them in the gait analysis. Wearable system
technology has made gait analysis an increasingly popular tool for
assessing and detecting PD [10].
The utilization of wearable gait sensors diminishes the necessity of
expensive laboratory setup and expert guidance. The ground reaction
force (GRF) sensor is the most widely adopted for evaluating PD [11]. By
utilizing wearable pad sensors, GRF sensors can accurately map joint
movements and muscle activities with exceptional precision [10]. Due to
their small size, non-invasive nature, and low cost, these gait sensors are
the most commonly used ones in gait analysis studies.
In recent years, advances in machine learning (ML) have made it
possible to automate gait analysis to reduce the time and workforce
problems associated with using conventional techniques for analyzing
gait. Moreover, it has the capability to tackle the challenge of evaluating
the severity of PD, which can be a demanding task for both healthcare
professionals and patients in terms of time and energy. The incorporation
of wearable sensors and ML can facilitate the speedy and efficient
monitoring of PD symptoms by both parties.
The objective of this study is to create a predictive system for PD
patients, utilizing data from wearable sensors that can be easily obtained.
To this end, we introduce an intelligent tool that can identify symptoms
of PD and estimate the corresponding severity level (based on UPDRS)
using gait data analysis. Our framework leverages wearable GRF sensors
to predict UPDRS scores and assess the severity of PD.
Our study proposed a multistage approach wherein the first stage
involved classification of PD patients using uni-directional long short-
term memory (Uni-LSTM) and bi-directional LSTM (Bi-LSTM) neural
networks, and the second stage involved assessing the severity of PD
based on the UPDRS rating scale and the same models. In the first
approach, a PD detection algorithm, we employed the aforementioned
neural networks for the evaluation of their efficacy for PD detection.
There would be a substantial benefit in using these networks in the early
diagnosis of PD if they could perform the required task exceptionally well
in classifying patients with PD and those with health conditions. This
technology allows physicians to make optimal clinical decisions by uti-
lizing artificial intelligence solutions that can be deployed rapidly. This is
because it can save time, resources, and technical effort in creating
models that may not be better or worse than those currently used. In the
detection phase, all PD patients with different UPDRS scores are
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Medicine in Novel Technology and Devices 22 (2024) 100297
combined into a single categorization.
Both detection and grading methodologies extracted the time-series
data complementary of time-frequency (TF) and fuzzy features (FFs).
By analyzing a time series from both a time and frequency perspective, TF
analysis is able to efficiently capture short-term changes by applying a
function with a two-dimensional (2D) domain in the real plane. TF
transform is used to analyze time series data rather than interpreting a
single-dimensional signal. The FF transformation is also a more
comprehensive technique compared to analyzing only a single aspect of
the data. It involves transforming the time series data into a multidi-
mensional space, where each dimension represents a distinct aspect of
the data. This allows for a more detailed analysis of the data.
Our multistage approach makes four major contributions.

First, this study introduces a TF/FF model for the effective and du-
rable classification tool of wearable GRF signals. The utilization of
simple TF features and FFs in the employed networks produce higher
accuracy and a sooner training period compared to the conventional
networks.

Secondly, Bayesian optimization was utilized for optimizing two
hyperparameters, which resulted in an effective outcome.

Thirdly, this approach uses UPDRS values to estimate the prognosis of
PD using a recurrent neural network (RNN) architecture.

Lastly, but certainly not least, this model outperformed other models
used in previous studies to detect PD patients. While it had a slightly
lower accuracy in differentiating between types of Parkinson's, it was
noted for its reduced weight and high precision, making it more
versatile than current state-of-the-art models. The study outlines a
highly effective algorithm that predicts the severity of UPDRS, which
is beneficial for clinical decision-making systems.
This study is structured as follows: Section 2 examines previous
research on automated methods for diagnosing PD. Materials and
methods are presented in Section 3. The experimental results and dis-
cussions are presented in Section 4. The study is concluded in Section 5.
Finally, Section 6 is dedicated to discussing limitations.
2. Literature review
PD is the second most common NDD that impairs the physical abilities
of individuals over time. This disease is characterized by the presence of
tremors, stiffness, and bradykinesia, which can lead to difficulty in
movement and loss of balance. Several modalities have been used for the
automated detection of PD, including imaging, non-imaging, and sensor-
based modalities. Imaging modalities such as magnetic resonance im-
aging (MRI), positron emission tomography (PET), and single-photon
emission computed tomography (SPECT) have been utilized for auto-
matic PD detection.
These modalities allow for the visualization of the brain and can
identify modifications in both the structure and functioning of the brain.
Several studies have shown that MRI has the capability to identify al-
terations in the brain composition of individuals with PD. As an example,
Biundo et al. [12] found that PD patients had significant changes in brain
volume compared to healthy controls (HC). PET and SPECT have also
been used to visualize changes in dopamine activity in the brain, which is
a hallmark of PD. However, these modalities are expensive and may not
be feasible for routine clinical use.
Non-imaging modalities such as electroencephalography (EEG),
electromyography (EMG), and electrooculography (EOG) have also been
used for the automated detection of PD. These modalities measure the
electrical activity in the brain, muscles, and eyes, respectively. Several
studies have shown that EEG can detect changes in brain activity in PD
patients. Accordingly, Anjum et al. [13] found that EEG could differen-
tiate PD patients from HC with 85.3% accuracy. EMG and EOG have also
been used to detect changes in muscle activity and eye movements,
respectively, in patients with PD. However, these modalities may not be
F. Abedinzadeh Torghabeh et al.
as specific as imaging modalities and may require additional validation.
Sensor-based modalities such as accelerometers, gyroscopes, and
force sensors have been used for the automated detection of PD. These
modalities are capable of capturing and analyzing movement data,
facilitating the identification of potential variations in motor function
among individuals diagnosed with PD. According to multiple research
studies, it has been demonstrated that sensor-based modalities are
capable of precisely detecting modifications in motor function among
individuals suffering from PD. For example, Williamson et al. [14] found
that a wrist-worn accelerometer could detect tremors in PD patients and
detect PD with an area under the ROC curve (AUC) of 0.69 on gait data.
However, these modalities may not be as sensitive as imaging or
non-imaging modalities and may require additional validation. Although
every modality exhibits distinct advantages and drawbacks, gait distur-
bances represent a prevalent manifestation of PD and can offer significant
insights into the prompt identification and assessment of the condition.
In recent years, researchers have focused on using gait signals for PD
detection and grading. Several studies have investigated the correlation
between gait signals and PD by ML algorithms.
Zeng et al. [15] used deterministic learning theory to diagnose PD
patterns in HC subjects using gait signals. Their methodology comprises a
training phase, during which gait dynamics are extracted and saved in
constant radial basis function neural networks. Additionally, a classifi-
cation phase is executed, where a set of dynamical estimators is gener-
ated to contrast the gait patterns of test PD patients and HC subjects with
the training set. The results show an accuracy of 96.39%, indicating the
effectiveness of the features and classifiers used in separating gait pat-
terns between the groups.
In a study, Joshi et al. [16] proposed a model for identifying Par-
kinson's gait using a combination of wavelet analysis and support vector
machine (SVM). The findings demonstrated that their approach attains a
classification accuracy of 90.32% by using a single gait parameter and
achieves 100% accuracy when all parameters from the left leg are
employed. For specific gait variables, the Haar wavelet outperformed the
Daubechies2 wavelet. Consequently, the study implies that wavelet
analysis presents a promising method for the automated and
non-invasive classification of NDDs. Abdulhay et al. [17] employed the
publicly available Physionet dataset in their investigation to classify PD
and HC. They used peak detection, pulse duration algorithms, medium
Gaussian SVM, and medium tree. They extracted several gait tremor
features, such as stride time, stance time, swing time, and foot strike
profile, which were significantly different between the two groups to
achieve an average accuracy of 92.7%.
Khoury et al. [18] described an ML technique for the diagnosis of PD
that employs vertical GRFs (VGRFs). Their approach consists of four
distinct steps: data pre-processing, feature extraction and selection, data
classification, and performance evaluation. Initially, the study excluded
the first and last 20 s of data to eliminate starting and stopping artifacts.
Next, they extracted 19 distinct features from the remaining data. Feature
selection was performed using a wrapper approach based on the random
forest (RF) algorithm. Their methodology involved supervised classifi-
cation techniques such as K-nearest neighbor (KNN), decision tree (DT),
RF, naïve bayesian (NB), SVM, and unsupervised methods such as
K-means and the gaussian mixture model (GMM). The SVM model ach-
ieved a classification accuracy rate of 90.32% in distinguishing between
PD individuals and HC subjects. The effectiveness of the methodology
was evaluated using a distinct dataset to classify PD against two other
NDDs. The KNN algorithm achieved an accuracy of 83.33% in differen-
tiating PD from HD and an accuracy of 92.86% in classifying PD from
ALS.
El Maachi et al. [19] applied the analysis of gait signals using a
one-dimensional (1D) convolutional neural network (CNN) to build a
classifier. Their algorithm achieved an accuracy of 98.7% in PD detection
and 85.3% in predicting the severity of the disease. Wang et al. [20]
proposed a gait classification system that combines signal processing and
ML techniques to detect gait anomalies and assess the severity of PD
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Medicine in Novel Technology and Devices 22 (2024) 100297
patients. Their method utilized a VGRF time series, wavelet analysis to
extract discriminant gait features, and an SVM for classification. Their
study reported a classification accuracy of 98.20% for early PD detection
and 96.69% for severity detection. Their approach offers a promising
non-invasive tool for automatic NDD classification.
Vidya and Sasikumar [21] proposed a model based on gait analysis,
using a hybrid CNN-LSTM network to predict PD severity. Initially, the
researchers utilized variability analysis to obtain noteworthy VGRF sig-
nals. Subsequently, they decomposed these signals utilizing the empirical
mode decomposition (EMD) technique to extract the significant intrinsic
mode functions (IMFs) that contain crucial gait features. In the second
step, the dominant IMFs of the selected VGRF signals were identified
through power spectral analysis, and the CNN-LSTM classifier model was
trained using these features. Their approach attained an accuracy of
98.32% in multi-class classification. Klinton Amaladass et al. [22] pro-
posed a novel technique for the early detection of PD using a signal
processing and feature extraction approach namely, shifted extended
local binary pattern (S-ELBP) and an artificial neural network (ANN)
classifier. Their method achieved promising results with an accuracy of
97.6%. Ma et al. [23] proposed a model that utilizes feature extraction,
dimension reduction, data balancing mechanisms, CNN, and three ML
models, namely SVM, KNN, and extreme gradient boosting (XGBoost).
Using XGBoost, the performance analysis had an accuracy of 97.32%,
while using CNN; the accuracy was 98.4%.
In general, analysis of gait signals, which can detect changes in motor
function, has the potential to serve as a valuable diagnostic tool for PD.
The use of VGRF signals in the PD detection and severity grading pro-
vides several benefits. First, gait disturbances are a common symptom of
PD, and the VGRF signals can provide valuable information about gait
patterns. Secondly, the VGRF signal can be utilized to analyze the vari-
ability of gait patterns, which can be a sensitive indicator of disease
progression. Thirdly, the VGRF signal can be decomposed into IMFs,
which contain vital gait features that can be used to train ML models for
accurate disease diagnosis and severity grading. Finally, the use of VGRF
signal analysis is non-invasive and cost-effective, making it an attractive
approach for the early detection and monitoring of PD. However, further
research is necessary to standardize gait analysis techniques and deter-
mine their clinical applicability in PD diagnosis and management.
3. Materials and methods
The GRF sensor, also known as a force plate or pressure plate, is used
to measure the forces exerted on the ground during human movements.
These sensors can provide valuable information about gait patterns,
balance, and stability, and can measure various parameters such as peak
forces, force duration, and patterns, which can be used to quantify gait
abnormalities. Different walking patterns can result in different values of
this force, making it an ideal tool for researching personal gait analysis.
Fig. 1 illustrates our proposed multistage DL approach, including detec-
tion and grading.
3.1. Materials
Physionet Gait in PD [24], a public access dataset comprised of gait
data, was used in this study. Data included 93 Parkinsonian patients with
a mean age of 66.3 and 63% of whom were males, as well as 73 HC
subjects with an average age of 63.7 and almost 55% of whom were
males. Gait signal measurements were performed with dual-tasking and
the usual walking procedure [25]. During normal walking, VGRF were
measured as the subjects walked on a level ground for 20 m and returned
to their initial location at their natural and usual pace for about 2 min
[25].
Eight sensors under each foot measured the force as a function of time
(in Newtons). The sampling frequency of 100 Hz has been used to digitize
and document each of these 16 sensors, as well as two other 1D VGRF
signals representing the sum of the eight sensor outputs for each foot.
F. Abedinzadeh Torghabeh et al.
Fig. 1. Proposed framework for detecting and evaluating PD through automation.
Dual-tasking was conducted by asking subjects to serially subtract seven
from a three-digit number (e.g., 200, 193, 186) while walking along the
same pathway and under the same conditions as the usual walking.
Consequently, 306 signals were recorded that were unbalanced (70% PD
with various UPDRS scales and 30% HC).
In addition, this database contains demographic information and
measures of disease severity (e.g., Hoehn & Yahr (HY) staging and/or
UPDRS). In PD severity prediction, we used UPDRS, where we converted
the continuous scale into five levels:
Class 1 : UPDRS < 4
Class 2 : 5  UPDRS < 15
Class 3 : 15  UPDRS < 25
Class 4 : 25  UPDRS < 35
Class 5 : 35  UPDRS
3.2. Methods
In this study, the total force signals from the right and left feet (TFRF
and TFLF) were first extracted for each subject. An analysis of the gait
must consider the coordination of the legs. Merely considering a one-foot
movement signal would not be sufficient; thus, we totaled up the force
applied by each foot (TFLF þ TFRF). These cumulative VGRFs are
mentioned as CVGRFs in this study. Fig. 2 illustrates the TFLF, TFRF, and
CVGRF of HC and five-class PD patients.
The CVGRF data were segmented into equal segments of 30-s win-
dows (equivalent to 3000 samples). This segmentation function ignores
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Medicine in Novel Technology and Devices 22 (2024) 100297
signals with a duration of fewer than 30 s. This segmentation function
ignores signals with a duration of fewer than 30 s. It also segments a
signal with more than 30 s of samples into segments with 30-s windows
and ignores the remaining part of the signal. As an example, a signal that
lasts 95 s is divided into three signals of 30 s each, and the remaining 5 s
are ignored. This segmentation may not only shorten the time of feature
extraction and training of the network, but it may also contribute to
making our method more suitable for real-time applications. It is also
possible that some gait patterns occur when walking for a shorter period
of time. Furthermore, it is more convenient for the patient to record a
shorter signal during a real-time clinical diagnosis.
3.2.1. Feature extraction
The performance of LSTM models can be improved by extracting
features from the data rather than relying solely on conventional LSTMs
[26]. To accomplish this, TF features and FFs were extracted.
3.2.1.1. Time-frequency features. The TF analysis is a non-linear dy-
namics technique that enables the visualization of state recurrences and
extraction of unique features by transforming a 1D signal into a 2D space.
To determine which features to extract, we are inspired by the idea that a
CNN can be trained using TF images, such as spectrograms. The approach
must be translated to 1D signals since we intend to use LSTMs rather than
CNNs. TF moments, including instantaneous frequency (IF) and spectral
entropy (SE), are utilized as a technique to obtain relevant information
from spectrograms.

Instantaneous Frequency
IF is a dynamic parameter that varies with time in a non-stationary
signal, which represents the rate of change of the signal's phase with
F. Abedinzadeh Torghabeh et al. Medicine in Novel Technology and Devices 22 (2024) 100297

Fig. 2. The TFLF, TFRF, and CVGRF of individuals a) without any health conditions and b-f) those diagnosed with PD classified according to the five UPDRS classes.

respect to time [27,28]. It is computed as the average frequency of the SðmÞ

PðmÞ ¼ P : (2)
signal over a small-time window as it evolves over time t. For the i SðiÞ
calculation of IF, MATLAB's instfreq function was utilized, where the
The SE denoted as H is given as:
function interpolates the signal to a uniform grid if the given signal is not
uniformly sampled. In this instance, the computation of the IF involves X
N
determining the initial conditional spectral moment of the TF distribu- H¼  PðmÞlog2 PðmÞ: (3)
tion of the given input signal, as expressed by Equation (1): m¼1

R∞ Then it will be normalized by dividing to log 2 N, representing the

f Pðt; f Þdf
finst ðtÞ ¼ R0 ∞ : (1) maximum possible SE of a frequency-domain white noise signal with a
0
Pðt; f Þdf uniform distribution. The probability distribution of a TF power spec-
Initially, the algorithm computes the power spectrum Pðt; f Þ of the trogram Sðt; f Þ can be represented mathematically as:
input signal using the short-time Fourier transform, generating a spec- P
f Sðt; mÞ
trogram that represents the signal's TF distribution. Then, it employs PðmÞ ¼ P P : (4)
Equation (1) to estimate the IF. f t Sðt; mÞ

SE is still the same as Equation (3). To compute the instantaneous SE

Spectral Entropy given a TF power spectrogram Sðt;f Þ, the probability distribution at time t
is:
In the frequency domain, SE is computed by taking the Shannon en-
tropy of the normalized power distribution of the signal. In this context, Sðt; mÞ
Pðt;mÞ ¼ P : (5)
Shannon entropy refers to the signal's SE. SE equations are derived from f Sðt; f Þ
equations for power spectra and probability distributions. Assume the 1D
signal of xðnÞ, the power spectrum is SðmÞ ¼ jXðmÞj2 , where XðmÞ is the Then the SE at time t will be:
discrete Fourier transform of xðnÞ. The probability distribution PðmÞ is
X
N
then: HðtÞ ¼  Pðt; mÞlog2 Pðt; mÞ: (6)
m¼1

5
F. Abedinzadeh Torghabeh et al.
SE was calculated by using MATLAB's pentropy function.
3.2.1.2. Fuzzy features. The fuzzy analysis technique, which is
commonly used in non-linear dynamics, involves transforming a signal of
1D into a 2D space. This method will extract unique features that describe
the behavior of various complex dynamic mechanisms underlying non-
linear time series. Extracting these novel features enhances the abilities
of LSTM networks for robust signal classification as well as signal
compression efficiency for DL models [26]. This study subjected CVGRFs
to fuzzy recurrence image entropy (FRIE) and fuzzy recurrence entropy
(FRE) extraction.

Fuzzy Recurrence Plot
In the study of dynamical systems, a common approach is to convert a
sequence of values into objects in space for analysis purposes. This
transformation enables the sequence to be examined in space, and the
resulting space is known as phase space. The set of objects within phase
space is referred to as the phase-space object. One way to convert a
sequence of values into a phase-space object is through time-delay
embedding [26]. It should be noted that the embedding dimension per-
tains to the spatial extent, such as a line, area, or volume, which encloses
the object in phase space. A time delay, also known as lag, is an
expression of how much an event is offset by another event. In mathe-
matical terms, phase-space reconstruction can be performed for a time
series ðz 1 ; z ; …; z I Þ using time-delay embedding as follows:
 
yi ¼ z i ; z iþφ ; …; z iþðd1Þφ ; i ¼ 1; …; Iðd  1Þφ (7)
where φ and d are the time delay and embedding dimension, respec-
tively. Fuzzy sets, used in fuzzy logic, allow for partial membership of
elements. Traditional sets have elements that either belong or do not
belong to the set, while fuzzy sets allow for a degree of membership
ranging from 0 to 1, where zero indicates no membership, and one in-
dicates full membership. Fuzzy sets were introduced by Zadeh [29] as a
way to represent uncertainty and vagueness in human reasoning. A
detailed description of fuzzy sets can be found in Ref. [29].
In brief, mathematically, let U be the universe of discourses and F its
subset. Defining the fuzzy set F in terms of its membership function μF ðxÞ
maps each element x 2 U to the interval ½0;1: μF ðxÞ : U → ½0;1. The real
value of μF ðxÞ is called the fuzzy membership grade of x in F. Accord-
ingly, the greater the value of the fuzzy membership grade, the greater
the probability that x is a member of F.
Fuzzy recurrence plot (FRP) is a visualization tool used in the analysis
of time series data. It is a variation of the recurrence plot (RP) technique,
which is commonly used to study the recurrence properties of a system
[30,31]. FRP presents recurrences of states of a dynamical system as a
grayscale image, where each pixel represents the degree of similarity or
membership between two states in the phase space. The membership is
calculated using fuzzy sets in the fuzzy logic context, allowing for a more
detailed representation of the system's recurrence properties [26]. In
contrast to the binary RP, which only considers the presence or absence
of recurrences, FRP provides a more refined view of the system's
behavior, making it a preferred texture analysis approach [32]. FRP can
be used for pattern recognition tasks, including the classification of PD
patients and control subjects using DL [33,34].
Briefly, FRP is a representation of a time series signal transformed
into a 2D (phase) space using fuzzy sets. It is denoted by R ~ and is defined
as a square matrix of size N  N, where N is the length of the time series
signal. Each element R ~ ði; jÞ of the matrix represents the fuzzy recurrence
rate between the i-th and j-th phase-space vectors of the time series
signal, which is determined based on their fuzzy membership grades and
ranges between 0 and 1.
 
~ ði; jÞ ¼ μ xi ; xj ; i ¼ 1; …; N
R (8)
6
Medicine in Novel Technology and Devices 22 (2024) 100297

Fuzzy Recurrence Image Entropy
FRIE is a measure of the complexity or irregularity of an FRP image. It
is based on Shannon entropy, which measures the uncertainty or
randomness of a system. FRIE is calculated by first computing the
normalized histogram of gray levels in the FRP image and then calcu-
lating the Shannon entropy of the histogram. A higher FRIE value in-
dicates a more complex and irregular FRP image, while a lower FRIE
value indicates a more regular and predictable image. Mathematically,
FRIE is defined as follows:
X
K
EFRI ¼  Pk log2 Pk : (9)
k¼1
The probability associated with each intensity level of the k-th bin of a
normalized histogram can be computed, where K represents the number
of gray levels in FRP, and Pk represents the probability of each intensity
level. The real values of pixels, ranging from 0 to 1, are converted to
integers in the range of 0 to 255 to obtain the gray levels of FRP.

Fuzzy Recurrence Entropy
FRE is a quantitative measure that describes the irregularity or
complexity of an FRP image. It is calculated as the Shannon entropy of
the normalized histogram of the FRP image, where each bin represents
the probability of occurrence of a certain intensity level. The non-
probabilistic entropy of a fuzzy set provides a definition for the en-
tropy of an N  N FRP, also known as the entropy of fuzzy recurrences.
This entropy measures the level of uncertainty associated with re-
currences in the reconstructed phase space of a signal. Specifically, it is
defined as follows:
N X
X N
         
EFR ¼ μ xi ; xj log2 μ xi ; xj  1  μ xi ; xj log2 1  μ xi ; xj ;
i¼1 j¼1
(10)
~ jÞ defined in Equation (8). The FRE
where μðxi ; xj Þ corresponds to Rði;
value ranges from 0 to 1, where a higher value indicates higher irregu-
larity or complexity in the FRP image.
3.2.2. Normalization
All extracted features are then normalized, whereby the average of
each sample is subtracted from it and subsequently divided by the
standard deviation.
3.2.3. Bayesian optimization
The Bayesian optimization method is a sequential optimization
strategy that does not assume a functional form for black-box functions.
The method is typically used to optimize functions with a high evaluation
cost. It is commonly used in ML and engineering applications where the
goal is to find the best set of parameters or hyperparameters for a model.
The technique involves building a probabilistic model of the function
that is being optimized, using a prior distribution to capture any existing
knowledge or assumptions about the function. The model is then updated
as new evaluations of the function are made, incorporating the observed
data to improve its accuracy and reduce uncertainty. At each iteration of
the optimization process, the algorithm selects the next point to evaluate
based on a trade-off between exploration and exploitation. The algorithm
balances the need to explore regions of the input space that are uncertain
or promising with the desire to exploit regions that are likely to yield the
best results. Using Bayesian optimization, a scalar objective function f ðxÞ
is minimized for x concerning a bounded domain. Depending on the
function, it may return deterministic or stochastic results, meaning that
the same function evaluated at the same point x may provide different
results.
F. Abedinzadeh Torghabeh et al. Medicine in Novel Technology and Devices 22 (2024) 100297

When training a deep neural network, it is crucial to regulate steps on the current state, while the bias contributes to the decision-
numerous hyperparameters that are both important and sensitive, such as making process of the model. The concatenation of the input weights,
the learning rate, weight decay, and optimization algorithm, as well as recurrent weights, and bias for each component is represented by the
some less sensitive hyperparameters, such as the momentum setting. matrices W, R, and B, respectively and determined by Equation (11):
These hyperparameters control various aspects of the training process 2 3 2 3 2 3
and can significantly impact the performance and convergence of the Wi Ri Bi
6 Wf 7 6 Rf 7 6 Bf 7
network. Therefore, it is necessary to optimize these hyperparameters to 6
W ¼4 7 6 6
; R ¼ 4 5; B ¼ 4 7
7 : (11)
Wg 5 Rg Bg 5
achieve the best possible results. Among all the hyperparameters, just
Wo Ro Bo
two of them were optimized. Due to the importance of a number of
hidden units in LSTM and the initial learning rate, they were subjected to The LSTM layer's four gates are represented by the input gate ðiÞ,
optimization using Bayesian optimization. MATLAB's bayesopt function forget gate ðf Þ, cell candidate ðgÞ, and output gate ðoÞ, respectively. These
was employed to fine-tune these parameters. Additionally, scientific ev- gates play a crucial role in determining the amount of information to
idence presented in the literature was used to select other keep, forget, or update in the cell state. The cell state at time step t is the
hyperparameters. outcome of these gates' collective influence on the previous cell state,
current input, and output from the hidden state. The cell state at time step

Initial Learning Rate t is as follows:

The learning rate is the parameter that controls the size of weight and
bias changes in the learning of the training algorithm. The initial learning
rate is a hyperparameter that determines the size of the update to the
model's weights during the initial phase of training. It is the rate at which
the model learns the optimal weights for minimizing the loss function. A
high initial learning rate can cause the model to overshoot the optimal
weights, leading to poor performance or even divergence, while a low
initial learning rate can result in slow convergence and suboptimal re-
sults. Therefore, choosing an appropriate initial learning rate is critical
for achieving good performance in DL models.

Hidden Units of the LSTM Layer
ct ¼ ft  ct1 þ it  gt ; (12)
where  represents the Hadamard product (element-wise multiplication
of vectors). Equation (13) represents the hidden state at time step t.
ht ¼ ot  σ cðct Þ: (13)
The state activation function is represented by σ c. At each time step t,
the components that determine the state of the LSTM layer are listed in
Table 1.
The calculation involving the gate activation function σ g is computed
using the hyperbolic tangent activation function, which is expressed as
follows:

The number of hidden units is defined as a positive integer, which is
the dimensionality of the output space of the LSTM layer. It corresponds
to the amount of information the layer remembers between time steps
(the hidden state). The hidden state can contain information from all
previous time steps, regardless of the length of the sequence. However,
excessive hidden units may result in overfitting, where the layer learns to
fit the training data too well, leading to poor generalization on unseen
data. The number of hidden units does not constrain the number of time
steps that the layer can process during an iteration.
3.2.4. Uni- and Bi-directional LSTM

Uni-directional LSTM
LSTM networks belong to the family of RNNs that specialize in
learning long-term dependencies between time steps in sequence data.
An LSTM layer processes a time series xt , where the output ht represents
the hidden state, and ct represents the cell state at each time step t. The
first block of the LSTM computes the initial output and updated cell state
using the initial network state and the first-time step. Subsequently, at
each time step t, the block leverages the current network state ðct1 ; ht1 Þ
and the next time step of the sequence to compute the output and the
updated cell state ct .
In an LSTM layer, two states exist, namely, the hidden state (also
known as the output state) and the cell state. At each time step t, the
hidden state contains the output of the LSTM layer, while the cell state
retains information from previous time steps. Gates are employed to
regulate the flow of information in and out of the cell state at each time
step. These gates control the degree of addition or deletion of information
in the cell state, thus maintaining its relevance to the current state of the
sequence. The components provided in the table below play a significant
role in determining the state of the cells and the hidden state of the layer.
σ ðxÞ ¼ ð1 þ ex Þ1 : (14)
The input at each time point is formed by combining the four
extracted features for a segment that corresponds to the same time point
via concatenation.

Bi-directional LSTM
An LSTM layer that learns long-term bi-directional relationships be-
tween two-time steps is called a Bi-LSTM layer network. The network can
benefit from these dependencies when learning from the entire time
series at each time interval. In other words, a Bi-LSTM is an expansion of
the conventional Uni-LSTM that can increase sequence classification
performance. In light of being trained with a single LSTM on the input
time series, a Bi-LSTM architecture is simultaneously learned with hid-
den forward and backward layers in both time directions. LSTM layers
used a hyperbolic tangent activation function, followed by a time-
distributed fully connected layer (i.e., output at each time step passes
through the fully connected layer) with two units for PD detection and
five units for severity prediction approach, followed by SoftMax
activation.
4. Experimental results and discussion
The dataset used in this study, consisted of 166 individuals, including
73 HC and 93 PD patients labelled according to their stage of disease
progression using the UPDRS scale.
Table 1
Description of the formulas for LSTM architecture components at time step
t.
Component Formula

The parameters that undergo learning in an LSTM layer consist of the Input gate it ¼ σ g ðWi xt þ Ri ht  1 þ Bi Þ
input weights ðWÞ, the recurrent weights ðRÞ, and the bias ðBÞ. The Forget gate ft ¼ σ g ðWf xt þ Rf ht  1 þ Bf Þ
learnable input weights pertain to the transformation of input data to the Cell candidate gt ¼ σ c ðWg xt þ Rg ht  1 þ Bg Þ
Output gate ot ¼ σ g ðWo xt þ Ro ht  1 þ Bo Þ
hidden state. The recurrent weights handle the influence of previous time

7
F. Abedinzadeh Torghabeh et al.
The segmentation technique was employed on the premise that the
feature dimensions of each subject are uniform, thereby ensuring that the
neural network does not experience any adverse effects. Creating signals
with equal duration (30-s windows) has several benefits for training
networks that process sequential data. When dividing the data into mini-
batches for training, having signals of equal duration allows for easier
processing and less computation time. This is because the signals can be
packed into a single tensor, and padding or truncation can be applied to
make all the signals have the same length. However, it is important to
note that padding or truncating can potentially degrade the performance
of the network. Padding can add irrelevant information, while truncation
can remove important information.
Then, without the need for any pre-processing attempts, we extracted
four TF features and FFs from the CVGRF signal. These features produce a
series of numerical values, which are utilized as the input of the network.
Our findings demonstrate that the four features used in this study are
highly informative and provide valuable insights into the underlying
analysis. Fig. 3 illustrates a sample FRP image from the HC and five
UPDRS groups. These FRP images generate FFs (FRIE and FRE features).
As per Fig. 3, there seems to be a clear-cut trend in the FRP illustrations
that relate to each group, specifically in CVGRF, and these are highly
regarded as significant features for further examination and utilization.
Furthermore, they are capable of characterizing complex, non-linear
systems by quantifying pattern recurrences within them. Using these
features as inputs to train an LSTM network has several advantages. First,
they can capture the non-linear dynamics of the system, which is
particularly important for time series data. Secondly, they can reduce the
dimensionality of the input data, making it easier to train the LSTM
network and decreasing the risk of overfitting. Thirdly, FFs are capable of
handling fuzzy or uncertain data, which is especially useful when
working with real-world data that is often noisy and imprecise. Incor-
porating fuzzy set theory into the feature extraction process can capture
the inherent uncertainty and variability of the data, leading to more
robust and accurate results.
In both phases, the Bayesian optimization algorithm was employed to
optimize two difficult-to-choose and challenging hyperparameters. The
Bayesian optimization algorithm iteratively updates the parameters of
each curve until they converge to the local minimum for each stage and
classifier, resulting in improved accuracy rates for the gait detection
system. By analyzing the objective function curve, we can determine the
most effective combination of the initial learning rate and hidden units of
the LSTM layer for achieving high accuracy rates in the system.
Fig. 4 depicts the process of optimizing the learning rate and the
number of hidden unit layers. This curve represents the changes in loss
over 30 iterations based on the model mean and the model minimum
feasible. Fine-tuned training options based on the Bayesian optimization
algorithm has summarized in Table 2 for each stage and classifier. In the
training environment, the MaxEpochs is 80, and the MiniBatchSize is
150.
After observing the trend of the curve and identifying the optimal
values for both parameters, we compare the final cost values of each
curve to determine which one converges faster. Fig. 5 compares the
observed minimum function and estimated minimum function for the
detection and grading phases of PD and networks used in this study with
the purpose of minimizing the loss function. The proximity of the mini-
mum observed function to the minimum estimated objective can offer
information on the accuracy and reliability of the estimation method
utilized.
We then trained the Uni-LSTM and Bi-LSTM networks using the
training set and tested the accuracy of the models using 10-fold cross-
validation to achieve a generalizable result. The results showed that
the LSTM network achieved an accuracy of 99.19% in classifying PD
patients and HC subjects, while the Bi-LSTM network achieved an ac-
curacy of 97.28%. The sensitivity and specificity of the LSTM network
were 99.12% and 99.72%, respectively, whereas the sensitivity and
specificity of the Bi-LSTM network were 97.76% and 97.72%,
8
Medicine in Novel Technology and Devices 22 (2024) 100297
respectively. The LSTM network outperformed the Bi-LSTM network for
the detection phase in all evaluation metrics summarized in Table 3. The
results suggest that the LSTM network is a more suitable model for the
detection of PD in a two-class classification task. The results are reported
as average values and standard deviations based on 10-fold cross-
validation.
In the severity prediction phase, we created a balanced dataset with
an equal representation of each stage of disease progression using the
synthetic minority oversampling technique (SMOTE). The results showed
that the Bi-LSTM network achieved an accuracy of 92.28%, while the
LSTM network achieved an accuracy of 90.29% in classifying patients
into the five stages. The sensitivity and specificity of the Bi-LSTM
network were 92.35% and 97.68%, respectively, whereas the sensi-
tivity and specificity of the LSTM network were 90.36% and 96.92%,
respectively. The Bi-LSTM network outperformed the LSTM network in
the grading phase, as shown in Table 4. The results suggest that the Bi-
LSTM network is a more suitable model for the classification of PD pa-
tients into the five stages of disease progression.
By using only one signal rather than multiple sources and extracting
only four valuable features, we could develop automated diagnostic
systems for the early detection of PD, which can improve the QoL of PD
patients and monitor disease progression. Additionally, our proposed
method uses a 2-layer Uni-LSTM/Bi-LSTM model that requires only 51
kilobytes (KB) of computer memory and can be easily implemented on a
microcontroller for real-time applications [35]. Additionally, the elimi-
nation of pre-processing steps can reduce the computational complexity
of the model and improve its speed and scalability, making it more
practical for real-world applications. Table 5 provides a review of pre-
vious research on automated methods for diagnosing HC subjects from
PD using the same dataset.
Abdulhay et al. [17] used a Chebyshev2 high-pass filter to remove
low-frequency components associated with changes in body orientation
during the measurement process that may affect the outcome of
time-domain gait analysis. To obtain maximum pass band flatness, they
applied a fast Fourier transform to analyze the signal in the frequency
domain and a second-order Butterworth filter as a pre-processing filter.
Using peak detection and pulse duration, they extracted stride time,
stance time, swing time, and foot strike profile as features. These features
were then classified into normal and PD. Their efforts, while
commendable, do not result in greater accuracy than those of us using no
pre-processing and Uni-LSTM.
Nineteen features were extracted by Khoury et al. [18] with consid-
erable effort. Then, they selected the most relevant subset of features by
using a wrapper feature selection technique. They tested their proposed
method using various supervised classifiers and two unsupervised
models. They achieved an accuracy rate of 90.32% using the SVM clas-
sifier to classify PD and HC subjects. Even though the process of building
CNNs from scratch is computationally expensive, El Maachi et al. [19]
invested considerable effort in developing a unique model to detect and
predict the severity of PD. A model was developed to process 18 1D
signals from foot sensors measuring VGRF. The first part of their network
consists of 18 parallel 1D-CNNs that correspond to system inputs. To
obtain a final classification, the outputs of the concatenated 1D-CNNs are
connected to a fully connected network. They achieved 98.7% accuracy
in detecting PD and 85.3% accuracy in predicting severity.
Wang et al. [20], constructed the phase-space of the VGRF initially,
which preserves non-linear gait system dynamics. Then, the character-
istic envelope of the phase-space signal is extracted using Shannon en-
ergy. Subsequently, the Shannon energy envelope is subjected to dual
Q-factor signal decomposition, which is derived from tunable Q-factor
wavelet transform, to isolate its high and low resonance components.
Afterward, the high and low resonance components are decomposed into
distinct intrinsic modes using variational mode decomposition, which
yields representative features. These features are then inputted into five
diverse ML-based classifiers to detect anomalies and rate the severity of
PD patients based on the HY scale. Regarding the detection of PD and
F. Abedinzadeh Torghabeh et al. Medicine in Novel Technology and Devices 22 (2024) 100297

Fig. 3. A sample image of FRP for a healthy subject and five-class PD, where each pixel indicates the degree of similarity between two states in the phase space.
Compared to the binary RP method, which only detects the presence or absence of recurrences, the FRP approach provides a more detailed and preferred texture
analysis of the system's behavior.

9
F. Abedinzadeh Torghabeh et al. Medicine in Novel Technology and Devices 22 (2024) 100297

Fig. 4. A model's objective function has been optimized by the Bayesian optimization algorithm to determine the optimal initial learning rate and the number of
hidden units. The test dataset's loss function was set as an objective during 30 iterations of optimization, with a range of [0.001 to 1] for the initial learning rate and
[50 to 120] for the number of hidden units. This optimization method can improve the performance of the model.

Table 2
Summary of fine-tuned training options using the Bayesian optimization.
Stage Classifier InitialLearnRate (Optimization Range ¼ 0.001 to 1) NumHiddenUnits (Optimization Range ¼ 50 to 120)

Two-classes Uni-LSTM 0.0043 73

Bi-LSTM 0.0013 50
Five-classes Uni-LSTM 0.0566 55
Bi-LSTM 0.0038 50

severity rating, the SVM classifier has reported classification accuracies
of 98.20% and 96.69%, respectively. Despite their superior performance,
we achieved an accuracy of 92.285% using a time-efficient, affordable
model with one 1D signal, CVGRF, and four features. In addition, an SVM
model requires 1490 kB of memory storage when implemented in a
microcontroller, whereas a two-layer LSTM only requires 54 kB [35].
Klinton Amaladass et al. [22] used gait signals to extract S-ELBP
features, which were then utilized as inputs to an ANN for classification
as either HC or PD. Their methodology yielded a classification accuracy
of 97.6% which was lower than our proposed method. Ma et al. [23]
applied three domains, namely the force domain, peak domain, and ab-
normality domain, in the gait analysis to extract twenty-two distinct
features. An analysis of variance (ANOVA) with a recursive reduction
technique was employed to determine whether certain features should be
eliminated. Ultimately, the researchers reduced the number of sensors
from 16 to 2 and identified six critical features based on the obtained test
results. By using XGBoost and CNN, they achieved a classification accu-
racy of 97.32% and 98.4%, respectively. In summary, we achieved

10
F. Abedinzadeh Torghabeh et al. Medicine in Novel Technology and Devices 22 (2024) 100297

Fig. 5. Model's minimum observed objective and minimum estimated objective during 30 iterations of employing Bayesian optimization to find the optimal value of
the initial learning rate and the number of hidden units of models.

Table 3
Two-class detection results of PD from healthy individuals: evaluation metrics presented as percentages of Accuracy, Sensitivity, Specificity, Precision, and F1-Score.
Accuracy Sensitivity Specificity Precision F1-Score

Uni-LSTM 99.192 ± 0.528 99.125 ± 0.641 99.727 ± 0.179 99.194 ± 0.566 99.149 ± 0.613
Bi-LSTM 97.283  0.99 97.761  1.447 97.725  3.338 96.833  2.174 97.220  0.953

Table 4
PD grading results based on five-class severity: evaluation metrics presented as percentages of Accuracy, Sensitivity, Specificity, Precision, and F1-Score.
Accuracy Sensitivity Specificity Precision F1-Score

Uni-LSTM 90.291  1.321 90.361  1.389 96.920  0.461 90.857  1.219 90.149  1.494
Bi-LSTM 92.285 ± 2.266 92.355 ± 2.246 97.689 ± 0.385 92.844 ± 1.755 92.082 ± 2.514

near-perfect performance by utilizing a lightweight and efficient model
and extracting only four features and one 1D signal.
5. Conclusion
In this research, a new intelligent approach is presented for detecting
and grading PD only through a single signal obtained from wearable
sensors. The proposed method employs the use of the CVGRF, which has
been shown to be effective in both classification and grading. Wearable
sensors are increasingly being used to evaluate patient outcomes in
clinical trials. Our proposed model achieves comparable or better results
without the need for additional pre-processing steps, thus emphasizing
its simplicity and efficiency. In addition, the proposed method takes
advantage of both frequency features and FFs of signals, resulting in a
shorter feature extraction time, shorter model training time, lower
computational complexity, and potential savings in a real-time system.
The authors of the study assert that the proposed method can be readily
applied to classify other biological and clinical signals, thus expanding its

11
F. Abedinzadeh Torghabeh et al. Medicine in Novel Technology and Devices 22 (2024) 100297

Table 5 Declaration of generative AI and AI-assisted technologies in the

Comparison between the proposed method and existing papers for two-class writing process
automated PD diagnosis on the same dataset.
Reference Method Accuracy During the preparation of this study, the authors used ChatGPT and
(%) Grammarly to improve readability and language. After using these tools,
[17] Peak detection and pulse duration algorithms, 92.68 the authors reviewed and edited the content as needed and take full re-
SVM sponsibility for the publication's content.
[18] KNN, DT, RF, NB, SVM, and K-means, GMM 90.32
[19] Deep 1D-CNN 98.07
[20] Phase-space reconstruction, Shannon energy 98.20
envelope, and SVM Declaration of competing interest
[22] S-ELBP and ANN 97.60
[23] XGBoost and CNN 98.41 The authors declare that they have no known competing financial
Proposed Uni-LSTM with Bayesian optimization 99.19 interests or personal relationships that could have appeared to influence
method
the work reported in this paper.

applicability in medical research and clinical settings. Additionally, the Acknowledgments

outcomes of the study suggest that this approach holds the potential to
reduce the necessity of multiple sensors in recording physiological data,
leading to both cost reduction and increased patient comfort. To
conclude, this study highlights the potential of using a single signal ob-
tained from wearable sensors and the CVGRF approach for PD detection
and grading. It also underscores the value of wearable sensors and their
potential to revolutionize the way patient outcomes are evaluated in
clinical trials. Further research in this area could enhance the accuracy
and reliability of PD diagnosis and treatment, leading to improved pa-
tient outcomes and QoL.
Limitations
While the research has yielded commendable outcomes, it is imper-
ative to acknowledge certain limitations. Firstly, the analysis for PD
diagnosis relies solely on gait sensor data. Future research could enhance
accuracy by incorporating multiple-sensor data from a multi-modal
framework. Another constraint is identified in the potential enhance-
ment of the model through exploring alternative segmentation strategies
or integrating dynamic segmentation methods. Moreover, the study
exclusively extracted four time-frequency and fuzzy features, possibly
overlooking other crucial information embedded in gait signals. This
limitation might have constrained the model's ability to fully capture the
complexity of the data. It is noteworthy, however, that the primary
emphasis of the proposed method was on simplicity and minimal pro-
cessing. Exploring additional sensitive hyperparameters and employing
state-of-the-art optimization techniques also could potentially enhance
our understanding of the model's stability, leading to superior perfor-
mance in future studies.
Funding
The authors declare that no funds, grants, or other forms of support
were received during the preparation of this manuscript.
Data Availability Statement
The datasets analyzed for this study can be accessed by the public
through the “Gait in Parkinson's Disease v1.0.0” database available at
https://physionet.org/content/gaitpdb/1.0.0/.
CRediT authorship contribution statement
Farhad Abedinzadeh Torghabeh: Conceptualization, Data curation,
Methodology, Software, Visualization, Writing – original draft. Yeganeh
Modaresnia: Visualization, Writing – review & editing. Seyyed Abed
Hosseini: Investigation, Supervision, Validation, Writing – review &
editing.
We deeply appreciate Jeffrey Hausdorff and his esteemed colleagues
for generously sharing their publicly accessible database, which has
proved invaluable to the progress of our research.
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