# Relevance of Surface Electromyography Assessment and Sleep Impairment in Scoliosis: A Pilot Study
## 2 Materials and Methods
### Therapeutic Intervention  
Our treatment regime included elements of global postural reeducation (GPR) combined with elements from Schroth therapy. The primary objective of this protocol was to address and prevent the progression of postural impairments by implementing appropriate corrective measures. The objectives of the physical therapy program are as follows:  
1. Correcting and reducing scoliosis curvatures. 2. Increasing and restoring joint mobility. 3. Strengthening the affected muscles through elongation and shortening exercises. 4. Correcting and maintaining muscle tone. 5. Reeducating the respiratory system. These objectives aim to address and improve postural impairments, muscle imbalances, and respiratory function through targeted exercises and corrective measures. The kinetic program is designed to promote overall functional improvement and enhance the individual's quality of life. The patients underwent treatment using the GPR (global postural reeducation) method, which involved performing two postures: _\"frog on the ground\"_ (Figure 3a) and _\"frog in the air\"_ (Figure 3b), both with open arms. These postures were implemented in two stages. The first stage lasted for 5 min, and the second stage lasted for 10 min. Rest intervals were provided as needed during the treatment sessions if necessary [21]. Figure 2: Electrode placement at a distance of 2 cm from the spine’s axis on the right and left side of the scoliosis’s curvature apex. A neutral electrode was positioned on the spinous process of the C7 verteba. During the _\"Frog\" posture on the floor_, individuals were instructed to lie supine on the stretcher with their hips in a partially flexed and externally rotated position. Their knees were flexed, and their feet were in dorsiflexion, with the heels together. Initially, the arms were positioned in 90\({}^{\circ}\) abduction, with the forearms supinated and fingers extended. For the _\"Frog\" posture in the air_, participants were in a supine position on a GPR (global postural reeducation) stretcher, but we adopted a modified position with legs supported on the wall. Their hips were flexed at a 90\({}^{\circ}\) angle with external rotation, while the knees were semi-flexed. The feet were in dorsiflexion with the heels together. The shoulders were positioned at 90\({}^{\circ}\) abduction, and the forearms were supinated with the fingers extended [22]. These specific postures were performed as part of the treatment protocol to target and address postural impairments. Each posture was carefully designed and customized by the physiotherapist based on the patient's specific spinal deformity and individual defense mechanisms. The therapist responsible for working with the patients underwent specific training (co-author IE) and is a certified GPR (global postural reeducation) physiotherapist. This specialized training and certification ensured that the therapist had the necessary expertise to develop and implement the postures effectively for each patient's condition. Our patient's exercise program also included elements from Schroth therapy. The patients commenced their exercise program under the supervision of a physiotherapist who is certified in Schroth therapy (co-author IE). The Schroth exercises were performed in an asymmetric position to optimize correction and attain trunk symmetry (Figure 4). These exercises encompassed activities such as spinal elongation, de-rotation, de-flexion, stretching, strengthening, and rotational breathing exercises, all aimed at maintaining proper vertebral alignment [23]. Each posture was sustained for a duration of 10 min during the exercise sessions. This structured approach allowed for targeted engagement of specific muscle groups and facilitated the correction and improvement of postural alignment. The physiotherapist's expertise in Schroth therapy ensured that the exercises were appropriately administered and tailored to meet the needs of each patient. Figure 3: (**a**) Frog on the ground (GPR) (**b**) Frog in the air (GPR).