Summary

The ability to walk 150 ft without physical help, which is the definition of recovery of typical measurement tools for rehabilitation studies, is achieved by most patients after stroke, traumatic brain injury (TBI), and incomplete SCI by 3-6 months after onset. This artificial ceiling on walking gains in rehabilitation studies is set too low, however. Many studies suggest that rehabilitation approaches for those who can walk ought to seek independent community ambulation as the goal, which means walking at least 80 cm/s for at least 200 m. Few RCTs have set this goal for a well-defined intervention. In addition, creative rehabilitation efforts built upon an understanding of the biological adaptability of networks for motor control are needed to get non-walkers who have some residual lower extremity movement to become more independent. Future trials would make a meaningful contribution to evidence-based practices if subjects were entered based on level of independence and initial walking speed. Trial designs should employ a reproducible therapy that is defined by its intensity and duration of actual practice to maximize gains in ambulation.

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