# Relevance of Surface Electromyography Assessment and Sleep Impairment in Scoliosis: A Pilot Study
## 5 Conclusions  
A multifactorial assessment of scoliosis offers concrete information regarding potential connections of muscle imbalance and the clinical status of the scoliotic patient. The patterns of muscle activity are different depending on the assessment posture (flexion, hyperextension, or orthostatic posture). In the majority of subjects with double-curve scoliosis, significant differences were noticed for flexion movement before and after completing an adapted therapeutic protocol. Variations noticed in the paravertebral muscles' electrical activity reveal the high importance of a correct EMG measurement. While static EMG evaluations did not differentiate subjects with scoliosis from non-pathological individuals, dynamic EMG signals provided distinct interpretations, which align with our study findings. 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. It can be noticed that for 14 out of 15 subjects (93.33%), the SAQ score 1 has a decreased value in T2 compared to the T1 moment. It can be also noticed that for 9 out of 15 subjects (60%), the SAQ score 2 has an increased value in T2 compared to the T1 moment. Through statistical analysis of the Epworth scale, significant differences can be observed between the two moments (T1--before the kinetic rehabilitation program; T2--after completing the rehabilitation program), while no significant difference was noticed for the Baecke scale. The physical aspects, such as symmetry and thoracic flexibility, improved, and there was a positive impact on respiratory function, resulting in reduced sleepiness and enhanced overall well-being. This relationship highlights the importance of addressing physical aspects in scoliosis management to improve respiratory capacity and the overall quality of life. Statistical analysis reveals correlations of the assessment scales with the clinical status of the patient after performing an individualized therapeutic protocol; this fact proves the efficiency of the combined Schorth and GPR exercises in the rehabilitation process of the scoliotic patient. As the present study was conducted on a limited number of subjects, further research is needed to extend the obtained results regarding the efficiency of Schroth and GPR exercises in the rehabilitation of scoliotic patients. The limitations of our study are linked with the ESS-CHAD scale as the test cannot be used to predict how likely a person is to fall asleep in any given situation in the future; also, the other two scales used are based on the children's responses and could be affected by their understanding and availability to provide real answers. At the same time, we consider that our study, like a pilot study, opens a way for new research in the study of idiopathic scoliosis and helps to provide a holistic approach that includes not only treatment but also a complex evaluation of the impact of scoliosis on the life of these children. D.P. and E.I., data collection, design of the study, methodology; L.R., conceptualization, methodology, writing--original draft preparation measurements, investigation; M.I.M., methodology, software, visualization; D.P. and E.I., resources, writing--original draft preparation, writing--review and editing. All authors have read and agreed to the published version of the manuscript. **Funding:** This research received no external funding. **Institutional Review Board Statement:** This study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the University of Craiova Research Centre for the Human Body; motricity study nr 235/18/10/2021. **Informed Consent Statement:** Informed consent was obtained from all subjects involved in the study. **Data Availability Statement:** Not applicable. **Conflicts of Interest:** The authors declare no conflict of interest.