ORIGINAL RESEARCH Various Surfaces Benefited Functional Outcomes and Fall Incidence in Individuals With Spinal Cord Injury: A Randomized Controlled Trial With Prospective Data Follow-up Sugalya Amatachaya, PT, PhD, a,b Donlaya Promkeaw, PT, PhD, a,b Preeda Arayawichanon, MD, b,c Thiwabhorn Thaweewannakij, PT, PhD, a,b Pipatana Amatachaya, EN,PhD b,d From the a School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen; b Improvement of Physical Performanceo and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen; c Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen; and d Department of Mechanical Engineering, Faculty of Engineering and Architecture, Rajamangala University of Technology Isan, Nakhon Ratchasima, Thailand. Abstract 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 (NZ54) with SCI who walked with or without a walking device. Intervention: Participants were randomly arranged into a control group (overground walking training, nZ26) or experimental group (walking training over a WTDS, nZ28) 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< .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 (nZ5, 18%) fewer than those in the control group (nZ12, 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. Archives of Physical Medicine and Rehabilitation 2020;-:------- ª 2020 by the American Congress of Rehabilitation Medicine Current rehabilitation strategies emphasize the effects of task- specific practice in order for every system required to be involved in the practiced task. 1,2 Therefore, to improve their walking ability, ambulatory individuals with incomplete spinal cord injury (SCI) who mostly walk nonfunctionally are commonly trained to walk over a flat, smooth, and firm surface. 3-6 However, such a training condition is different from what the patients encounter in their daily living after discharge that they usually face with irregular and unstable areas. Therefore, more than half of Clinical Trial Registration No.: NCT03622710. Disclosures: none. 0003-9993/20/$36 - see front matter ª 2020 by the American Congress of Rehabilitation Medicine https://doi.org/10.1016/j.apmr.2020.08.009 Archives of Physical Medicine and Rehabilitation journal homepage: www.archives-pmr.org Archives of Physical Medicine and Rehabilitation 2020;-:-------