We read with interest the recent article by Riggins and colleagues.1 The authors highlight a contentious but important issue which needs to be openly addressed. At issue are the risks of focusing on neural plasticity and walking through locomotor training and recovery programs in patients with serious spinal cord injury and very little lower-limb strength. The authors provide some evidence that when walking is not achieved 1 year later, these patients have high levels of depression and pain, and a low quality of life.