Use of Surface EMG in Clinical Rehabilitation of Individuals With SCI: Barriers and Future Considerations

Why Surface EMG Hasn’t Made It Into Routine SCI Rehabilitation

Surface electromyography (sEMG) offers rehabilitation clinicians something few other tools can: objective, quantifiable insight into the myoelectric output of a muscle. Yet despite decades of research use, sEMG remains largely absent from day-to-day clinical rehabilitation for individuals with spinal cord injury (SCI). A perspective piece published in Frontiers in Neurology, co-authored by researchers from the Kessler Foundation, Rutgers New Jersey Medical School, and Koneksa Health, lays out why, and what it would take to change that.

Where the Barriers Lie

• Clinical workflow constraints: Integrating the time-consuming aspects of sEMG into the already demanding schedules of physical therapists, occupational therapists, and other clinicians is a major practical obstacle to adoption.
• Confidence and training gaps: Many clinicians lack confidence using sEMG technology, stemming from limited exposure during training and, often, limited mathematical grounding in signal analysis through their educational and professional curricula.
• Slow technology transfer: Advances from sEMG research are slow to make their way into off-the-shelf EMG systems, partly because limited clinician demand for advanced features creates little commercial pressure to build them.
• Usability shortfalls: A lack of user-friendly, intuitive interfaces further limits adoption, alongside the need for a multidisciplinary approach to accurately handle and interpret sEMG data.
• SCI-specific interpretation challenges: The paper notes that sEMG recording and interpretation in SCI populations is complicated by non-standardized approaches, driven by the physiological and structural variability of spinal cord injury itself.

What It Would Take to Change This

The authors frame the path forward as fundamentally collaborative: closing the gap between sEMG’s research potential and its clinical use will require a coordinated, interdisciplinary effort, not a single technical fix. Suggested steps include strengthening sEMG-based case studies and hands-on research exposure in clinical education curricula, and building shared platforms where clinicians and technicians can exchange knowledge and self-educate.

For sponsors and technology developers working on neuromuscular or rehabilitation-focused digital measures, this perspective is a useful reminder that device and signal validity are necessary but not sufficient; clinical workflow fit and end-user confidence are just as critical to real-world adoption.

Reference: Pilkar R, Momeni K, Ramanujam A, Ravi M, Garbarini E, Forrest GF. Use of Surface EMG in Clinical Rehabilitation of Individuals With SCI: Barriers and Future Considerations. Front Neurol. 2020;11:578559. doi:10.3389/fneur.2020.578559. PMID: 33408680.