Forty one studies were included in the review: three RCTs; 22 pre-post test studies; 12 post-test studies; one case control study; and three case reports. Twelve studies were on BWSTT, seven on FES, 10 on lower-extremity bracing (braces/orthoses) and 12 included a combination of strategies. Study quality of included RCTs ranged from 6 to 8 using the PEDro tool. Study quality of the non-RCTs included in the review ranged from 6 to 19 using the modified Down and Blacks Tool.
One RCT (n=146) found no difference in FIM-L or walking speed between BWSTT and overground gait training in patients with acute/subacute spinal cord injury. However, patients with American Spinal Injury Association (ASIA) impairment scale C and D spinal cord injury in both groups showed improved functional ambulation.
One RCT (n=27) investigated manual BWSTT, robot-assisted BWSTT, BWSTT and FES and overground training and FES. Participants in the BWSTT and FES, and overground training and FES groups both showed significant improvements in walking speed, but those in the manual or robot assisted BWSTT did not.
One RCT (n=9) investigated gait training combined with the use of intravenous GM1 ganglioside. Gait training combined with GM1 ganglioside use resulted in increased motor skills, walking distance and walking velocity.
Other study designs showed that 61% of participants who received BWSTT showed improvement following treatment; patients who received FES showed increased walking speed or distance, some of which persisted after the stimulator was turned off; the use of orthoses/braces could facilitate patients with subacute or chronic complete paraplegia to stand independently and achieve some functional ambulation skills with the aid of assistive devices; and there was evidence that bracing and FES may have provided additional benefits to functional ambulation over either intervention alone.