Acceptance of sEMG is an issue of paradigm shift. It puts clinician in an uncomfortable position to choose between tradition-innovation, convenience-diligence, quick-correct, etc. There is behavioural inertia that is slowing the acceptance of sEMG. Paradigm shifts of recent times are “recycling of plastic”, “shifting from combustion engines”, “shift from thermal power to hydro/solar”, “standardization of Health establishments”, “annual to semester calendar”, “digitization of records/processes” etc. All these changes were advantageous, but they didn't happen easily. An orchestrated policy, backed by qualified “techno-bureaucratic will” realized such paradigm shifts that are now norms. Generally, clinicians are technology laggards and issues of resources availability are not directly under clinicians’ control. Administrators of healthcare are the controllers of “resource allocation” (systems, space, finance, manpower and support services). They are executives articulating between management's interests (primarily) and demands of clinicians. They are sensitive to profit enhancing propositions and statutory compliances. Surface EMG fails on both of these attributes. It is not mandated by norms and its cost effectiveness studies are limited (1). Adopting sEMG implies a significant learning effort (undesirable to clinician) and increased resources (undesirable to administration). Hence well-known limitations of sEMG, reported in research studies, are stressed to avoid dealing with the subject. This is a common approach to distract attention from root-cause. Actual issues are rarely reported objectively. A decisive policy is needed to upgrade teaching and outdated clinical practice, as discussed in literature (2–4).

The following sections list and describe a number of proposed actions and the role of the stakeholders.

The first author has been directly involved in Indian Government policy-making for implementing reforms in academic syllabi, accreditation, internship-training, assessing public/private institutions, career enhancement schemes, regulatory compliance, etc. and has observed great differences between what health managers say in research/reports and how they behave in practice. Vital initiatives required to establish sEMG in the order of importance are:

In India, and many other countries, PTs undergo 4 years of UG education (BS) followed by 2 years of PG education (MS) and a PhD. They do clinical diagnosis (5) and measurement of muscles/movement and should be educated to record, process and interpret sEMG signals as expressions of neuromuscular control. Physiotherapists are at the pivot of creating knowledge about movements, on one side, and applying STEM methodologies for patient-care, on the other side. PTs are vital in assessing and monitoring rehabilitation of all movement disorders. With the phenomenal improvement in research and academics, PTs are the most efficient lever to optimize therapies and measure outcomes in a rehab team. The majority of physicians/surgeons endorse the role of PTs as vital in early and effective functional restoration of movement. PTs are widely accepted in society and patient community at large. Recognized as pain relieving and activity restoration specialist by non-drug methods PTs are welcome saviours especially for managing chronic disorders (5). PTs are among the few health operators who exploit electronic instrumentation such as electrical stimulation, ultrasonic, diathermy and are well versed with use and safe handling of electrical equipment. Clinical monitoring of anomalies by evoked responses like Faradic-Galvanic testing, chronaxie, rheobase, strength-duration curve etc. are age-old in PT. Additional training of physiotherapists may include sEMG signal processing, electrode placement, data acquisition, feature extraction and interpretation, sources of errors, etc.

The precise role of PTs in this regard can be categorized in the following strata that also apply to any other technological field:

The largest target for sEMG knowledge dissemination are UG students. Their approach is positive and, if motivated, they do show keenness towards sEMG. Students show interest in modern instrumentation and their capacity to grasp STEM technology is higher than physiotherapists’ who focus on patient loads. The tendency to resist changes in clinical practices is less likely in students, especially if it is linked with their academic-performance/curricular-credits. sEMG instrumentation can be made available in institutions whereby more students can learn at one center. Clinicians show less interest in CME on sEMG as they never learned its scope/relevance in practice.

Three pronged “EMG strategy” should be applied to present sEMG knowledge and instrumentation to the learner's mind: (1) Educate, (2) Mandate, and (3) Grow.

There is a widespread consensus about the need of reducing the gap between the available sEMG knowledge in the field of rehabilitation assessment and the clinical application of such technology in physiotherapy and movement sciences (2–4). There is also (a) extensive literature concerning the clinical applications of sEMG a sample is provided in (17–26), (b) the need to adopt evidence-based practice (EBP) approaches and (c) the need to increase consensus about sEMG-based planning and evaluation of interventions (2, 3, 15, 16). The need of translational efforts to increase the competence and technical expertise of clinical operators in these fields is also widely recognized. However, consensus on how to address these problems, how to disseminate knowledge and improve academic education, training and competence of professional clinical operators, is lacking. The benefits of sEMG are increasingly acknowledged, there is a critical need to increase its adoption. By enhancing the integration of sEMG into clinical practice, we can ensure a more structured approach to rehabilitation assessments, ultimately improving the effectiveness of interventions and patient outcomes.