# Are Electromyography Data a Fingerprint for Patients with Cerebral Palsy (CP)? [PERSON]  
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2 Laboratory of Neuromechanics, School of Physical Education and Sports Science at Serres, Ariste University of Thessaloniki, 541 24 Thessaloniki, Greece; [EMAIL_ADDRESS] 2  
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Footnote 1: email: {[[http://www.sciencedirect.com/science/article](http://www.sciencedirect.com/science/article)]([http://www.sciencedirect.com/science/article](http://www.sciencedirect.com/science/article))  
reasoning, understanding muscle activation patterns during gait with CP is essential for enhancing clinical decision-making and treatment outcomes. A key question that arises in this context is whether the electromyogram (EMG) remains consistent as a \"fingerprint\" in patients with CP following orthopedic surgery. Visually inspecting pre- and post-operative EMG signals in patients with CP, [PERSON] et al. [4] answered this question as a 'yes', indicating that EMG is robust to surgery. Therefore, they proposed the idea that we do not need to measure the EMG after the operation. However, the reliance on a limited sample size and the subjective interpretation of raw EMG signals are two main limitations of their study. Eliminating subjectivity, particularly in the context of CP, where EMG patterns are complex and patient-specific, is crucial to ensure that conclusions are scientifically robust and applicable across diverse populations. Employing objective methods, such as signal processing and pattern recognition, minimizes bias, enhancing data precision and reliability. Systematic EMG analysis validates its robustness post-surgery, offering clinicians more accurate tools for assessing long-term outcomes in patients with CP. [PERSON] et al. further explored pre- and post-treatment EMG patterns by monitoring 34 patients with CP, focusing on changes in the EMG signal envelopes rather than raw signals [5]. They observed a systematic improvement in the EMG of shank muscles (soleus, tibialis anterior, and lateral gastrocnemius) after a single-event multilevel surgery (SEMLS). However, the reported changes compared to kinematics and kinetics were relatively small. The majority of the patients in their study had equinus foot deformity with a history of calf muscle lengthening surgery, indicating the significant impact of shank soft tissue surgery on EMG in patients with CP. These findings align with other studies that indicated muscle activation patterns, as well as their recruitment in patients with CP, may change after an intervention [6; 7; 8]. Consequently, they concluded that EMG can describe the clinical condition of the patient before and after orthopedic surgery, and it can be considered for better clinical decision-making, such as the approach developed by [PERSON] et al. [9] to predict the results of rectus transfer surgery. The suggestion from [PERSON] et al. [5], which served as the main motivation for the current study, was to conduct a controlled study with a larger population and more homogeneous surgical treatment. They argued that employing such standardized approaches could help clarify the pre-operative compensatory mechanisms present in patients, ultimately improving the prediction of surgical intervention outcomes. Nonetheless, there remains a need for the development of new analytical methods to interpret EMG signals effectively in a clinical context. Moreover, the subjective evaluation of the pre-operative motor control status' impact on surgical outcomes, in conjunction with CP biomechanics, constitutes a notable gap in the extant literature warranting attention. Using clustering analysis, [PERSON] et al. [10; 11] established an association between the pre-operation activity of muscles in patients with CP and their response to the surgery. Moreover, they introduced a simple index as the ratio between the activity of the rectus femoris and gastrocnemius lateralis muscles as a predictor of the chance of improvement in patients with a crouch gait.