Clinical Bottom Line: With the very limited amount of quality evidence that has been conducted in the use of BWSTT to improve overground walking ability in the SCI population, it appears that BWSTT is able to improve overground ambulation but is no better than conventional physical therapy. In the only RCT with a comparison group that received conventional physical therapy, BWSTT and conventional physical therapy treatment arms generated similar improvements in overground walking speed and FIM-L scores (Dobkin et al 2006). Subjects in this study attained overground gait speeds greater than 0.9 m/s which indicate the potential for using walking as a primary means of mobility in the community. In the prospective within subject design studies that reported outcomes measuring overground gait speed, no subjects attained gait speeds that would permit walking to be used as the primary means of mobility in the community environment. Some participants demonstrated changes in overground gait speed indicating a potential for increased levels of household ambulation or very low levels of community ambulation (i.e. walking would not be the primary means for mobility in this environment). While the current literature does not support the ability of BWSTT to generate large changes in the household or community ambulatory status of patients with incomplete SCI, future research should incorporate outcomes that more directly measure the household or community ambulatory function in patients with SCI because such outcome measures are currently nonexistent. Future investigations need to explore other outcome measures such as quality of life and physiological changes associated with gait when attempting to quantify the effect of BWSTT in this population and should employ appropriate comparison groups to determine whether any observed changes are superior to other forms of conservative physical therapy. Lastly, research should also explore the ideal dosage and therapist assistance needed during BWSTT to create any clinically important changes in household ambulation, community ambulation, quality of life, or other relevant outcome measures.
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