Overground training can only be undertaken with higher functioning people with incomplete SCI, although the emergence in recent years of robotic exoskeletons has facilitated the opportunity for overground gait training in motor-complete SCI. However, overground training provides an important mode of exercise for improving walking function, and likely other physical and mental functions (e.g., muscle strength, balance, bone health, cardiovascular function, or depression symptoms) shown to be positively affected by exercise in the general population. In people with motor-incomplete SCI, several studies have indicated the benefits of overground training on functional walking capacity (Forrest et al. 2014; Oh & Park 2013). Overground training has also been integrated with wider variety of other exercises to provide more comprehensive therapy (Jones et al. 2014) and others have suggested the additive benefits of providing visuotemporal cues during walk training (Pramodhyakul et al. 2016). One Level 1 RCT (Senthilvelkumar et al. 2015) shows no differences between overground vs treadmill-based training. Oh and Park (2013) found that an intensive 6x/week, 4-week training program resulted in effects at 1-year follow-up and demonstrate the positive benefits of exercise.
There is Level 1 evidence (Senthilvelkumar et al. 2015) that overground and treadmill-based training are comparable.
There is level 4 evidence (Oh & Park 2013) that community-based ambulation training that is progressively challenging may result in long-lasting benefits in incomplete SCI.