Last year, Ensign therapists were introduced to a new balance pad system called the Sanddune Stepper. It is said to have significant effects on improving proprioception and ankle strategy in patients with a neurological diagnosis.

The device is constructed of a combination of memory foam and closed cell foam, which causes a rapid rebound of the memory foam, increasing the challenge and resistance with each step. This also equalizes the reaction force on the feet when the patient is standing, making the device respond closer to the patient environment.

Clinical Observations

How well does the Sanddune Stepper improve proprioception and ankle strategy compared to other balance pads on the market? The main difference between the Sanddune Stepper and other balance pads is the different type of foam allowing for rapid stepping and the division between sides (giving the device the sand dune look). This division allows the contralateral foot to be lifted with no effect on the other, because it is essentially two pads in one.

Evidence states that muscle fatigue in lower extremities is a contributing factor to reduced postural control (Fox et al). “Balance exercises comprising steady-state and reactive components should be included in a balance program with the goal to prevent elderly people from falling,” according to Granacher, Muehlbauer and Gruber.

Using the “running in place or flutter step” exercise suggested by the manufacturer, we see a rapid onset of fatigue in our patients and use this technique to improve resistance to fatigue. Using this device with patients diagnosed with Parkinson’s disease, we observe immediate carryover in most cases following three minutes of rapid stepping on the device. The patient will usually demonstrate better stepping with gait on firm surfaces following this treatment intervention.

In patients with medical diagnosis of stroke and related balance deficits, this device improves carryover of ankle strategy from the Sanddune Stepper compared to other foam balance pads and on firm surfaces. Bird et al states that learned response with balance training improves carryover through leg strength and balance training. This can have a positive effect on fall prevention in older adults.


At Olympia Transitional Care and Rehabilitation, we have been using the Sanddune Stepper as our go-to balance pad. We consistently see more rapid recovery in proprioception and ankle strategy with our neurologically involved patients.

There is still evidence to be collected and more case studies to be written. Our initial observation is that this device is a power tool in our arsenal of balance training devices, and we use it more frequently than our other balance pads. We suggest that a dedicated study on the effects of the Sanddune Stepper would be beneficial to the field of rehabilitation for our neurological patients.

By C. Scott Hollander, DPT, Olympia Transitional Care and Rehabilitation, Olympia, WA