Training to achieve over ground walking after spinal cord injury: A review of who, what, when, and how

Spinal cord injury (SCI) results in devastating changes for the individual and costly consequences for the individual, their families, and society. Restoration of walking is a rehab priority; retraining walking after SCI has been a vibrant area of research since 1990, brought about by the discovery that mammals with complete SCI can be retrained to produce walking movements with weight bearing if they are trained on a treadmill. However, methods, equipment and intensity of training differ greatly. This review provides clinicians with the best current evidence for effective retraining of over ground walking. 

Who: Patients with motor incomplete lesions and some preservation of strength in the legs. Individuals with ASIA C and D lesions are more likely to achieve functional walking. 
What: Walking must be a major part of the therapy. Treadmill, over ground, or both: all produce favorable results. 
How: Unassisted or with partial assistance from either a robot or therapists. Active participation from the individual is necessary. Robotic design advances are promising but not tested yet. 
When: As soon as possible – better walking outcomes are achieved with early training, but chronic injuries can still improve. 

Take home message: Intensive training using walking as the main activity in the training, with partial or no assistance, is the most important ingredient for success. Walk! > From: Yang et al., J Spinal Cord Med 35 (2012) 293-304. All rights reserved to The Academy of Spinal Cord Injury Professionals, Inc.

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