# Relevance of Surface Electromyography Assessment and Sleep Impairment in Scoliosis: A Pilot Study
## 4 Discussion
This relationship highlights the importance of addressing physical aspects in scoliosis management to improve respiratory capacity and the overall quality of life. To predict the tendency of scoliotic conditions, asymmetric EMG signals recorded in the paravertebral musculature of adolescents may not be conclusive. In this context, the relevance of these variables may become more apparent upon completion of the growth process, providing a clearer picture of their impact on scoliotic development [34]. This study supports our results, which indicate minimal evolutions of the restoration of symmetry in the three situations considered by us. While there is a cohort of studies linking muscular electrical activity to the functional status of scoliotic patients, many aspects remain unclear. The lack of standardized values for recorded EMG parameters makes research findings a reference point or means of support for previous studies rather than a provider of definitive conclusions. Therapies combining symmetrical muscle loading and asymmetrical stretching exercises were used to assess the effectiveness of optimal physical exercises for patients with scoliosis. The results showed significant differences in EMG values before and after completing the rehabilitation program. These findings suggest that tailored exercise regimens can lead to notable changes in muscle activity, potentially improving muscular balance and postural control in scoliosis patients [35]. Another one of the therapies we explored in this study that relates to the information above is Schroth therapy. Exercise rehabilitation helps patients understand their unique spine and learn postural modifications for improved symmetry and spinal stabilization. This knowledge becomes valuable for managing scoliotic curves, especially for young patients, as they can apply these techniques throughout their lives if necessary [14]. The study of [PERSON] et al. (2016), reported a Schroth treatment regime that was in accordance with ours. In that study, treatment regimens lasted for six weeks, with 18 sessions conducted either as outpatient visits or as a home-based program. Patients in the Schroth exercise group began their exercise program under physiotherapist supervision, dedicating 1.5 h a day, three days per week. The Schroth exercises were performed in an asymmetric position to maximize correction and achieve trunk symmetry. There are only small differences in the concept of our treatment regime regarding the period of time, which lasted longer for our study (12 months), and the consistency, which was actually lower (two times per week) in our study [36]. Another study [37] assessed patients before and after 6 weeks of Schroth exercises using optical topography, electromyography, and stabilometry. The EMG detail was also explored in our study. However, the sustainability of the improvement over a longer period was not investigated. [PERSON] et al. reported a significant increase in muscle strength after 1 year of intervention [38]. This fact is directly related to our study. From what we have researched, Schroth exercises combined with the standard of care have been shown to increase back extension endurance. Other studies have, similarly, observed ceiling effects in patients with smaller curves who undergo conservative treatment, similar to the treatment program that we suggested in our study, as evidenced by SAQ scores. In another study, it is shown that the success of [PERSON] therapy is attributed to its proprietary Schroth rotational angular breathing (RAB) technique [39]. By using the elements from Schroth therapy and GPR, with their specific breathing techniques, we obtained a better outcome in the measurements of the chest circumference coefficient, something that is related to the information obtained from previous studies. The results of our study try to provide answers regarding sleepiness and scoliosis, which were generated in a long debate.