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Background and Purpose-A new gait training strategy for patients with stroke proposes to support a percentage of the patient's body weight while retraining gait on a treadmill. This research project intended to compare the effects of gait training with body weight support (BWS) and with no body weight support (no-BWS) on clinical outcome measures for patients with stroke. Methods-One hundred subjects with stroke were randomized to receive one of two treatments while walking on a treadmill: 50 subjects were trained to walk with up to 40% of their body weight supported by a BWS system with overhead harness (BWS group), and the other 50 subjects were trained to walk bearing full weight on their lower extremities (no-BWS group). Treatment outcomes were assessed on the basis of functional balance, motor recovery, overground walking speed, and overground walking endurance. Results-After a 6-week training period, the BWS group scored significantly higher than the no-BWS group for functional balance (Pϭ0.001), motor recovery (Pϭ0.001), overground walking speed (Pϭ0.029), and overground walking endurance (Pϭ0.018). The follow-up evaluation, 3 months after training, revealed that the BWS group continued to have significantly higher scores for overground walking speed (Pϭ0.006) and motor recovery (Pϭ0.039). Conclusions-Retraining gait in patients with stroke while a percentage of their body weight was supported resulted in better walking abilities than gait training while the patients were bearing their full weight. This novel gait training strategy provides a dynamic and integrative approach for the treatment of gait dysfunction after stroke. (Stroke. 1998;29:1122-1128.)

Objective-To compare the efficacy of step training with body weight support on a treadmill (BWSTT) with over-ground practice to the efficacy of a defined over-ground mobility therapy (CONT) in patients with incomplete spinal cord injury (SCI) admitted for inpatient rehabilitation.Methods-A total of 146 subjects from six regional centers within 8 weeks of SCI were entered in a single-blinded, multicenter, randomized clinical trial (MRCT). Subjects were graded on the American Spinal Injury Association Impairment Scale (ASIA) as B, C, or D with levels from C5 to L3 and had a Functional Independence Measure for locomotion (FIM-L) score <4. They received 12 weeks of equal time of BWSTT or CONT. Primary outcomes were FIM-L for ASIA B and C subjects and walking speed for ASIA C and D subjects 6 months after SCI.Results-No significant differences were found at entry between treatment groups or at 6 months for FIM-L (n = 108) or walking speed and distance (n = 72). In the upper motor neuron (UMN) subjects, 35% of ASIA B, 92% of ASIA C, and all ASIA D subjects walked independently. Velocities for UMN ASIA C and D subjects were not significantly different for BWSTT (1.1 ± 0.6 m/s, n = 30) and CONT (1.1 ± 0.7, n = 25) groups.Conclusions-The physical therapy strategies of body weight support on a treadmill and defined overground mobility therapy did not produce different outcomes. This finding was partly due to the unexpectedly high percentage of American Spinal Injury Association C subjects who achieved functional walking speeds, irrespective of treatment. The results provide new insight into disability after incomplete spinal cord injury and affirm the importance of the multicenter, randomized clinical trial to test rehabilitation strategies.Annually, approximately 10,000 Americans have a traumatic spinal cord injury (SCI). For many patients, the most visible lingering disability is the inability to walk or a slow spastic- NIH Public Access Author ManuscriptNeurology. Author manuscript; available in PMC 2014 July 17. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript paretic gait with high energy cost. 1 A gait training strategy, using body weight support on a treadmill (BWSTT), 2,3 has evolved from physiologic studies of the effects of the level and timing of limb loading during stepping and of stance and swing phase kinematics in spinal transected quadrupeds [4][5][6][7] and in patients with complete SCI. [8][9][10] The experimental intervention received clinical support from nonrandomized studies of patients with incomplete SCI early and late after injury. 2,3,[11][12][13] No randomized trials with blinded outcomes, however, had compared different physical therapy strategies aimed at the recovery of walking during initial inpatient and outpatient rehabilitation. Further, no prospective trials in SCI had collected measures related to functional walking, such as walking speed, distance, and the need for assistive devices. 14,15The Spinal Cord Injury Locomotor Trial (SCILT) was a single-bli...