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(See Data S1, the SCALE Score Sheet, Directions for Administration, and Instructions for Grading, supporting information, published online.) Individual joint SCALE http://www.selleckchem.com/products/AP24534.html scores were compared using non-parametric repeated measures methods (Friedman procedure); the corresponding test for trend (Page test)18 was computed to analyse the relation among joints from hip to toes for the left and right lower limbs. Additionally, score frequencies for all pairs of joints were cross-tabulated for the left and right sides. When the proximal joint score was equal to or greater than the distal joint, we called this proximal to distal concordance (PDC). The percentage of PDC was calculated for all combinations of joint pairs within each limb. One hundred per cent PDC indicated that distal joint scores never exceeded those of proximal joints. StatXact 8.0 (Cytel Inc, Cambridge, MA, USA) was used for statistical computations. Mean SCALE scores showed greater SVMC impairment in distal than proximal joints bilaterally (Fig.?2). A statistically significant decrease in SCALE scores from hip to toes was found using the Page statistical test for trend (p http://www.selleckchem.com/products/Imatinib-Mesylate.html were significantly different from all other joint scores except the toes. The right ankle joint scores differed from the hip and knee scores and showed a tendency toward a difference from the subtalar joint score (p=0.065) Comparisons between scores for toes versus subtalar, and toes versus ankle, did not show a significant difference for either limb. Table?II presents p values for all pairwise comparisons using http://en.wikipedia.org/wiki/MERTK the Friedman test. The percentage PDC for cross-tabulations of joint score frequencies ranged from 81 to 100% (Fig.?3). Excluding comparisons between score frequencies for toes and subtalar joints, the percentage PDC was 94 to 100% (Fig.?3). Distal joint scores exceeded proximal ones for only nine limbs (seven participants) when comparisons involving the toes were excluded. To our knowledge, this is the first study to report SVMC of the hip, knee, ankle, subtalar, and toe joints in individuals with spastic CP. Our hypothesis of greater distal than proximal SVMC impairment within each limb was mostly confirmed. These results support the concept of increased vulnerability of CSTs associated with distal lower-extremity musculature. Previous research examining muscle strength15�C17 similarly found increased deficits in distal joints. Impaired SVMC may be associated with the observations reported in these studies. To determine the relative influence of muscle strength (force-generating capacity) and SVMC (neurological recruitment by CSTs) on movement production, both test positioning and the movement pattern requested must be examined.