Towards Biomarker Discovery for Early Cerebral Palsy Detection: Evaluating Explanations Through Kinematic Perturbations

ABSTRACT Cerebral Palsy (CP) is a prevalent motor disability in children, for which early detection can significantly improve treatment outcomes. While skeleton-based Graph Convo-lutional Network (GCN) models have shown promise in automatically predicting CP risk from infant videos, their "black-box" nature raises concerns about clinical explainabil-ity. To address this, we introduce a perturbation framework tailored for infant movement features and use it to compare two explainable AI (XAI) methods: Class Activation Mapping (CAM) and Gradient-weighted Class Activation Mapping (Grad-CAM). First, we identify significant and non-significant body keypoints in very low and very high risk infant video snippets based on the XAI attribution scores. We then conduct targeted velocity and angular perturbations, both individually and in combination, on these keypoints to assess how the GCN model's risk predictions change. Our results indicate that velocity-driven features of the arms, hips, and legs have a dominant influence on CP risk predictions, while angular perturbations have a more modest impact. Our findings demonstrate the use of XAI-driven movement analysis for early CP prediction, and offer insights into potential movement-based biomarker discovery that warrant further clinical validation. Index T erms-- explainable AI, CAM, Grad-CAM, skeleton data, Cerebral Palsy 1. INTRODUCTION Cerebral Palsy (CP) is the most common motor disability in childhood, affecting approximately 2.11 per 1,000 live births worldwide [1]. Early detection of CP is crucial for initiating timely interventions that can significantly improve outcomes and quality of life for affected individuals [2].