Kinematic Knowledge Maps for Pattern Alignment: Structured Latent Representational Learning in Multimodal Gait Analysis

Abstract

Multimodal clinical AI is limited by weakly aligned inputs and the absence of domain-specific interpretable representations, particularly when learning from dense video stream, structured time-series, and template-based kinematic text. Here we present ScoliDetect, an explainable framework for adolescent idiopathic scoliosis screening from monocular gait video, built around a kinematic knowledge map (KKM) and complementary template-based kinematic text derived from per-sequence pose statics. KKM is a fixed-index structured representation that encodes gait features across absolute motion, self-skeleton configuration and joint-joint signal correlation, providing anchor-referenced multimodal fusion and factor-level interpretation. We integrate video, KKM, and template-based kinematic text through bidirectional cross-attention with latent-bottleneck aggregation. In a multicenter cohort (n = 1,858 after exclusions), prespecified supervised ablations on an external screening cohort show that KKM-mediated multimodal fusion outperforms unimodal models and late concatenation. Under a staged training protocol, trimodal contrastive pretraining is applied after architecture selection as representation initialization, improving external ROC-AUC from 0.961 to 0.972. Furthermore, the structured nature of the KKM provides inherent, factor-level attributions mapped directly to specific kinematic phases and skeletal indices, offering verifiable interpretability. The results demonstrate that embedding explicit structural topologies into latent spaces significantly enhances both the generalization and explainability of multimodal pattern analysis systems.