Nooijen et al. 2009
USA
Pedro = 7
RCT
N = 51

Population: All subjects had motor-incomplete spinal cord injuries and were at least 1 year post injury; Group 1: mean age = 38.15; T11-C3; Group 2: mean age = 39.47; T9-C4; Group 3: mean age = 41.64; T6-C4; Group 4: mean age = 44.33; L2-C6.
Treatment: 12-week training period. All body weight support locomotor training (BWSLT): Group 1 = treadmill with manual assistance; Group 2 = treadmill with peroneal nerve stimulation; Group 3 = overground with peroneal nerve simulation; Group 4 = treadmill with assistance from Lokomat
Outcome Measures: Cadence, step length, stride length, symmetry index, intralimb coordination, timing of knee extension onset within the hip cycle; all compared to non-disabled controls.

1. No significant between-SCI group differences. Pooled data were then used to assess the effects of training.
2. Training significantly improved: cadence, step length and stride of both the stronger and weaker legs.
3. After training, subjects were able to take more steps per minute
4. There was an interaction effect between step and stride lengths. Post hoc analyses revealed Group 3 had a significantly larger gain compared to group Group 4.
5. No training effects found on symmetry or coordination.
6. After training gait outcome measures were more similar to able-bodied controls than they were before training.

Musselman et al. 2009;
Canada
PEDro = 6
RCT with crossover
N = 4

Population: 2 male and 2 female subjects, age 24-61, level of injury C5-L1, all AIS-C.
Treatment: All subjects received 3 months of BWSTT, then subjects underwent 3 months of BWSTT and 3 months of skill training in random order
Outcome Measures: Modified Emory Functional Ambulation Profile (mEFAP); 10-meter walk test; 6-minute walk test; Berg Balance Scale; Activity Specific Balance Confidence (ABC).

1. Improvement of mEFAP with skill training in all subjects (average improvement 731.5); improvement also seen with BWSTT in 2 of 4 subjects (-1379 and -731 respectively); gains were maintained after training (statistical test for significant was not done)
2. Results for the 10m and 6-min walk tests improved more with skill training (average 0.10m/s) compared to BWSTT (average 0.02m/s); again tests for significance was not done
3. Minor improvements in Berg Balance Scale (9, 0, 10 and 5 points for subjects 1, 2, 3 and 4 respectively), and no improvement for ABC

Field-Fote et al. 2005; USA
PEDro = 6
RCT
N= 27

Population: 27 males and females; age 21-64 yrs; with incomplete SCI; C3-T10 lesion level; >1 yr post-injury.
Treatment: Randomized to 4 gait training strategies, 45-50 min, 5X/week, 12 weeks: 1) manual BWSTT (n=7); 2) BWSTT+FES (common peroneal nerve) (n=7); 3) BWS overground + FES (n=7); 4) BWS Lokomat (robotic gait device) (n=6).
Outcome measures: Walking speed over 6 m (short-bout) and 24.4 m (long bout).

No significant differences between pre- and post-intervention walking speed in the manual BWSTT or BWS Lokomat groups. However, there was a tendency for subjects with initially slower walking speeds (<0.1 m/s) to have a greater percent increase in walking speed (57% to 80%) compared to those with initially faster walking speeds (-19% to 5%)

Gorassini et al. 2009;
Canada
Downs & Black = 15
Prospective Controlled Trial
N = 23

Population: 17subjects with incomplete SCI, mean age 43.8+16.5, injury level C3-L1, and 6 AB controls. Subjects were divided into 2 groups: those who improved in walking ability (responders, n=9, 4 AIS-C, 5 AIS-D) and those who did not (nonresponders, n=8, 7 AIS-C, 1 AIS-C)
Treatment: BWSTT, on average 3.3+1.3 days/week for 14+6 weeks
Outcome Measures: EMG; Walking Index for Spinal Cord Injury II (WISCI II)

1. Responders had an average WISCI II increase of 4.6pts, compared to no increase in the nonresponders.
2. The amount of EMG activity increased significantly after training in responders, whereas no change was observed in nonresponders.

Hicks et al. 2005; Canada
Downs & Black = 16
Pre-post
N=14

Population: 14 males and females; age 20-53 yrs; 2 subject with diagnosis of AIS B and 12 subjects with diagnosis of AIS C; C4-L1 lesion level; 1.2-24 yrs post-injury.
Treatment: BWSTT: <45 min, 3x/wk, 144 sessions (12 months).
Outcome measures: Wernig Walking Capacity Scale.

1. 6/14 subjects improved in walking capacity, but only 3 maintained improvements at 8 months post-training.
2. 3/10 initially non-ambulatory subjects could walk (with assistance) post-training.

Wirz et al. 2005; Switzerland
Downs & Black = 15
Pre-post
N=20

Population: Age range =16-64 yrs; 9 subjects with diagnosis of AIS C and 11 subjects with diagnosis of AIS D; C3-L1 lesion level; 2-17 yrs post-injury
Treatment: BWSTT: <45 min, 3-5x/wk, 8 wks.
Outcome measures: WISCI II, 10MWT, 6MWT.

1. 2/20 subjects improved WISCI II scores.
2. Overall increase in 10MWT of 0.11 ± 0.10 m/s (56% improvement).
3. 15/16 subjects improved in 6MWT.

Winchester et al. 2009
USA
Down & Black = 14
Pre-post
N = 30

Population: Mean age = 38.3±13.6; 22 male; 23 subjects with tetraplegia, 7 with paraplegia; time since injury = 16.3±14.8 months.
Treatment: Locomotor training, including: robotic assisted BWSTT, manually assisted BWSTT, and over ground waking. 3 times per week for 3 months.
Outcome Measures: Walking performance (WISCI II) and 10 meter walk test (10MWT).

1. 22 subjects showed improvement in walking speed; 8 showed no change post-training.
2. Pre-training, 16 subjects could not walk. Post-training, 5 remained unable to ambulate, 7 recovered ambulation but needed assistance, and 4 recovered independent ambulation.
3. Step-wise regression analysis showed that time post-injury, voluntary bowel and bladder voiding, functional spasticity, and walking speed before training were the strongest predictors of post-training overground walking speed.

Protas et al. 2001;
USA
Downs & Black = 14
Pre-post
N=3

Population: 3 males; age 34-48 yrs; Subject diagnosis were AIS C and D; T8-T12 lesion level; 2-13 yrs post-injury
Treatment: BWSTT: 20 min, 5x/wk, 12 wks.
Outcome measures: Garrett Scale of Walking, Assistive Device Usage Scale, Orthotic Device Usage Scale, gait speed (5m), gait endurance (5 minutes).

1. All subjects showed an increase in gait speed and endurance.
2. All subjects showed improvement, indicated by the Garrett Scale of Walking or the type of assistive or orthotic devices used.

Thomas & Gorassini 2005; Canada
Downs & Black = 12
Pre-post
N=6

Population: Age 29-78 yrs; 4 subjects with diagnosis of AIS C and 2 subjects with diagnosis of AIS D; C5-L1 lesion level; 2-28 yrs post-injury
Treatment: BWSTT: < 60 min, 3-5X/week, 10-23 weeks.
Outcome measures: 10 meter walk test (10MWT), 6 meter walk test (6MWT), walking performance measure (WISCI II).

1. 5/6 subjects improved WISCI II score. Overall significant improvements in 6MWT and 10MWT and improvements correlated with the increase in corticospinal connectivity.

Effing et al. 2006;
Netherlands
Downs & Black = 11
Pre-post
N=3

Population: 3 males; age 45-51 yrs; subject diagnosis were AIS C and D; C5-C7 lesion level; 29-198 mos post-injury
Treatment: BWSTT: 30 min, 5x/wk,12 wks.
Outcome measures: Wernig Walking Capacity Scale, gait speed over 7m.

1. Gait improvements in all subjects, indicated either by faster gait speed or higher score in Walking Capability Scale.

Wernig et al. 1995; Germany
Downs & Black = 10
Case Control
N=97

Population: Study 1: 44 males and females subjects with chronic paraplegia or tetraplegia. Study 2: 53 males and females subjects with chronic paraplegia or tetraplegia.
Treatment: Study 1: BWSTT: 30-60 min, 5x/wk, 3-20 wks (median 10.5 wks). Study 2: 29 subjects underwent BWSTT (as in Study 1) versus 24 historical controls who underwent conventional rehabilitation.
Outcome measures: Wernig Walking Capacity Scale.

1. Study 1: 25/33 initially non-ambulatory could walk after BWSTT. Results of 11 initially ambulatory subjects unclear. At 6 months post-training, 18/21 ambulatory patients maintained abilities or improved endurance.
2. Study 2: 14/18 initially non-ambulatory subjects could walk after BWSTT. Only 1/14 initially non-ambulatory in the historical controls learned to walk. Other specific improvements in initially ambulatory subjects in either the BWSTT or historical control groups were not clearly described.

Wernig et al. 1998; Germany
Downs & Black = 9
Pre-post
N=35

Population: 35 males and females; age 19-70 yrs; C4-T12 lesion level; 1-15 yrs post-injury
Treatment: BWSTT: 30-60 minutes, 5x/wk, 8-20 wks.
Outcome measures: Wernig Walking Capacity Scale.

1. 20/25 initially non-ambulatory improved to walking with aids.
2. 2/10 ambulatory patients improved functional class, but all improved speed and endurance.
3. At follow-up (0.5-6.5 years later) all ambulatory patients remained ambulatory, with changes only in functional class.