Impact of Grass Surface Walking on Dynamic Balance in Individuals with Chronic Stroke
Shantanu Sharma *
Department of Physiotherapy, Janardan Rai Nagar Rajasthan Vidyapeeth (Deemed to be University), Udaipur, Rajasthan, India.
Shailendra Mehta
Department of Physiotherapy, Janardan Rai Nagar Rajasthan Vidyapeeth (Deemed to be University), Udaipur, Rajasthan, India.
*Author to whom correspondence should be addressed.
Abstract
Background: Impaired dynamic balance is a common consequence of chronic stroke, often limiting mobility and increasing fall risk. Traditional rehabilitation typically involves training on flat, stable surfaces, which may not adequately simulate real-world conditions. Incorporating walking on natural grass may offer a functional and effective way to enhance postural control and balance recovery.
Aims: To evaluate the impact of grass surface walking program on improving dynamic balance in individuals with chronic stroke.
Place and Duration of Study: Out-Patient Department, Kanishka Physiocare Physiotherapy Centre, Jaipur, between October 2024 and March 2025.
Methodology: Study was conducted with 20 chronic stroke survivors, all were adults aged between 50-70 years, diagnosed with ischemic or hemorrhagic stroke at least six months before recruitment (chronic phase), ability to walk independently with or without assistive devices (Functional Ambulation Category ≥3), Mini-Mental State Examination (MMSE) score ≥24 (to ensure cognitive ability to follow instructions), and medically stable and cleared for physical activity by a physician. ‘Participants were divided equally into two groups’: the experimental group underwent a 4-week grass walking intervention, while the control group received routine physiotherapy. Dynamic balance was assessed pre- and post-intervention using the ‘Timed Up and Go (TUG) Test and the Dynamic Gait Index (DGI)’. Statistical analysis included ‘paired t-tests and group comparisons’, with significance set at ‘P < 0.05’.
Results: This study included a total of 20 participants (10 in each group), with equal distribution of gender (5 males and 5 females per group). The mean age was comparable between groups — 62.5 years in the Grass Walking group and 62.7 years in the Control group. The grass walking group saw a notable decrease in TUG scores (mean reduction from 22.11s to 17.20s, P = 0.000) and a marked improvement in DGI scores (mean increase from 14.4 to 18.4, P = 0.000). In contrast, the control group exhibited minimal changes in both TUG and DGI, which, although statistically significant due to low variability, were not clinically meaningful.
Conclusion: Walking on a natural grass surface significantly enhances ‘dynamic balance and functional gait’ in individuals with chronic stroke. Incorporating grass surface into rehabilitation programs may offer a cost-effective, practical, and functionally relevant strategy for improving post-stroke mobility outcomes.
Keywords: Chronic stroke, dynamic balance, grass surface, TUG test, DGI, proprioception, functional mobility