# Relevance of Surface Electromyography Assessment and Sleep Impairment in Scoliosis: A Pilot Study
## 4 Discussion
It has been shown that exercise-based studies have indicated reductions in Cobb angle and improvements in chest expansibility, vital capacity, and respiratory muscle strength [29]; we also find these remarks in our study because the chest elasticity showed improvement after therapeutic intervention. GPR is grounded on the concept that postural muscles function as coordinated \"muscle chains\" positioned both anteriorly and posteriorly to the spine. GPR targets these muscle chains to restore balance and improve overall postural alignment [30]. Treatment with an active muscle stretching method not only influences the spine but also has physiological effects at the motor cortical level. In previous studies, pain and functionality were commonly explored as outcome variables [13], while specific variables related to postural balance and muscle efficiency with electromyography (EMG) were relatively less frequently investigated [31]. EMG is also widely used in studies of the paraspinal muscles in scoliotic patients. Over two decades ago, EMG signals were recorded from the paravertebral muscles in adolescents diagnosed with idiopathic scoliosis. These signals were compared with EMG signals from subjects without this condition. The results showed that the EMG signals from the left lumbar paravertebral muscles were increased compared to those from the right lumbar paravertebral muscles at the beginning and during the early stages of muscle contraction in scoliosis patients [32]. The results of this study demonstrate the role of EMG in monitoring the evolution and also in the development of the physical therapy intervention for increasing muscle balance at the paravertebral level. Also in our study, EMG recording helped us to analyze the evolution. In relation to this study, our results also indicate marked muscular asymmetry, as demonstrated by electromyography recordings. The statistical analysis revealed the persistence of this imbalance in both standing and hyperextension situations. Our results are supported by the EMG recordings, and, recently, additional examinations focusing on EMG signals have been conducted, specifically targeting the paravertebral muscles during exercises involving both symmetric loading and asymmetric stretching. Furthermore, an accelerated progression of idiopathic scoliosis has been found to be correlated with an increased proportion of type 1 muscle fibers in the convex region of the scoliotic curvature. These findings raise questions about the interplay between asymmetry in the paraspinal musculature and the incidence of idiopathic scoliosis in adolescents [33]. This study correlates with our findings regarding the symmetry index, which indicates significant right-left asymmetries. These asymmetries may be explained, in part, by changes in muscular composition, specifically, the predominance of certain types of muscle fibers. The documentation regarding the subject addressed in this research allowed us to conclude that the studies related to the muscle behavior in idiopathic scoliosis were carried out on a small number of subjects; therefore, our research highlights an innovative approach in which the muscle behavior was correlated with evaluations that involve three important aspects that can accompany the child with idiopathic scoliosis, namely, sleepiness, the mental perception of the installed physical deficit, and the participation in physical activities with character sporty. The significant statistical evolution of the Epworth Sleepiness Scale results from our study indicates a correlation with physical status, which is represented by the improvement in symmetry indices and thoracic elasticity. These improvements signify enhanced trunk dynamics and, consequently, an increase in oxygen intake during respiration. This suggests that as the physical aspects, such as symmetry and thoracic flexibility, improve; there is a positive impact on respiratory function, resulting in reduced sleepiness and enhanced overall well-being.