Kunming Locomotor Training: neurological, functional, and autonomic outcomes in complete spinal cord injury.

PURPOSE OF REVIEW: Recovery after spinal cord injury (SCI) is variable, and the contribution of locomotor training to neurological and functional outcomes remains debated. This review summarizes post-SCI locomotor recovery patterns, compares training modalities, and presents recovery findings from the Kunming Locomotor Training (KLT) program, one of the largest reported series of patients with initial complete (AIS A) injuries. RECENT FINDINGS: Several months of intensive task-specific overground training yielded substantial gains in neurological, locomotor, and autonomic outcomes. In a retrospective cohort of 485 AIS A patients, 47% improved their AIS grade, while nearly all showed some locomotor recovery measured by the Kunming Locomotor Scale (KLS). A ≥4-point KLS gain strongly predicted AIS conversion (sensitivity 83%, specificity 82%). Recovery probability was highest with lower thoracic and lumbar injuries. Improvements, including ambulation with assistive devices, and significant bladder and bowel recovery occurred even without AIS change. These outcomes reinforce the importance of active, patient-driven training. SUMMARY: KLT experience indicates that prolonged, intensive overground locomotor training can promote neurological and functional recovery in individuals with initially complete injuries. KLS provides a sensitive measure of functional progress. These findings underscore the clinical value of task-specific stepping and provide a new benchmark for evaluating sustained rehabilitation strategies and research into post-SCI recovery.