Weight-Supported Treadmill Versus Over-Ground Training After Spinal Cord Injury: From a Physical Therapist’s Point of View

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To the Editor:

In this letter, I would like to address the significance for physical therapy of a recent study by Dobkin et al.¹ This randomized clinical trial investigated the effectiveness of a combination of body-weight–supported treadmill training (BWSTT) and over-ground mobility training versus solely over-ground mobility therapy in subjects with an incomplete spinal cord injury (iSCI). A large number of the subjects with iSCI regained walking ability independent of the group to which they were assigned. Compared with historic data, an unexpectedly high percentage (92%) of patients with an American Spinal Injury Association Impairment Scale (ASIA) classification C regained an independent walking ability. In addition, the walking speed of the subjects classified as ASIA C and D did not differ between the groups. The authors concluded that BWSTT was not superior in restoring walking ability compared with over-ground mobility therapy in people with iSCI early after trauma.

From a physical therapist’s point of view, the results of the study by Dobkin et al¹ could be considered very encouraging. As even a sensitive outcome measure such as walking speed² did not show any difference, Dobkin and colleagues had evidence that their intervention, which consisted of task-oriented over-ground training, was equally effective when compared with BWSTT. Body-weight–supported treadmill training can be considered an intervention with a thorough theoretical framework based on animal experiments and an impressive amount of animal and (mainly uncontrolled) human evidence indicating effectiveness (for a review, see Dietz³). Because physical therapy interventions often are criticized for their lack of scientific arguments based on theoretical background or treatment effectiveness, the results of Dobkin and colleagues’ study are positive findings.