OBJECTIVE: To provide an overview of, and evaluate the current evidence on locomotor training approaches for gait rehabilitation in individuals with incomplete spinal cord injury (SCI) to identify the most effective therapies. DATA SOURCES: Electronic databases AMED, CINAHL, Cochrane, Medline, PEDro and PubMed were searched systematically from first date of publication until May 2013. References of relevant clinical trials and systematic reviews were also hand searched. STUDY SELECTION: Only randomized controlled trials (RCT) evaluating locomotor therapies after incomplete SCI in an adult population were included. Full-text versions of all relevant articles were selected and evaluated by both authors. DATA EXTRACTION: Eligible studies were identified and methodological quality assessed with the PEDro scale. Articles scoring < 4 points on this scale were excluded. Sample population, interventions, outcome measures and findings were evaluated with regard to walking capacity, velocity, duration and quality of gait. DATA SYNTHESIS: Data were analysed by systematic comparison of findings. Eight articles were included in this review. Five compared body weight supported treadmill training (BWSTT) or robotic assisted BWSTT (Lokomat) with conventional gait training in acute/subacute subjects (<= 1 year post injury). The remaining studies each compared three or four different locomotor interventions in chronic participants (> 1 year post injury). Sample sizes were small and study designs differed considerably impeding comparison. Only minor differences in outcomes measured were found between groups. Gait parameters improved slightly more after BWSTT and robotic gait training for acute participants. For chronic participants, improvements were greater after BWSTT+FES and overground training+FES/BWS compared to BWSTT+manual assistance, robotic gait training or conventional physiotherapy. CONCLUSION: Evidence on the effectiveness of locomotor therapy is limited. All approaches show some potential for improvement of ambulatory function without superiority of one approach over another. More research on this topic is required.

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