OBJECTIVES: To compare effects of walking training on a walking track with different surfaces (WTDS), including artificial grass, soft, and pebbles, as compared to overground walking training on the functional ability necessary for independence and incidence of falls of ambulatory individuals with spinal cord injury (SCI). DESIGN: A randomized controlled trial (single-blinded design) with 6-month prospective fall data follow-up. SETTING: Tertiary rehabilitation centers and several communities. PARTICIPANTS: Independent ambulatory individuals (N = 54) with SCI who walked with or without a walking device. INTERVENTION: Participants were randomly arranged into a control group (overground walking training, n = 26) or experimental group (walking training over a WTDS, n = 28) for 30 min/d, 5 d/wk over 4 weeks. MAIN OUTCOME MEASURES: The 10-m walk test, timed Up and Go test, five times sit-to-stand test, and 6-minute walk test were repeatedly measured 4 times, including before training, and after 2 and 4 weeks, and 6 months. In addition, participants were prospectively monitored for the fall data over 6 months. RESULTS: Participants who walked with an average speed of 0.52 m/s and postinjury time > 7 years could safely walk over a WTDS. They demonstrated significant improvement at 2 and 4 weeks after experimental training (p < 0.001), but not after control training. During the 6-month follow-up, participants in the experimental group also had the number of those who fell (n = 5, 18%) fewer than those in the control group (n = 12, 46%). CONCLUSIONS: Being at a chronic SCI with ability of independent walking, participants needed a challenging task to promote their functional outcomes and minimize fall risk. The findings suggest the use of various surfaces as an alternative rehabilitation strategy for these individuals.

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