IEEE TRANSACTIONS ON NEURAL SYSTEMS AND REHABILITATION ENGINEERING, VOL. 28, NO.
4, APRIL 2020 961
Classifying Major Depressive Disorder Using
fNIRS During Motor Rehabilitation
Yibo Zhu, Jagadish K. Jayagopal , Ranjana K. Mehta , Madhav Erraguntla , Joseph Nuamah ,
Anthony D. McDonald, Heather Taylor, and Shuo-Hsiu Chang
Abstract — Major depressive disorder (MDD) has shown
to negatively impact physical recovery in a variety of
medical events (e.g., stroke and spinal cord injuries). Yet
depression assessments, which are typically subjective
in nature, are seldom considered to develop or guide
rehabilitation strategies. The present study developed a
predictive depression assessment technique using func-
tional near-infrared spectroscopy (fNIRS) that can be rapidly
integrated or performed concurrently with existing phys-
ical rehabilitation tasks. Thirty-one volunteers, including
14 adults clinically diagnosed with MDD and 17 healthy
adults, participated in the study. Brain oxy-hemodynamic
(HbO) responses were recorded using a 16-channel wear-
able continuous-wave fNIRS device while the volunteers
performed the Grasp and Release Test in four 16-minute
blocks. Ten features, extracted from HbO signals, from each
channel served as inputs to XGBoost and Random Forest
algorithms developed for each block and combination of
successive blocks. Top 5 common features resulted in
a classification accuracy of 92.6%, sensitivity of 84.8%,
and specificity of 91.7% using the XGBoost classifier. This
study identified mean HbO, full width half maximum and
kurtosis, as specific neuromarkers, for predicting MDD
across specific depression-related regions of interests
(i.e., dorsolateral and ventrolateral prefrontal cortex). Our
results suggest that a wearable fNIRS head probe mon-
itoring specific brain regions, and limiting extraction to
few features, can enable quick setup and rapid assess-
ment of depression in patients. The overarching goal is to
embed predictive neurotechnology during post-stroke and
post-spinal-cord-injury rehabilitation sessions to monitor
patients’ depression symptomology so as to actively guide
decisions about motor therapies.
Index Terms — Depression, fNIRS, rehabilitation, random
forest, XGBoost.
I. I NTRODUCTION
D EPRESSION, also known as major depressive dis-
order (MDD), is the leading contributor to global
disability [1], [2]. Depression prevalence rates following
Manuscript received October 19, 2019; revised January 7, 2020;
accepted February 4, 2020. Date of publication February 7, 2020; date of
current version April 8, 2020. (Corresponding author: Ranjana K. Mehta.)
Yibo Zhu, Jagadish K. Jayagopal, Ranjana Mehta, Madhav Erraguntla,
Joseph Nuamah, and Anthony D. McDonald are with the Department
of Industrial and Systems Engineering, Texas A&M University, College
Station, TX 77845 USA (e-mail: rmehta@tamu.edu).
Heather Taylor and Shuo-Hsiu Chang are with the Department
of Physical Medicine and Rehabilitation, The University of Texas
Health Science Center at Houston, Houston, TX 77030 USA (e-mail:
shuo-hsiu.chang@uth.tmc.edu).
Digital Object Identifier 10.1109/TNSRE.2020.2972270
1534-4320 © 2020 IEEE. Personal use is permitted, but republication/redistribution requires IEEE permission.
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medical events including stroke, hip fracture, total joint
arthroplasty, and spinal cord injury (SCI) range from 9.8%
to 60%, which is substantially higher than the general
population, [3]–[9]. The effects of depression on recovery
following a variety of medical events have been studied
extensively; depression is associated with negative impacts on
health outcomes pursuant to a medical event either directly
or indirectly [10]–[17]. For example, depression can influence
patients’ attitudes toward rehabilitation and their ability to
participate in the process [4], [18].
Although several studies have documented the ability of
rehabilitation to act as a mediating factor between depression
and the functional or cognitive recovery of patients [19], [20],
an explicit link between the impact of depression on the
rehabilitation process and the functional recovery of patients
has not yet been established. A small number of studies
(e.g., [21], [22]) have addressed the integration of depression
care into the rehabilitation protocol. Furthermore, only a few
studies have used depression assessment within the context
of the study to provide or personalize physical therapy. For
example, despite the high prevalence of depression post SCI,
only 11% of patients with depression receive pharmacological
treatment [4]. This illustrates the critical need to restructure
the rehabilitation process to better accommodate the needs of
post-stroke and post-SCI patients with depression.
A. Traditional Assessment of Depression
Traditional assessment methods in research and clinical
practice include structured diagnostic interviews (e.g., Depres-
sion Interview and Structured Hamilton [23], Structured Clin-
ical Interview for DSM-IV [24]), self-report (e.g., Beck
Depression Inventory–II [25], Center for Epidemiologic
Studies-Depression (CES-D) scale [26]) and observer instru-
ments (e.g., Patient Health Questionnaire-9 (PHQ-9) [27],
Hamilton Depression Scale [28]). These options are limited
by their subjectivity and unreliability [29]–[32]. Furthermore,
these methods are limited by their timeliness. For example,
the PHQ-9 requires patients to consolidate their symptoms
over a two-week period, whereas depression symptoms are
known to vary by day [33].
A survey of physical therapists details several barriers
to integration of depression monitoring and care including
the service not being part of standard care policy in their
organization or practice, limited knowledge on the provider’s
962 IEEE TRANSACTIONS ON NEURAL SYSTEMS AND REHABILITATION ENGINEERING, VOL. 28, NO. 4, APRIL 2020
part, insufficient follow-up resources and time, and unfamiliar-
ity with depression assessment tools [34]. A separate survey
of occupational therapists revealed that while nearly 93%
of surveyed therapists believe mental health care delivery
needs to be improved within the scope of their practice,
only approximately 50% of therapists try to integrate various
aspects of mental health care into their practice [35]. Those
that do not integrate mental health care or choose to involve
professionals from other disciplines to individualize care report
pressure to maximize efficiency and productivity with limited
time, prioritization of functional or motor recovery, insuffi-
cient resources, patient hesitance, and provider unfamiliar-
ity with the service as common barriers [35]. The survey
emphasized that inadequate depression assessment techniques
can further act as a barrier to integration. These limitations
suggest a need for reliable, real-time, and objective measures
of MDD.
B. Recent Depression Measurement Techniques
Efforts to objectively quantify depression symptomatology
have gained attention over the past few decades. These
include physical activity and gait monitoring using accelerom-
eters [36], [37], hand and eye tracking with virtual real-
ity [38]–[40], and brain signal tracking using neuroimaging
techniques [41], [42]. Extensive research has been conducted
to understand neural mechanisms of depression using neu-
roimaging techniques such as electroencephalography (EEG),
functional magnetic resonance imaging (fMRI), computer-
ized tomography (CT), functional near-infrared spectroscopy
(fNIRS), and positron emission tomography [36], [43]–[45].
Several of these studies (e.g., [43]–[46]) have found that focal
functional and structural abnormalities in the prefrontal cortex
(PFC), the hippocampus, the amygdala, and parts of the stria-
tum and thalamus are accompanied with depression related
impairments. Among the techniques employed in these studies,
fNIRS has shown promise in assessing neural underpinnings
of depressive symptomatology [47].
fNIRS measures brain activation through the change in
concentration of oxygenated and de-oxygenated hemoglobin
in measured brain areas [48]. Although fNIRS offers lower
spatial and temporal resolution compared to fMRI and EEG,
respectively, it is relatively inexpensive, portable, easy to set
up and less sensitive to motion artifacts [49]. Previous fNIRS
studies (e.g., [50]–[53]) have found an association between
MDD and functional activation of the PFC. For example,
studies have reported lower activation in the PFC, especially in
the dorsolateral PFC (dlPFC) and superior temporal regions,
in MDD patients compared to healthy adults [46], [54], [55].
This decrease in oxygenated hemoglobin in adults with depres-
sion has shown to be consistent with the reduction in regional
cerebral blood flow and metabolism in the dlPFC region at
resting states using PET and fMRI [56]. Although these prior
studies have shown the utility of fNIRS in psychiatric research,
they have focused largely on the cognitive characteristics of
MDD through the utilization of cognitive tasks, such as verbal
fluency [47].
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C. Depression Classification Using Machine Learning
Machine learning techniques have shown promise in the
diagnosis, and treatment of mental health conditions including
depression [57]. Support vector machines (SVM), decision
trees, and naïve bayes [58]–[60] have been applied to fNIRS
data to classify MDD patients and healthy adults. For example,
Song et al. [58] achieved a classification accuracy of 86.77%
using SVM to distinguish between MDD patients and healthy
adults from fNIRS data collected while participants performed
a cognitive task. Zhu and Mehta [60] obtained a classification
accuracy of 85% using a One Rule algorithm to assess
depression in fNIRS data obtained from healthy adults and
MDD patients who performed hand grip force production
tasks. These results are promising but also are limited in
their exploration of machine learning algorithms, specifically
ensemble methods.
Ensemble machine learning methods consist of combina-
tions of multiple simple algorithms (e.g., decision trees).
Classification in ensemble methods is performed by a plurality
or weighted vote among the simple classifiers (e.g., [61]).
This voting structure reduces classification bias and, in prac-
tice, tends to increase algorithm generalizability. Two com-
monly applied ensemble methods are Random Forests [49]
and extreme gradient boosting (XGBoost). RF consist of an
ensemble of decision trees (typically as many as 500). Each
tree is trained with a random subset of both the training data
and features. Classification in an RF is performed based on a
majority vote among the trees [61]. XGBoost is an iterative
training process in which successive trees are trained on the
residual training error cases from the previous tree [62]. Clas-
sification in XGBoost is performed by a weighted prediction
among the trees [62]. While RF and XGBoost have been
successful in other classification tasks [63], [64], we found no
evidence that they have been applied to the detection of MDD
symptoms.
D. Gaps Identified
Depression plays a major role in the health and well-being
of post-stroke and post-SCI patients, and shown to adversely
affect motor function recovery and rehabilitation outcomes.
In clinical rehabilitation practices, monitoring and diagno-
sis for depression often occurs when the clinical symptoms
have developed, after which the patients are referred to
specialists during rehabilitation. While the physical thera-
pist or occupational therapist focuses on motor recovery,
depression symptoms could be overlooked and therefore
the impacts of depression on recovery could be greater.
To better provide effective and efficient rehabilitation to
promote motor recovery, there is a critical need for a
feasible, valid, and reliable depression assessment method
that is rapid, can be integrated or performed concurrently
with existing activities (such as motor function assess-
ments), and with fewer training requirements, such that it
can be employed at multiple time points without requir-
ing additional clinical resources or adversely impact clinical
productivity.
ZHU et al.: CLASSIFYING MDD USING fNIRS DURING MOTOR REHABILITATION
TABLE I
D EMOGRAPHIC D ATA (M EAN ± SD)
E. Objective of Study
Machine learning technologies applied to fNIRS data cap-
tured from MDD patients have the potential to positively
influence rehabilitation outcomes. However, computational
requirements to develop real-time classification, coupled with
the time required to perform fNIRS probe design and setup
should also be considered to reduce the burden of depression
assessment during actual physical therapy sessions to ensure
feasibility and sustainability. In the present study, we seeked
to address these practical issues by developing a predictive
depression assessment technique that apply RF and XGBoost
models to fNIRS data collected from participants performing
relevant rehabilitation tasks. Unlike previous studies that have
focused on classifying depression when participants performed
cognitive tasks and/or were immobile, this study aimed to
highlight the feasibility of fNIRS to assess and classify
depression using a motor rehabilitation task, which enable
physical therapy-embedded depression assesssment but are
also associated with high movement artifacts.
II. M ETHOD
A. Participants
Thirty-one participants were recruited for this study,
including 14 clinically diagnosed MDD adults (6 males
and 8 females), and 17 healthy controls (6 males and
11 females). Volunteers who were clinically diagnosed with
MDD (i.e., Structured Clinical Interview for DSM-IV [24])
were recruited under the MDD group and general healthy
participants were recruited under the control group. All par-
ticipants also completed the CES-D scale [26] to verify that
the two groups differed in depression scores. The two groups
were recruited via convenience sampling from the Texas A&M
University community. Participant demographics is presented
in Table I. Inclusion criteria for the control group included
no lifetime history of any depressive disorder and that for
the MDD group included a diagnosis of MDD as determined
by CES-D questionnaire. Both groups also were required to
be right-hand dominant and between 20-80 years of age.
Exclusion criteria for both groups included cardiovascular dis-
eases, metabolic conditions, or musculoskeletal disorders that
interfered with upper extremity functions. Written informed
consent of all participants were obtained at the beginning of
the study, which was approved by the Texas A&M University
Institutional Review Board.
B. Procedure
Upon consent, each participant was instructed to com-
plete a demographic and health history survey, following
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963
Fig. 1. Participant instrumented and sitting upright.
which anthropometric measurements (e.g., height, weight)
were obtained. Participants were first instructed to sit upright
with their upper arm resting on an arm support at their side and
elbow flexed at 90◦ (Fig 1) to collect baseline signals from the
fNIRS sensors. Following the baseline, participants completed
a series of motor rehabilitation tasks described below.
C. Grasp and Release Test
The Grasp and Release Test (GRT) is a common motor reha-
bilitation task for patients with Tetraplegia [65]. We employed
this task to address a key research question – can a
fNIRS-based depression screening technique be embed-
ded successfully in real-time motor rehabilition procedure?
Answering this question will address gaps identified earlier
on understanding the influence of type of task (motor versus
cognitive) on the performances of the models, as well as
determining the optimal duration of the motor task that will
result in improved depression classification, which may have
implications for clinical feasibility of real-time depression
assessment during therapy sessions.
In this study, we modified the GRT according to Fitts’ Law,
given by [65], [66], to manipulate the task difficulty.
  
I ndex o f di f f i cult y = log 2 2D W
where D is the distance between the starting position to the
target, and W is width of the target along the axis of motion.
Our modified GRT included four different tasks. Participants
were instructed to pick up an object, tape (W = 2.50 cm)
or fork (W = 0.52 cm), from one marked circular area,
small (diameter = 0.50 cm) or large (diameter = 1.00 cm)
to the other marked area, small or large. This was done
to offer variability in the task difficulty that would test the
generalizability of the study findings. Participants familiarized
themselves with the GRT using a cylindrical tape and a fork.
They were asked to grasp the tape/fork from the starting
circular area, move it over a barrier, and release the tape/fork
in the target circular area.
For the main experiment, participants were instructed to
maintain accuracy of the grasp and release while performing as
many GRT iterations as they could in 30 s. Each 30 s GRT was
followed by a 30 s rest period. Participants performed these
16 times in a block. A total of four blocks – block 1 (B1),
block 2 (B2), block 3 (B3), block 4 (B4), were performed with
5 minutes of rest between each block (see Fig. 2). The order
of the object and area types were counterbalanced within each
block using the Balanced Latin square design.
964 IEEE TRANSACTIONS ON NEURAL SYSTEMS AND REHABILITATION ENGINEERING, VOL. 28, NO. 4, APRIL 2020
Fig. 2. Experimental procedure. FS/TS: Fork and Tape Small area;
FL/TL: Fork and Tape Large area.
Fig. 3. PFC activation sensitivity map of fNIRS probe. Red and blue
dots indicate sources and detectors, respectively, green lines indicate
channels. Source-detector separation distance is 2.5 cm.
D. fNIRS Measurement and Preprocessing
We used a continuous wavelength fNIRS system (fNIRS
Device model 1000, United States) to record light intensity
discharged through 4 emitters and recorded at 10 detectors to
obtain hemodynamic response at a total of 16 channels based
on the International 10/20 system (Fig. 3). The source-detector
distances are set at 3 cm and the four regions identified are
bilateral dorsolateral and ventromedial PFC (Fig 3). Following
the procedures recommended in Zhu et al. [67], we converted
acquired light intensities into optical densities, and band-pass
filtered with cut-off frequency at 0.01 Hz and 0.5 Hz to reduce
the high-frequency noise and cardiac cycle noise [67]. We used
a spline interpolation algorithm to detect and correct motion
artifacts that showed abrupt changes [68]. Finally, we com-
puted oxygenated (HbO) and deoxygenated (HbR) hemoglobin
at the 16 channels using the modified Beer-Lambert law [69].
E. Feature Extraction
We extracted 10 metrics from the HbO signal (Fig 4) of
each participant including mean, variance, activity start time,
left slope, right slope, kurtosis, skewness, area under the curve,
full width half maximum (FWHM) and peak amplitude [70].
Some, or combination of, these metrics have shown to be
associated with group differences based on traumatic brain
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Fig. 4. Feature extraction strategy of a sample HbO signal.
injury [65], motor fatigue [67], or cognitive states [68]. The
metrics were averaged across all trials in each block and
calculated for each of the 16 channels. In this study, each
channel-metric combination in a block was considered as
an individual feature. Thus, 160 features (16 channels ×
10 metrics) were extracted in each block for each of the
31 participants.
F. Classification
We developed separate classification models using single
blocks (i.e., B1, B2, B3, B4) and combinations of successive
blocks (B1-2, B2-3, B3-4, B1-2-3, B1-2-3-4) to examine the
impact of GRT task duration on model performance. This
could have implications for the tradeoff between depres-
sion assessment accuracy and feasibility for real-time assess-
ment during therapy. We chose to develop the models using
XGBoost and RF algorithms for their capability to provide
Variable Importance Factors that allowed us to extract signif-
icant common features associated with MDD (Fig 5).
For each algorithm, we searched the parameter space for
optimal test error performance. Since the sample size was
small, we chose 90% of the data for training and the remaining
for testing. We obtained top 10 channel-feature combinations,
ordered by rank, from each of the models using the feature
importance function in XGBoost and RF. Classification perfor-
mance was evaluated using accuracy, sensitivity and specificity
of the models. A repeated bootstrapped sampling approach
with 1,000 replicates was used to provide a generalizable
estimate of each measure. Top 10 features based on variable
importance based on reduction in Gini Index were selected
for XGBoost and RF algorithms. Five common features
between the two algorithms were then selected (Fig 5). The
reason for performing this was to identify the parsimonious
feature set with good prediction performance, but are also
invarieant/robust to machine alearning algorithm.. All models
were trained using the XGBoost 0.80 and Scikit-learn 0.20.0
packages in Python 2.8.
III. R ESULTS
Table II shows the classification results for the block com-
binations with the complete feature set. Blocks 4 and 3-4
resulted in higher accuracies, sensitivities, and specificities
ZHU et al.: CLASSIFYING MDD USING fNIRS DURING MOTOR REHABILITATION
Fig. 5. Variable importance plots for the top 10 features of the best XGBoost (Right) and Random Forest (Left) models are extracted and compiled
to synthesize the top 5 features.
TABLE II
C LASSIFICATION R EPORT OF VARIOUS B LOCK C OMBINATIONS
among all block combinations. For Block 4, the XGBoost
algorithm, with all 320 features (160 features ∗ 1 block),
resulted in an accuracy of 83.95 %, sensitivity of 73.16 %
and specificity of 87.07%. For Blocks 3-4 combination, the RF
algorithm, with all features (160 features ∗ 2 blocks), resulted
in an accuracy of 81.49 %, sensitivity of 73.41 % and
specificity of 81.48 %.
The variable importance plots for the XGBoost and RF
algorithms using the Block 3-4 data are shown in Fig. 5 along
with the process to obtain top five common features across
the two algorithms. The important features were i) variance
of the HbO signal in channel-3, ii) mean value of the HbO
signal in channel-8, iii) full-width maximum in channel-14,
iv) mean value of the HbO signal in channel-4, and v) kurtosis
in channel-15.
Classification results of the top 5 common features across
both algorithms for Block 3-4 are reported in Table III. While
the XGBoost classifier was nominally more accurate and more
sensitive than the RF, the RF had higher specificity.
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965
TABLE III
C LASSIFICATION R ESULTS FOR T OP 5 C OMMON
F EATURES F ROM B LOCK 3-4
In order to provide context to the feature importance find-
ings, it is beneficial to visualize the differences in features in
the raw data. Fig 6 illustrates hemodynamic response function
in a sample healthy and an MDD participant, comparing
the top five important features, namely, variance, kurtosis,
FWHM, and mean value of HbO signal. We subjected the five
features in Fig 6 to the Kolmogorov-Smirnov test (KS-test) to
determine if the feature values differed significantly between
the two groups. This test was chosen as it makes no assumption
on the distribution of the data. Except Channel-8 HbO Signal
Mean that approached significance (p = 0.067), all other
features showed significant differences between healthy and
MDD patients (p < 0.05).
IV. D ISCUSSION
In the present study we developed a predictive depression
assessment technique that applied RF and XGBoost models
to fNIRS-derived neural signals collected from participants
performing a representative motor rehabilitation task. The
findings indicated that the models that utilized five features
(i.e., channel-metric combination), and signals from later and
longer duration motor tasks performed better than those that
utilized a larger feature set and earlier and shorter duration
motor tasks. Moreover, this study highlights the feasibility
of fNIRS to assess and classify depression using a motor
rehabilitation task with inherent movement. This will open
new avenues for future research to consider motor tasks to
detect depression symptomology in patients.
Overall, the study found that model performances ranged
from ∼60% to ∼90% accuracies to classify MDD, owing to
the number of features and the size of the datasets used. The
5 channels identified by both RF and XGBoost algorithms
966 IEEE TRANSACTIONS ON NEURAL SYSTEMS AND REHABILITATION ENGINEERING, VOL. 28, NO. 4, APRIL 2020
Fig. 6. Comparison of hemodynamic response function of top five features between a sample healthy adult and a MDD adult.
were channels 3, 4, 8, 14 and 15 which correspond to brain
regions left dlPFC, left vlPFC, medial PFC, right vlPFC
and right dlPFC respectively (Fig 3). These regions corre-
late with the significant regions for MDD patients identified
in existing depression research studies (e.g., [42], [46], [54],
[55], [71]). The top features identified by both algorithms
were variance of the HbO signal, mean value of the HbO sig-
nal, FWHM, kurtosis. Established functional imaging findings
have implicated distinct, e.g., opposite, neural patterns with
MDD - hypoactivity in dlPFC and hyperactivity in vmPFC.
The findings from the present study corroborate with the extant
literature (e.g., [47], [72], [73]). Similar to Adorni et al. [47],
Zhang et al. [72], and Ahn et al. [73], we found hypofrontality
in MDD patients, indicated in lower mean levels of HbO
in dlPFC (Fig 6). Additionally, medial PFC was associated
with hyperfrontality (i.e., higher HbO levels) in MDD adults
(Fig 6). That our models were able to identify these two
features (mean HbO in vlPFC and medial PFC) as two of
the five most important features to classify MDD indicates
the potential of fNIRS as a wearable imaging predictive
depression assessment technique. The other three important
features included variance, kurtosis, and FWHM of the HbO
signal. These features are not currently explored as markers
of depression in neuroimaging research. Given that mean
HbO-based features found in the current study aligned with
established neuroimaging knowledge on depression, future
investigations of variance, kurtosis, and FWHM of the HbO
signals may lead to potential new insights on depression
pathophysiology and associated neuromarkers and thus should
be explored.
The focus of this study was to facilitate effective, rapid,
and real-time assessment of depression during procedures
already conducted by physical therapists. The inclusion of
GRT as a screening task was paramount to reducing any
additional resources in clinical settings, as therapists regularly
assess patient motor recovery using this test [74]. While
using fNIRS signals to classify depression using machine
learning is not entirely novel, this is one of the first machine
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learning studies that utilized a motor task as a screener
to classify depression. Previous studies employed cognitive
tasks, such as verbal fluency [50], [54], working memory
tasks [55], [75], as screeners owing to the role of PFC in
regulating executive functions as well as serving as a clinical
neural substrate for depression [49], [53], [54]. Our study
found that a reach and grasp task offered comparable model
performances that utilized fNIRS neural signals to classify
depression. This finding encourages future clinical feasibility
investigations of real-time depression assessment using fNIRS
during motor therapy sessions.
Design of any real-time depression assessment technique
needs to assess clinical utility factors and barriers, in addition
to its effectiveness, that may otherwise impede adoption of
the technology or its continued usage. Depression assessments
in physical rehabilitation were reported to be time-consuming
and burdensome to administer [76], [77]. Thus, our approach
not only required using an existing motor assessment task
(i.e., GRT) which would allow for concurrent depression
screening during therapy but also utilized a probe design that
corresponds to the five brain regions identified in the present
study, which will facilitate quick fNIRS setup (∼1 minute).
Additionally, because real-time assessments require minimum
computational classification costs [78], we subjected model
development to feature importance screening process. Our
findings highlighted top 5 common features from 320 features
that could potentially reduce classification computation time
to allow for real-time assessments in the future. Finally,
by developing models based on time blocks, we identified the
time frame and duration during which depression assessment
will be the most effective, thus reducing data collection and
computation requirements to specific times of motor exercises
during the therapy session.
This study is not without limitations. One challenge was
sample population size and type. The study sample size for
the MDD group in the present study are comparable to pub-
lished fNIRS-based studies targeting neurobiological injuries
and disorders [79]–[81]. Nonetheless, to address the sample
ZHU et al.: CLASSIFYING MDD USING fNIRS DURING MOTOR REHABILITATION
size issue, we conducted 1000 iterations (bootstrapping) to
minimize higher errors in performance estimates. It is likely
that factors such as history of substance abuse or other psy-
chological conditions (e.g., schizophrenia) could impact our
findings. Because these were not taken into consideration dur-
ing recruitment, future research should address these factors as
potential exclusionary factors or control for it through stratified
sampling. Future work is needed to generalize these results
across a larger sample of neurodiverse population. Addition-
ally, current findings should be tested across groups differing
in MDD treatment plans as medication history and length
of illness was not accounted in the present work. Another
future step will be to recruit post-stroke and SCI patients
going through rehabilitation. It is likely that the models might
change, or results may vary based on patient demographic
(age, sex), injury type, severity and post injury time. Use of
deep learning for classification of MDD and healthy subjects
will be considered in future since they don’t require feature
extraction and have proven to outperform traditional machine
learning algorithms in some applications.
V. C ONCLUSION
This study demonstrates the utility of a predictive neurotech-
nology to classify depression symptomology in adults as they
perform a motor task. By applying machine learning algo-
rithms to fNIRS data, we identified significant feature-channel
combinations from the PFC as well as specific time points dur-
ing which the classification is most effective. Potential impacts
of accompanying psychological conditions, drug history, and
rehabilitation treatment duration on the features identified
here as well as on the computational cost of the machine
learning algorithms will need to be clarified with a larger and
more neurodiverse participant pool. The overarching goal is
to embed predictive neurotechnology during post-stroke and
post-SCI rehabilitation sessions to monitor patients’ depres-
sion symptomology so as to actively guide decisions about
motor therapies. Thus, future work will also explore utility
of such assessments during different seated and ambulatory
rehabilitation tasks in SCI and stroke patients.
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