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  <front>
    <journal-meta />
    <article-meta>
      <title-group>
        <article-title>Planning to Support Physical Rehabilitation</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <string-name>Alessandro Umbrico</string-name>
          <xref ref-type="aff" rid="aff1">1</xref>
          <xref ref-type="aff" rid="aff2">2</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Roberta Bevilacqua</string-name>
          <email>r.bevilacqua@inrca.it</email>
          <xref ref-type="aff" rid="aff2">2</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Marco Benadduci</string-name>
          <email>m.benadduci@inrca.it</email>
          <xref ref-type="aff" rid="aff2">2</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Amedeo Cesta</string-name>
          <email>amedeo.cesta@istc.cnr.it</email>
          <xref ref-type="aff" rid="aff1">1</xref>
          <xref ref-type="aff" rid="aff2">2</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Francesca Fracasso</string-name>
          <email>francesca.fracasso@istc.cnr.it</email>
          <xref ref-type="aff" rid="aff1">1</xref>
          <xref ref-type="aff" rid="aff2">2</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Alessandro Leone</string-name>
          <xref ref-type="aff" rid="aff2">2</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Elvira Maranesi</string-name>
          <email>e.maranesi@inrca.it</email>
          <xref ref-type="aff" rid="aff2">2</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Mauro Marzorati</string-name>
          <email>mauro.marzorati@itb.cnr.it</email>
          <xref ref-type="aff" rid="aff0">0</xref>
          <xref ref-type="aff" rid="aff2">2</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Andrea Orlandini</string-name>
          <email>andrea.orlandini@istc.cnr.it</email>
          <xref ref-type="aff" rid="aff1">1</xref>
          <xref ref-type="aff" rid="aff2">2</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Giovanna Rizzo</string-name>
          <email>giovanna.rizzo@itb.cnr.it</email>
          <xref ref-type="aff" rid="aff0">0</xref>
          <xref ref-type="aff" rid="aff2">2</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Gabriella Cortellessa</string-name>
          <email>gabriella.cortellessa@istc.cnr.it</email>
          <xref ref-type="aff" rid="aff1">1</xref>
          <xref ref-type="aff" rid="aff2">2</xref>
        </contrib>
        <aff id="aff0">
          <label>0</label>
          <institution>National Research Council of Italy; Institute of Biomedical Technologies</institution>
        </aff>
        <aff id="aff1">
          <label>1</label>
          <institution>National Research Council of Italy; Institute of Cognitive Sciences and Technologies</institution>
        </aff>
        <aff id="aff2">
          <label>2</label>
          <institution>Temporal Planning</institution>
          ,
          <addr-line>Timeline-baed Planning, Heuristic Search, Multi-objective Search, Planning</addr-line>
        </aff>
      </contrib-group>
      <abstract>
        <p>This work presents a contribution about the use of a temporal planning framework for the synthesis of a personalized rehabilitation exercise program in the shape of dancing sessions. A ifrst part of the paper focuses on the modeling workflow to encode/represent all the technical and clinical information necessary to the planner. A second part describes the temporal planning framework and the multi-objective reasoning approach adopted to support the desired (clinical) objectives. An experimental evaluation then assesses the technical feasibility of planning framework and its capability of reasoning on diferent features to support (clinical) objectives.</p>
      </abstract>
      <kwd-group>
        <kwd>(A</kwd>
        <kwd>Cesta)</kwd>
        <kwd>0000-0001-9442-870X (F</kwd>
        <kwd>Fracasso)</kwd>
        <kwd>0000-0002-8970-3313 (A</kwd>
        <kwd>Leone)</kwd>
        <kwd>0000-0002-2414-3773</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <body>
    <sec id="sec-1">
      <title>1. Introduction</title>
      <p>population will lead to an increase in the demand of healthcare professionals in face of
an increased need for a higher level of care for future assistance.</p>
      <p>
        In this context, a relevant research trend is Socially Assistive Robotics which aims at
realizing increasingly supportive, proactive and personalized assistive services for the
aging or frail population, and current results in this field suggest the development of
potential new and innovative processes in healthcare [
        <xref ref-type="bibr" rid="ref2">2</xref>
        ]. Many projects and research
initiatives like e.g., [
        <xref ref-type="bibr" rid="ref3 ref4 ref5">3, 4, 5</xref>
        ] do exists which have pursued this objective by focusing on
diferent aspects of social and/or health assistance. Another example is represented by an
ongoing research project, SI-Robotics that proposes a holistic approach to assistive and
monitoring interventions in pro-active assisted living applications, in diferent contexts
such as the house of an older person, hospitals and residential facilities. The ofered
services are tailored according to the user’s needs and the context of delivering, and
include: i) physical activity monitoring (occupational, leisure time and household activity)
and coaching; ii) physiological monitoring (chronic diseases, ageing features, psychological
status, both emotional and cognitive, stress level); iii) habits recognition, lifestyle changes
and promotion; iv) physical/cognitive decline assessment and support; v) lifestyle support
and physical/cognitive stimulation (nutrition, cooking, physical activity) and; vi) advanced
tele-operation with caregivers. In order to address all these challenges, SI-Robotics relies,
among others, on the integration of a number of AI technologies ranging from Knowledge
Representation and Reasoning, for user modeling and personalization to Machine Learning
and Automated Planning for a continuous proactive and adaptive assistance.
      </p>
      <p>
        The project pursues a mixed-initiative approach by putting clinicians and therapists
into the AI-based loop for the synthesis and monitoring of personalized and adaptive
assistance [
        <xref ref-type="bibr" rid="ref6 ref7">6, 7</xref>
        ]. Automated Planning plays a central role in supporting domain experts
(i.e., clinicians/therapists). Planning technologies are, in this project, crucial to support
therapists in making decisions and merge clinical objectives with health needs of diferent
end-users and diferent assistive scenarios.
      </p>
      <p>This work focuses on the use of timeline-based planning technologies to support
physical rehabilitation programs. Following a mixed-initiative methodology, plans are
personalized according to the specific clinical objective selected by a therapist. Therapists
specify the (clinical) objective of a rehabilitation session and the planner synthesizes a
rehabilitation exercise program as a set of suitable stimuli. The planning process reasons
on a number of clinical and technical features of known stimuli in order to select those
that meet clinical requirements but also can be carried out correctly by users. The
mixed-initiative methodology supports a continuous refinement of planning knowledge
according to therapists’ feedback. The paper first presents the overall
therapist-in-theloop methodology pursued to elicit and continuously refine suitable planning knowledge.
Then an experimental evaluation assesses the reasoning capabilities of the planner and
its eficacy in addressing clinical objectives. The following section focuses on a specific
target of old population and explains the role of the planning technology to support their
rehabilitation programs.</p>
    </sec>
    <sec id="sec-2">
      <title>2. Physical Therapy and Parkinson’s Disease</title>
      <p>
        Neurological disorders are the leading source of disability globally [
        <xref ref-type="bibr" rid="ref8">8</xref>
        ]. In the Global
Burden of Disease, Injuries, and Risk Factors Study, Parkinson’s Disease (PD) is described
as the fastest growing in prevalence, disability, and deaths. The rising prevalence of
PD is linked with the rising of the ageing population considering that age above 65–70
years is a well-established risk factor. Advancing age is indeed associated with a faster
rate of disease motor progression, decreased levodopa responsiveness, more severe gait
and postural impairment, and more severe cognitive decline, exiting in the development
of dementia [
        <xref ref-type="bibr" rid="ref9">9</xref>
        ]. Within the unmet care needs of PD population, the identification of
strategies to support the feeling of being active part of the society, is the most requested
one by the patients and their families [
        <xref ref-type="bibr" rid="ref10">10</xref>
        ].
      </p>
      <p>
        To this purpose, guidelines recommend physical therapy early at the onset of the
disease, to support mobility by counteracting the insurgence of motor symptoms [
        <xref ref-type="bibr" rid="ref11">11</xref>
        ].
PD patients, in fact, are routinely treated through rehabilitative approaches aimed
at improving static and dynamic balance, recovery of walking, falls and mobility [
        <xref ref-type="bibr" rid="ref12">12</xref>
        ].
Within non-pharmacological treatments, many studies [
        <xref ref-type="bibr" rid="ref13">13</xref>
        ] have recently demonstrated
that regular physical exercise practice, predominantly aerobic, have a beneficial efect
on balance and gait functional mobility [
        <xref ref-type="bibr" rid="ref14">14</xref>
        ]. In particular, novel interventions based on
diferent types of dance (e.g., Tango or Irish dance) have been designed to recover the
normal gait of patients with PD [
        <xref ref-type="bibr" rid="ref15 ref16">15, 16</xref>
        ].
      </p>
      <p>One of the objectives of SI-Robotics is therefore to realize dance-based
training/rehabilitation conducted by a social robotic coach and supervised by the physiotherapist.
The service will be integrated in the daily activity of the IRCCS-INRCA rehabilitation
Unit, located in Ancona (Italy), that routinely conducts group therapy with older PD
patients at diferent stage of disease severity 1.</p>
      <sec id="sec-2-1">
        <title>2.1. The Role of the Planner</title>
        <p>Within the designed dance-based rehabilitation program, the planner is in charge of
supporting the therapist in the construction of rehabilitation sessions (i.e., synthesis of
suitable rehabilitation exercise programs). The planner is responsible for the synthesis of
rehabilitation exercise programs and thus for the selection of the physical exercises that
patients will perform during each rehabilitation session.</p>
        <p>More specifically, the therapist provides the planner with information about the
rehabilitation session (e.g., song time and song speed) and the health needs of participating
users. These needs characterize the clinical objective of the session and thus determine
the “shape” of the resulting rehabilitation exercise. Given this input, the planner builds
a “choreography” of a dance session by selecting the combinations of dancing steps (i.e.,
stimuli) that best fit the desired clinical objective.</p>
        <p>As we will show in the next section, the execution of each dancing step is seen as
the administration of a particular physical stimulus addressing one or more
health1https://www.inrca.it/inrca/home.asp?ling=en
related aspects of a user. The selection of such stimuli should therefore be contextualized
according to the selected objective and thus to patients’ health-related needs.</p>
      </sec>
    </sec>
    <sec id="sec-3">
      <title>3. Materials and Methods</title>
      <sec id="sec-3-1">
        <title>3.1. Knowledge Acquisition and Model Validation</title>
        <p>To achieve the desired objective a planning system should be endowed with carefully
designed domain knowledge. Broadly speaking, a planner should know a possibly rich
set of stimuli. It should know the efects of such stimuli on the health-related needs of a
user. It should be able to contextualize such stimuli with respect to diferent (clinical)
objectives in order to synthesize efective plans. In addition, a planner should know
technical constraints concerning the physical execution and concatenation of dancing
steps like e.g., “spatial efects” of motions, in order to synthesize plans that are valid
in the considered scenario. The acquisition of such knowledge is not trivial and entails
continuous refinements and constant interactions with therapists. Figure 1 shows the
mixed workflow implemented for the definition and refinement of the domain knowledge
necessary to support the planning process.</p>
        <p>As shown, the workflow is iterative and may entail (mixed) iterations at diferent levels
of the knowledge definition and validation process. The flow starts with the Exercise
Definition and thus with the definition of the dancing steps that will be considered in
the synthesis process. These steps represent the primitive stimuli the planner should
concatenate to build rehabilitation exercise programs. The definition of these steps is
guided by the therapist in order to define a portfolio of physical stimuli that are suitable
for the considered target of end-users.</p>
        <p>The next two steps of the flow aims at: defining a number of features that characterize
each dancing step from a technical and clinical perspective and; defining a set of clinical
objectives that characterize how to concatenate known dancing steps. After these three
steps a complete planning knowledge is ready for the definition of a suitable planning
model. The next three steps are therefore mainly guided by the planning expert with the
aim of synthesizing and executing contextualized rehabilitation exercises.</p>
        <p>The execution of each session (i.e., rehabilitation exercise program) is monitored and
assessed by a therapist who validates the outcomes of the exercise and the contribution
of the planner. The last step of the flow (“Session Assessment”) therefore can “approve”
the executed exercise so that the developed planning framework can be used for next
sessions. Otherwise, the therapist can “reject” the executed exercise and thus trigger
a new iteration of the flow in order to refine the planning knowledge and “tune” the
behavior of the planner to better fit the desired objectives.</p>
        <sec id="sec-3-1-1">
          <title>3.1.1. Definition of Stimuli and Spatial Constraints</title>
          <p>Putting aside clinical and rehabilitation aspects, the role of the planner is to decide a
sequence of motions (i.e., dancing steps) patients should perform over time. To correctly
plan such sequences the planner take into account spatial constraints in order to correctly
combine/concatenate users’ motions.</p>
          <p>Figure 2 generally describes the physical layout of the scenario. Users are put in front
of a wide screen where an avatar shows the dancing steps they are supposed to perform in
a game-like way. The two-dimensional grid of the figure shows a schematic representation
of the “dance floor” and possible motions of a user. For the sake of simplicity we here
consider only one user but the layout can be easily extended to the case with more users.</p>
          <p>A user is placed at the center of the layout with the head pointed to the game screen.
Users’ motions consist of steps along vertical and horizontal axes and body rotations. It
is important to point out that rotations change body orientation and thus the reference
system of a user. This means that the axis afected by a motion depends on the body
orientation of the user. For examples, a step forward with orientation 0 degree (i.e.,
with the head pointed to the game screen) afects the vertical axis. A step forward with
orientation 90° (i.e., after a body rotation to the right) instead afects the horizontal axis.
Each motion of a user consumes one “space unit” along a particular axis. Taking into
account the default position (i.e., the user placed at the center with the head pointed
to the game screen) a user can perform a maximum number of  steps forward and
backward along the vertical axis (for a total available space of 2 units) and can perform
a maximum number of  steps rightward and leftward along the horizontal axis (for a
total available space of 2 units).</p>
          <p>Given this layout it is necessary to characterize the basic motions a user can perform.
These steps constitute the stimuli a planner should concatenate to synthesize rehabilitation
exercises (i.e., the plans). As a result a dataset of (primitive/basic) steps has been defined
containing a total number of 134 steps. Each step is characterized with respect to the
“efects” that related motions have on a user in the considered layout. Technical features
characterize “spatial efects” of each step and other technical information necessary to the
planner. Table 1 shows the structure of the dataset and describes the defined technical
features.</p>
        </sec>
        <sec id="sec-3-1-2">
          <title>3.1.2. Definition of Clinical Features and Objectives</title>
          <p>In addition to the technical knowledge about the defined dancing steps, the planner
needs clinical knowledge to build sessions that meet clinical requirements. To synthesize
efective rehabilitation exercise programs indeed the planner should know how available
stimuli (i.e., dancing steps) afect the health state of users. To this aim, the second
step of the workflow in Figure 1 generates an additional dataset to characterize clinical
parameters of dancing steps. A number of clinical features are defined to characterize
how the execution of a particular step “stimulate” the health-state of a user. Table 2
shows the structure of the dataset with a description of the defined clinical features.</p>
          <p>The third step of the workflow of Figure 1 then concerns the definition of clinical
objectives (i.e., planning goals). This information is crucial to characterize the expected
qualities of plans and thus synthesize rehabilitation exercises that are efective with respect
to the health conditions of users. Assuming that the choice of the clinical objective is
made by therapists according to their knowledge about the status of the participants,
two main cases have been considered:
• Stimulation of physical equilibrium. The rehabilitation exercise should stimulate
users’ capability of keeping a good equilibrium and thus coordinate their motions.
The “intensity” of the exercise is not central in such a case. Rather it is important
to administrate a set of stimuli that properly train coordination and body balance
of users.
• Stimulation of metabolic response. The rehabilitation exercise should stimulate
users’ energy expenditure and cardiovascular fitness. The “intensity” of the exercise
is central in this case. It is important to identify and administrate a set of stimuli
that achieve a proper level of cumulative energy in order to stimulate the physical
resistance of users.</p>
          <p>
            In general each clinical objective entails the capability of reasoning on a number of
(heterogeneous) features. A planner should therefore be capable of pursuing a
multiobjective perspective in order to synthesize efective plans.
Integer ∈ [
            <xref ref-type="bibr" rid="ref10">0, 10</xref>
            ]
Integer ∈ [
            <xref ref-type="bibr" rid="ref10">0, 10</xref>
            ]
          </p>
          <p>
            Integer ∈ [
            <xref ref-type="bibr" rid="ref10">0, 10</xref>
            ]
Coordination
          </p>
          <p>
            Integer ∈ [
            <xref ref-type="bibr" rid="ref10">0, 10</xref>
            ]
Body Balance
          </p>
          <p>
            Integer ∈ [
            <xref ref-type="bibr" rid="ref10">0, 10</xref>
            ]
          </p>
          <p>Description
A string uniquely identifying a basic step within the dataset.</p>
          <p>Estimation of the muscular efort on the legs required for the correct
execution of the associated dancing step.</p>
          <p>Estimation of the muscular efort on the arms required for the
correct execution of the associated dancing step.</p>
          <p>Estimation of the amount of energy required for the execution of the
associated dancing step. This information allows the planner to
contextualize dancing steps with respect to the energy metabolism
and the “training level” of a user.</p>
          <p>Characterize the dificulty of a dancing step with respect to both
cognitive and motor aspects. This information is crucial to adapt the
technical dificulty of a choreography to the actual motor skills and
cognitive capabilities of users.</p>
          <p>Characterize the dificulty of a dancing step with respect to the
maintenance of body equilibrium.</p>
        </sec>
        <sec id="sec-3-1-3">
          <title>3.1.3. Execution and Validation of Synthesized Plans</title>
          <p>A planning instance can be defined after the third step of the workflow and thus the
definition of a complete planning knowledge is completed. In this regard, the workflow of
Figure 1 wants to stress the continuous validation of domain experts (i.e., therapists). The
“Session assessment” step indeed assesses the quality of the executed exercise (i.e., plan).
Feedback from therapists is crucial to incrementally refine the defined model of stimuli,
the planning model and the implemented selection criteria. Next sections describe how
the gathered knowledge is actually modeled into a (timeline-based) planning specification
and how clinical features are used to adapt the search of a planner to achieve the clinical
objective selected by the therapist.</p>
        </sec>
      </sec>
      <sec id="sec-3-2">
        <title>3.2. Timeline-based Planning</title>
        <p>
          Timeline-based Planning has been introduced in early 90s [
          <xref ref-type="bibr" rid="ref17">17</xref>
          ] by taking inspiration from
the Control Theory. A key aspect of this paradigm is the integration of planning and
scheduling and the synthesis of plans as envelopes of valid (and synchronized) temporal
behaviors of some domain entities. This aspect have characterized the practical use of
this paradigm in several real-world scenarios, especially from space like e.g., [18, 19].
        </p>
        <p>In the current work, we apply the timeline-based approach to the synthesis of
personalized rehabilitation exercises by extending the solving capabilities of an open-source
timeline-based framework called PLATINUm [20]. Before entering into the details of the
defined planning model and the experimental evaluation this section provides the reader
with some backgrounds about the planning formalism and the general solving capabilities
of the framework.
3.2.1. The Formalism in a Nutshell
A timeline-based specification describes the valid behaviors of a number of domain entities.
Given this description, a timeline-based planning process synthesizes a set of (temporally)
lfexible behaviors (i.e., timelines) that describe how these entities should evolve to achieve
some objectives. According to the formalization proposed in [21], domain features are
modeled by means of state variables.</p>
        <p>Definition 1. A State Variable is a tuple  = ⟨ ,  , ,  ⟩
domain entity:
describing valid behaviors of a
•  is a set of values   ∈  representing states or actions an entity can perform or
assume over time.
•  ∶  → 2  is a state transition function describing for each value   ∈  its possible
successors.
•  ∶  →  ×  is a duration function specifying for each value   ∈  its expected
duration bounds, expressed in some temporal domain  (typically ℕ+).
•  ∶  → {, , } is a controllability tagging function specifying the controllability
property of a value.</p>
        <p>Controllability properties characterize the execution of SVs’ values with respect to the
dynamics of the environment.</p>
        <sec id="sec-3-2-1">
          <title>Definition 2.</title>
          <p>A value   ∈  of a state variable  = ⟨ ,  , ,  ⟩
is:
• Controllable ( (  ) =  ) if the system can decide both the start and end times of its
execution.
• Partially-controllable ( (  ) =  ) if it can only be started by the system, while its
end time can only be observed.
• Uncontrollable ( (  ) =  ) if it can only be observed and thus the system can neither
decide its start nor its end.</p>
          <p>Information about controllability and temporal flexibility are crucial to deal with temporal
uncertainty and support robust execution of temporal plans (see the controllability
problem [22]).</p>
          <p>A flexible timeline for a state variable   is a sequence of temporal intervals called
tokens that describes an envelope of valid temporal behaviors.</p>
          <p>Definition 3. If   = ( ,  ,  , )
form:
is a state variable, a token   for the variable has the</p>
          <p>′ ′
  = (  , [  ,   ], [  ,   ],  (  ))
where   ∈  is the value assumed by the token   , [  ,  ′] is the end-time interval of  
(with   ≤  ′) and [  ,  ′] is the minimum and maximum duration of   (with   ≤  ′).</p>
          <p>Synchronization rules specify additional constraints that are necessary to synthesize
timelines that achieve desired objectives (i.e., planning goals).</p>
          <p>Definition 4.</p>
        </sec>
        <sec id="sec-3-2-2">
          <title>A synchronization rule has the form</title>
          <p>0[ 0 =  0] →  1[ 1 =  1], ...,   [  =   ].
where every   [  =   ] is a token variable denoting a temporal interval in which a
state variable   assumes the value   . The left-hand part of the synchronization rule
( 0[ 0 =  0]) is called the trigger of the rule. The set  specifies temporal relations
between token variables.</p>
          <p>Synchronization rules with the same trigger are treated as disjunctions and represent
alternative constraints that should hold between diferent sets of token variables.</p>
          <p>These are the main concepts composing a timeline-based planning specification. The
reader may refer to [21] for a complete description of the formalism.</p>
        </sec>
        <sec id="sec-3-2-3">
          <title>3.2.2. Iterative Refinement of Temporal Behaviors</title>
          <p>PLATINUm2 is an open-source timeline-based framework compliant with the described
formalism. The synthesis of a valid solution plan  is implemented as a general plan
refinement procedure.</p>
          <p>Given a set of state variables (  ) and synchronization rules ( ) a partial plan is
initialized from facts and goals of a planning problem. A partial plan represents a set of
partially instantiated timelines whose behavior is neither complete nor valid. The solving
process iteratively refines such timelines until a complete and valid set of SVs’ behaviors
is synthesized. In this regard, a flaw is a general condition afecting the completeness or
validity of a timeline. Flaws may concern either tokens to be added to a timeline (i.e.,
planning flaws) or, overlapping tokens of a timeline (i.e., scheduling flaws). Each iteration
of the planning process detects flaws on the current partial plan, selects the flaw to solve
and refines the plan by applying possible solutions. A solution is found when the “current
plan” does not contain any flaw i.e., the timelines of the plan are valid and complete.
Algorithm 1 summarizes this refinement procedure.</p>
          <p>Two decision points of Algorithm 1 are particularly crucial. One is the selection of the
lfaw to solve to refine the “current plan”. Although this is not a backtracking decision, it
strongly afects eficiency and determines the way planning and scheduling refinements
are interleaved. Heuristics ℋ encapsulates evaluation criteria that help Algorithm 1 to
select “the most promising” flaw to solve among those found on the current (partial)
plan.</p>
          <p>Another decision point concerns the selection of the plan to extract from the fringe.
Heuristics ℋ in this case encapsulates criteria that help Algorithm 1 to evaluate the
partial plans that compose the fringe and select the “most promising plan” to refine.
This is a backtracking decision and is particularly relevant with respect to the quality of
synthesized plans.</p>
          <p>2https://github.com/pstlab/PLATINUm
Algorithm 1 Timeline-based plan synthesis
Input:   ,  , ℋ , ℋ
Output:  = (  , )
1: Π ← ∅
2:  ← initialize(  ,  )
3: while ¬ isSolution( ,   ,  ) do
4: Φ ← flaws ( ,   ,  )
5: Φ∗ ← chooseFlaws (Φ, ℋ )
6: for  ∈ Φ ∗ do
7: Π ← refine ( , . resolvers)
8:  ← choosePlan (Π, ℋ )
9: return</p>
        </sec>
        <sec id="sec-3-2-4">
          <title>3.2.3. Pareto-based Heuristic Search</title>
          <p>To reason on the diferent clinical and technical aspects of the problem the search of
the solving process follows a multi-objective approach. Specifically, we have extended
PLATINUm by integrating a Pareto-based heuristic search to support heterogeneous
metrics and objective functions. Algorithm 1 thus relies on a multi-objective heuristic
ℋ that evaluates and compares partial plans   by taking into account clinical feature.
Similarly to other works [23, 24], for each metric  an evaluation function   (  ) is computed
as the sum of two elements:
  (  ) =   (  ) + ℎ (  )
(1)</p>
          <p>A cost element   (  ) estimates a metric  on the consolidated part of the partial plan   .
It takes into account the tokens that are part of the timelines of the plan   . A heuristic
element ℎ (  ) instead estimates a metric  on the possible refinements of the timelines of
  . It analyzes pending goals of the partial plan   (i.e., the agenda) and evaluates the
metric  on the possible projections of the timelines (i.e., tokens that could be added to the
timelines in future refinements). Since projections represent alternative refinements and
thus alternative behaviors, the heuristic value ℎ (  ) compute the minimum and maximum
estimated values of the projections. The minimum estimated value is generally considered
in order to guarantee the admissibility of the heuristic and thus do not overestimate the
actual cost of refinements.</p>
          <p>Equation 1 is used by ℋ to evaluate all the considered metrics  on all the partial
plans   of the fringe. The concept of Pareto dominance is used to establish relationships
between partial plans.</p>
          <p>Definition 5. Given a set ℱ = { 1, ...,   } of objective functions that a (timeline-based)
planning process aims at optimizing, a partial plan   is said to dominate a partial plan
  (with  ≠  ) if</p>
          <p>∀   ∈ ℱ ,   (  ) ⋈   (  )
where ⋈ = {&lt;} in the case that function   should be minimized and ⋈ = {&gt;} in the case
that function   should be maximized.</p>
          <p>The concept of Pareto dominance guides the search towards the Pareto set of the
fringe i.e., the subset of (not-explored) partial plans that do not dominate each other.
Such partial plans represent suitable trade-ofs with respect to the considered objective
functions. The choice among plans belonging to the Pareto set and thus the selection of a
specific solution is then made by “prioritizing” objective functions (solution polarization).</p>
        </sec>
      </sec>
    </sec>
    <sec id="sec-4">
      <title>4. Results</title>
      <sec id="sec-4-1">
        <title>4.1. A Planner for SI-Robotics</title>
        <p>Given the described timeline-based framework, this section further describes the defined
planning model and the objective functions that support the desired clinical objectives.</p>
      </sec>
      <sec id="sec-4-2">
        <title>4.2. Modeling “Choreography” Constraints</title>
        <p>The domain specification consists of a number of state variables characterizing the
structure of a rehabilitation exercise and a number of synchronization rules characterizing
possible combinations of dancing steps.</p>
        <p>Three types of state variable are defined. A goal state variable describes high-level
planning requests with a specified song duration and song rhythm expressed in bpm (beats
per minute). A level state variable describes the logical steps composing rehabilitation
exercises. The values of this state variable “sample” the whole exercise in a number of
blocks or logic steps that are necessary to contextualize the structure of the exercise
to the selected rhythm of a song. The number of logical steps that will compose a
plan (i.e., a rehabilitation exercise) depends on the duration of the song and its bpm.
Consider for example a song with a duration of 2 minutes and 60 bpm. In the case of
blocks with a fixed duration of 10 bpm a total number of 12 blocks (or logical steps)
will compose the exercise. Specifying 120 bpm with the same song duration and “block
size” instead the exercise will be composed by 24 blocks. In general, the values of this
state variable can be distinguished between “simple steps” that are directly mapped to
known (primitive) steps, and “complex steps” that are mapped to patterns specifically
designed by therapists. A step state variable then describes all the primitive steps known
by the planner. Synchronization rules map each simple step to all known primitive steps
and each complex step to the combinations of primitive steps defined by therapists. At
this level each rule represents a disjunctive choice and allow a planner to reason about
alternative rehabilitation exercises. Considering the dataset defined through the workflow
of Figure 1, each simple step is characterized by a branching factor of 134 (alternative)
choices of implementation/decomposition.</p>
        <p>In addition to these state variables two consumable resources are defined to model
and reason about spatial constraints of the layout. The vertical and horizontal axes of
Figure 2 are modeled as two consumable resources with maximum capacity 2 and 2
respectively. The levels of the two resources implicitly map the current position of a user
and thus the amount of space available in the vertical and horizontal areas of the layout.
Let us consider for example a horizontal axis resource with maximum capacity  = 4
and level  = 3 . This means that the user has  = 3 units of space available on the left-side
of the layout and  −  = 1 unit of space available on the right-side of the layout. The
same applies to the vertical axis resource.</p>
        <p>According to the body orientation of a user, each primitive step (i.e., each motion)
consumes or produces a certain amount of resource according to the required body
translation (see the technical features of Table 1). Let us consider a user with 0° orientation
and current position encoded by resource levels   = 1 (vertical axis) and  ℎ = 3 (horizontal
axis). A motion requiring the user to “make a leftward step” is modeled as an activity
consuming the horizontal axis resource of 1 unit. The execution of such a step would
decrease the level of the resource from  ℎ = 3 to  ℎ = 2.</p>
        <p>Steps that do not require an actual body translation but “only” some spatial requirement
(see again the technical features of Table 1) are treated in a similar way by combining
productions and consumptions of associated resources. Consider a user with 0° orientation
and current position encoded by resource levels   = 1 (vertical axis) and  ℎ = 3 (horizontal
axis). A motion requiring the user to “raise (and lower) the right arm to the shoulder”
is modeled as an activity that produces the horizontal axis resource of 1 unit during
its execution but that consumes the same amount of resource at its end. Namely, the
level of the horizontal axis resource is raised to  ℎ = 4 during the execution of the step
and lowered to  ℎ = 3 at its end (i.e., restoring the starting state of the resource). Such
resource constraints are modeled by means of dedicated synchronization rules (one for
each dancing step).</p>
      </sec>
      <sec id="sec-4-3">
        <title>4.3. Reasoning on Clinical Features</title>
        <p>The rules specified into the planning model allows the planner to synthesize sequences
of dancing steps that are correct with respect to the spatial constraints of the layout
and the expected duration (and timing) of the selected song. The planner then should
decide which sub-set of steps best fits the specific health-related needs of a particular
rehabilitation session. To this aim, the search strategy of the planner should be able
to combine and evaluate diferent metrics (i.e., diferent clinical features of Table 2)
according to the clinical objective selected by the therapist.</p>
        <p>From an optimization perspective the planning problem can be described by: a horizon
ℋ ∈ ℕ+ defined according to the specified song duration; a set
ℒ = 1, ...,  of expected
blocks’ IDs denoting the logical steps (defined according to the specified duration and
bpm of the song) and; a set  = 1, ..,</p>
        <p>of known primitive steps’ IDs. For each block
 ∈ ℒ and step  ∈  a binary decision variable is defined as follows:

 = {
1, if step  is selected during block 
0, otherwise
resulting plan “covers” the entire duration of the song.
the assignment of values to decision variables   should be such that the duration of the</p>
        <p>The objective concerning the stimulation of metabolic response can be seen as the
problem of maximizing the “efects” of the rehabilitation exercise on the metabolism of
the users while keeping the dificulty of the coordination low.</p>
        <p>maximize {  }, minimize {  }</p>
        <p>= ∑ ∑</p>
        <p>where functions   denotes the cumulative energy demand of a plan  .</p>
        <p>These objective functions determine the way a planner should reason on the clinical
features of plans. These objective functions are therefore encapsulated into the planning
towards the solutions that best fit the desired clinical objective.
framework as diferent search strategies</p>
        <p>ℋ in order to guide the search of Algorithm 1
where   ∈ ℕ is the duration of step  ∈  as specified in the dataset (see the technical
features of Table 1).</p>
        <p>Taking into account the clinical features of Table 2, clinical objectives are encoded
as two diferent multi-objective functions. The objective concerning the stimulation of
physical equilibrium can be seen as the problem of maximizing the “efects” of the
rehabilitation exercise on the overall cognitive/motor aspects of the users as well as
maintenance of body equilibrium.</p>
        <p>maximize {  ,   }
balance and body coordination of users.
where functions   and   denote respectively the cumulative impact of a plan  on body
 
∑ ∑     ≥ ℋ
(2)
(3)
(4)
(5)
(6)
(7)
(8)
  = ∑ ∑</p>
        <p>= ∑ ∑    
 



( )
( )
( )</p>
      </sec>
    </sec>
    <sec id="sec-5">
      <title>5. Discussion</title>
      <p>We have made an experimental evaluation of the developed planning framework with
the objective of assessing the eficacy of synthesized plans. To this aim we have defined
a number of planning problems by varying the following domain parameters: (i) song
time with values 60 seconds, 90 seconds and 120 seconds; (ii) song bpm with values 60
bpm and 120 bpm; (iii) layout dimension with values  ×  (i.e., the capacity of the
vertical/horizontal axis resources) equal to { 4 × 4, 6 × 6, 8 × 8 and 10 × 10 }.</p>
      <p>For each problem we have configured and run three planning instances: (i) a planning
instance labeled with 1 supports stimulation of physical equilibrium (i.e.,Equation 4);
(ii) a planning instance labeled with 2 supports stimulation of metabolic response (i.e.,
Equation 7); (iii) a last planning instance labeled with   does not support a specific
objective in order to show the behavior of a planner without a specific heuristic guide. A
number of 24 experiments for each planning configuration has been run (i.e., a total of
72 experiments). Table 3 shows average results out of 3 repetitions of each experiment
and a timeout of 3 minutes (i.e., 180 seconds).</p>
      <p>Results show initial but promising results concerning the capability of the planning
framework to deal with both spatial constraints and clinical requirements. A first part
of results show and compare the qualities of plans generated by the three planning
instances. Specifically, Table 3 shows the average scores of the discussed clinical features.
As expected, planner   without heuristics does not synthesize plans that are efective
with respect to the desired clinical objectives. In this case indeed plans do not show
neither the best value of balance nor the best value of energy. The planner 1 instead
efectively addresses the clinical objective concerning stimulation of physical equilibrium.
This configuration synthesizes plans with the highest values of balance and coordination.</p>
      <p>The performance of planner 2 instead is not efective as expected. As can be seen from
Table 3 indeed the planner does not achieve the best level of energy which is in particular
lower than the value achieved by planner 1 . Also, planner 2 is the configuration
with the lowest success rate denoting a dificulty of the heuristic in efectively guiding the
search to achieve the associated clinical objective (Equation 7). As a general observation,
solving behavior and the eficacy of the heuristics strongly depend on the encoded domain
knowledge and thus the scores assigned to the steps of the dataset. In this regard, the
behavior of 2 (compared to the behavior of 1 ) is clear signal of the need for refining
domain knowledge (see the workflow of Figure 1) in order to better characterize and
diferentiate the “impact” of known stimuli on users.</p>
      <p>For what concern the technical requirements and planning time, Table 3 shows how
layout and song duration afect solving performance. In particular, the parameters of the
layout determine capacity constraints of the underlying reservoir resources that strongly
afect the reasoning overhead due to consistency check of resource profiles. As can be
seen indeed a lower resource capacity (i.e., smaller layout) entails a harder planning
problem since a higher number of resource peaks (i.e., resource-related flaws) is detected.
Similarly a higher song bpm entails a harder planning problem since the planner should
consider a higher number of steps.</p>
      <p>Although initial and with some room for improvements (especially concerning planner
2 ), the experimental assessment shows promising results. Experiments show the
capability of “tailoring” the general-purpose search of the (timeline-based) planning
framework to diferent clinical objectives. These results therefore represent a solid basis
to further improve the reasoning capabilities of the framework and incrementally address
a wider set of clinical objectives and features.</p>
    </sec>
    <sec id="sec-6">
      <title>6. Conclusions</title>
      <p>The paper has described an ongoing work about the use of timeline-based planning for the
synthesis of personalized rehabilitation exercise programs. An experimental evaluation
has shown the technical feasibility of the developed framework. Next steps will focus
on improving the solving capabilities of the framework and performing experiments
with real users. In this regard, this work lays the foundations for the integration of
learning mechanisms suitable to “specialize” and improve solving performance. We plan
to integrate data from real users to automatically synthesize “specialized heuristics” and
pruning mechanism to reduce planning time.</p>
    </sec>
    <sec id="sec-7">
      <title>Acknowledgments</title>
      <p>This work is supported by “SI-Robotics: SocIal ROBOTICS for active and healthy ageing”
project (Italian M.I.U.R., PON – Ricerca e Innovazione 2014-2020 – G.A. ARS01_01120).
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[19] A. Jonsson, P. Morris, N. Muscettola, K. Rajan, B. Smith, Planning in Interplanetary
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[20] A. Umbrico, A. Cesta, M. Cialdea Mayer, A. Orlandini, Integrating resource
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