# Relevance of Surface Electromyography Assessment and Sleep Impairment in Scoliosis: A Pilot Study
## 1 Introduction  
The vertebral column, also seen as the axis of the human skeleton, involves essential functions assigned to the body's physiology and kinesiology [1]. In the case of young persons, the most widespread structural changes are represented by scoliosis and kyphosis. In scoliosis, the shape of the spine changes in the sense of the appearance of atypical curves that follow either the line of the letter \(C\) or of the letter \(S\)[2]. Also, Lehnert-Schroth (LS) played a significant role in the advancement and classification of these curve patterns. The LS classification, according to Schroth terminology, is a system used in pattern-specific physiotherapy to distinguish between two main types of scoliosis: \"functional 3-curve scoliosis\" and \"functional 4-curve scoliosis\". These distinctions help tailor physiotherapeutic treatment for scoliosis patients. Scoliosis is generally detected when the angulation of the vertebral curvature exceeds 10 degrees [3], mainly appearing in adolescents with an average age of 10 to 16; sometimes scoliosis may be discovered in adulthood [4]. The severity of the deformity is based on the scoliotic curvature, on the asymmetries of the shoulders and hips, as well as on the rotation of the vertebral bodies. Long debatedin scoliotic cases were also the sleep quality and sleepiness. Since sleep is considered a state of physical and mental rest, its importance becomes crucial, especially in the case of children and adolescents. Their health and development are directly correlated with sleep quality [5]. A total of 91 patients diagnosed with idiopathic scoliosis and aged between 10 and 19 years were analyzed using the Pittsburgh Sleep Quality Index scales (PSQI) and Epworth Sleepiness Scale (EPSS). Of the participants, 64.8% indicated a low sleep quality, while the state of sleepiness during the day was described as normal by 85.7% of the participants [6]. Evaluated in numerous studies and associated with various pathologies, sleep and sleepiness were not clearly correlated with scoliotic attitudes. This fact indicates the need for continuous research in this direction [7]. Early detection and regular monitoring of idiopathic scoliosis prove to play a decisive role in preventing the progressive process of scoliosis as well as in the recovery process of spine dysfunctions [8]. For a reliable evaluation of the functional status, surface electromyography (EMG) can be used. In this sense, the activity of the paravertebral muscles, at the level of T8 and L3, for patients with idiopathic scoliosis proved to be increased, in terms of amplitude, in the convex region of the scoliotic curvature [9]. The same study shows that, compared to a control group, scoliotic patients do not show significant variations in the myoelectric parameters. However, EMG evaluations are not based on reference values; this leads to a lack of standardization through electromyography evaluation. In this context, numerous studies are based on electrical muscle assessment completed before and after the application of a therapeutic protocol. Such a study took place in 2018 on five patients diagnosed with idiopathic scoliosis with an average age of 14.4 years. The result of the study showed that the EMG signal proved to be significantly different after completing the therapeutic protocol for all muscle groups [10]. Equally, studies based on the comparison of the electrical activity of the erect spinae on scoliotic patients as well as healthy subjects show noticeable EMG signal differences; in the convex region of the scoliotic curve, muscle activity proved to be increased [11]. From a therapeutic point of view, the approaches focused on the use of general Global postural reeducation (GPR) and Schroth therapy have not been intensely debated. Global postural reeducation (GPR) is a method that focuses on adjusting and reorganizing the posture of the human body to achieve a rebalancing of the postural muscles. GPR identifies and stretches the specific muscles that are considered responsible for postural changes.