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PANat Urias Johnstone User Manual

Theoretical framework, clinical management and application of the urias johnstone air splints
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PRO-Active approach to Neurorehabilitation
integrating air splints* and other therapy tools
®
(* Urias
Johnstone air splints)
PANat:
Theoretical framework, clinical
management and application of
®
the Urias
Johnstone air splints.
1. Theoretical Framework
2. User Guide
2017

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Summary of Contents for PANat Urias Johnstone

  • Page 1 PRO-Active approach to Neurorehabilitation integrating air splints* and other therapy tools ® (* Urias Johnstone air splints) PANat: Theoretical framework, clinical management and application of ® the Urias Johnstone air splints. 1. Theoretical Framework 2. User Guide 2017...

  • Page 2: Table Of Contents

    TABLE OF CONTENT 1. THEORETICAL FRAMEWORK AND CLINICAL MANAGEMENT OF PANat ... 3 ........................4 UMMARY ........................4 NTRODUCTION PANat ..................5 HEORETICAL RAMEWORK OF ....................... 5 LINICAL ANAGEMENT PANat ............6 NTEGRATION OF INTO THE REHABILITATION PROCESS ........................7...

  • Page 3: Theoretical Framework And Clinical Management Of Panat

    1. Theoretical framework and clinical management of PANat G. Cox Steck, dipl. Physiotherapist FH, accredited Teacher of PANat Manuscript reviewed and accepted by the PANat group of teachers March 2009, revised February 2015 v2015 © Rights reserved PANat 2009, revised 02/2015, version 2017...

  • Page 4: Summary

    PANat. ® PANat: PRO-Active approach to Neurorehabilitation integrating Urias Johnstone air splints and other therapy tools. PANat is a further development of the Johnstone concept. (Margaret Johnstone, FCSP 1919-2006) [2-3] In the 1970’s Margaret Johnstone FCSP pioneered the use of air splints in active training of the hemiplegic limb in the severely impaired stroke patient.

  • Page 5: Theoretical Framework Of Panat

    Theoretical Framework of PANat The theoretical framework of PANat is based on the contemporary systems theory of [9-16] motor control and motor learning . This theory suggest that movement patterns emerge as a result of the interaction of multiple processes and include intrinsic (perceptual, cognitive and motor processes within the individual) and extrinsic (interactions between the individual, the task and the environment) factors.

  • Page 6: Integration Of Panat Into The Rehabilitation Process

    Integration of PANat into the rehabilitation process Integrating PANat into the rehabilitation process will incorporate patient centered goals and use task specific strategies to minimize compensatory movements that occur during functional activity. This is achieved by maintaining muscle flexibility and extensibility,...

  • Page 7: Conclusion

    Johnstone Air Splint / Selbsttatiges, repetitives Armmotoriktraining bei ausgepragter Hemiparese mit den Johnstone-Luftpolsterschienen nach PANat* / Traitement autonome et repetitif de la motricite du bras lors d'une hemiplegie prononcee, a l'aide de les attelles gonflables de Johnstone d'apres PANat.” Wälder F. 2008...

  • Page 8: Pro-Active - What Is In The Word

    Active: The training programme is based upon the principles of contemporary motor learning theories. (How) P: Pathology PANat is primarily for stroke rehabilitation. It can also be used for other neurological problems e.g. multiple sclerosis and acquired brain injury. The objective and emphasis of the treatment will depend on the diagnosis.

  • Page 9: Appendix

    Johnstone air splints are recommended for following reasons:  Margaret Johnstone and other PANat instructors designed a variety of air splints to fit the different training programmes  The material of the Johnstone air splints is made from flexible PVC (according to European standards), double-layered and transparent.

  • Page 10: References

    Cox Steck GA. User guide for information and instructions to familiarize application and handling of ® the Urias Johnstone air splints used in PANat, Rehabilitation centre, Bürgerspital, Solothurn, Switzerland, 2009. Wälder F. Selbsttätiges, repetitives Armmotoriktraining bei ausgeprägter Hemiparese mit den Johnstone-Luftpolsterschienen nach PANat.

  • Page 11: Application Of The Urias

    PRO-Active approach to Neurorehabilitation integrating air splints* and other therapy tools ® (* Urias Johnstone air splints) 2. Application of the ® Urias Johnstone air splints used in PANat USER GUIDE © Rights reserved PANat 2009, revised 02/2015, version 2017...
  • Page 12 Birgitte Gammeltoft, Occupational Therapist, Denmark.  Renata Vodickova, DiS., Physiotherapist, Czech Republic Copyright © 2009, revised February 2015 www.panat.info ® The Urias Johnstone air splints are manufactured by Arden Medical Limited. http://www.arden-medical.com © Rights reserved PANat 2009, revised 02/2015, version 2017...

  • Page 13: Advantages Of Use

    The air splints were developed by physiotherapists Margaret Johnstone and Ann Thorp as a rehabilitation aid for those with stroke and multiple sclerosis. Their ideas have been updated and PANat was launched in January 2007 to reflect the development of the underlying theoretical assumptions and therapeutic uses of these air splints.

  • Page 14: General Information

    The URIAS orally inflated air splints are made from specially developed PVC. Based on the principles of PANat, monitoring change and increasing awareness of the hemiplegic side are important aspects when integrating specific air splints into the individual’s rehabilitation programme. Nurses and carers are taught how to apply the air splints and support the client out of therapy sessions and at home.
  • Page 15 A personal detachable mouthpiece for inflation is recommended. This is easily fitted to the inflation tube,  Many clients prefer to have their own air splints and when necessary, carers and family members are taught to use them by the therapist. © Rights reserved PANat 2009, revised 02/2015, version 2017...
  • Page 16 When the granules turn from orange to white (clear) the bottle must be discarded. For the sake of clarity, throughout the text, the patient is referred to as ´he´. © Rights reserved PANat 2009, revised 02/2015, version 2017...

  • Page 17: Long Arm Air Splint - 70 Cm And 80 Cm

    Cover the entire arm but leave the (the right arm if it is the client’s right arm). A hand free. hand shake hold is used to correctly support the hemiplegic hand. © Rights reserved PANat 2009, revised 02/2015, version 2017...
  • Page 18 The fingers are straight and held together - not apart. The wrist is supported in approx 10° dorsal extension. Both of your hands are needed to keep the client’s hand in the optimal position. Correct position. © Rights reserved PANat 2009, revised 02/2015, version 2017...
  • Page 19 To mobilise tight muscle groups apply the air splint 2-3 times daily for 20 minutes.  Never use the air splints for positioning overnight. © Rights reserved PANat 2009, revised 02/2015, version 2017...

  • Page 20: Half Arm Air Splint - 53 Cm

    Put the cotton sleeve on your own arm irritation. Cover the forearm but leave the hand (the right arm if it’s the client’s right arm). Take free. the hemiplegic hand in a hand shake hold. © Rights reserved PANat 2009, revised 02/2015, version 2017...
  • Page 21 Direct the client’s attention to the hand so he is tips to the open end of the air splint: this aware of changes in feeling or in movement of ensures even pressure over the arm and hand. the limb. © Rights reserved PANat 2009, revised 02/2015, version 2017...
  • Page 22 Use a brush to stimulate sensation. finger tips use a variety of objects to stimulate stimulated by drawing a sensation and selective movements. rough towel under forearm and palm of the hand. © Rights reserved PANat 2009, revised 02/2015, version 2017...
  • Page 23 Never turn onto the stomach with the shoulder inwardly rotated. Always roll into prone through the unaffected side. Ensure the hemiplegic shoulder is in outward rotation (external). • Never use the air splints for positioning overnight. © Rights reserved PANat 2009, revised 02/2015, version 2017...

  • Page 24: Hand Air Splint (Double Chamber ) - 20 Cm

    Form the hand into a fist then stretch it out. Full range of movement of the hand including fist closure is checked daily. © Rights reserved PANat 2009, revised 02/2015, version 2017...
  • Page 25 To mobilise tight muscle groups apply the air splint 2-3 times daily for 20 minutes.  Never use the air splints for positioning overnight. © Rights reserved PANat 2009, revised 02/2015, version 2017...

  • Page 26: Hand & Wrist Air Splint (Double Chamber) - 30 Cm

    Form the hand into a fist then stretch it out. Full range of movement of the hand including fist closure is checked daily. © Rights reserved PANat 2009, revised 02/2015, version 2017...
  • Page 27 To mobilise tight muscle groups apply the air splint 2-3 times daily for 20 minutes.  Never use the air splints for positioning overnight. © Rights reserved PANat 2009, revised 02/2015, version 2017...

  • Page 28: Elbow Air Splint - 40 Cm

    Mobilise the wrist into dorsal extension. The metacarpals are individually mobilised and the palm is rounded and flattened. Each finger is passively lengthened. Form the hand into a fist then stretch it out. © Rights reserved PANat 2009, revised 02/2015, version 2017...
  • Page 29 Slowly release your grasp on the splint as it inflates. This ensures that a large cushion of air lies over the back of the elbow joint. © Rights reserved PANat 2009, revised 02/2015, version 2017...
  • Page 30 To mobilise tight muscle groups apply the air splint 2-3 times daily for 20 minutes. • For weight bearing exercises through the arm ensure the hemiplegic shoulder is in external (outward rotation). • Never use the air splints for positioning overnight. © Rights reserved PANat 2009, revised 02/2015, version 2017...

  • Page 31: Finger Air Splint (One Sided Single Chamber) - 15 Cm

    Form the hand into a fist then stretch it out. Full range of movement of the hand including fist closure is checked daily. © Rights reserved PANat 2009, revised 02/2015, version 2017...
  • Page 32 To mobilise tight muscle groups apply the air splint 2-3 times daily for 20 minutes. • Never use the air splints for positioning overnight. © Rights reserved PANat 2009, revised 02/2015, version 2017...

  • Page 33: Foot Air Splint

    Direct the client’s attention to the movement. Gently mobilise the small muscles of the foot (intrinsic muscles and plantar fascia). The toes are passively lengthened. © Rights reserved PANat 2009, revised 02/2015, version 2017...
  • Page 34 Do not leave the air splint on for more than 30-45 minutes. Within the course of a treatment session it may be removed and reapplied if it is being used dynamically rather than as a tool to stretch soft tissues. • Never use the air splints for positioning overnight. © Rights reserved PANat 2009, revised 02/2015, version 2017...

  • Page 35: Foot Air Splint (Double Chamber)

    Use a rag or towel to reduce friction, so as to mobilise the foot joint. Gently mobilise the small muscles of the foot (intrinsic muscles and plantar fascia). The toes are passively lengthened. © Rights reserved PANat 2009, revised 02/2015, version 2017...
  • Page 36 Sample exercises Use these to develop your own exercise programmes. Use to encourage Gait re-education Tandem standing. rhythmical foot tapping. and practise. © Rights reserved PANat 2009, revised 02/2015, version 2017...
  • Page 37 Do not leave the air splint on for more than 30-45 minutes. Within the course of a treatment session they may be removed and reapplied if they are being used dynamically rather than as a tool to stretch soft tissues. • Never use the air splints for positioning overnight. © Rights reserved PANat 2009, revised 02/2015, version 2017...

  • Page 38: Leg Air Splint (Double Chamber) - 60 Cm, 70 Cm And 80 Cm

    Direct the client’s attention to the movement. Mobilise the forefoot. Gently mobilise the small muscles of the foot (intrinsic muscles and plantar fascia). The toes are passively lengthened. © Rights reserved PANat 2009, revised 02/2015, version 2017...
  • Page 39 (patella) and to bringing the heel down onto the stabilise the pressure around floor slightly bending the knee. (flexing) the knee. © Rights reserved PANat 2009, revised 02/2015, version 2017...
  • Page 40 Do not leave the air splint on for more than 30-45 minutes. Within the course of a treatment session it may be removed and reapplied if it is being used dynamically rather than as a tool to stretch soft tissues. • Never use the air splints for positioning overnight. © Rights reserved PANat 2009, revised 02/2015, version 2017...

  • Page 41: Leg & Foot Air Splint For Resting (Specially Designed For Patients With Multiple Sclerosis)

    Gather the excess fabric into your hands to maintain the ankle and foot in a neutral position. The air splint may be applied to one or both legs depending on client’s presenting problem and underlying pathology. © Rights reserved PANat 2009, revised 02/2015, version 2017...
  • Page 42 Do not leave the air splints on for more than 30-45 minutes. If necessary take off and re-apply. To mobilise tight muscle groups apply the air splint 2-3 times daily for 20 minutes. • Never use the air splints for positioning overnight. © Rights reserved PANat 2009, revised 02/2015, version 2017...

  • Page 43: Leg & Foot Air Splint For Standing (Specially Designed For Patients With Multiple Sclerosis)

    As the air fills the air splint, slowly release your grasp on the excess fabric around the ankle joint. This allows the foot to maintain the correct alignment in the air splint. © Rights reserved PANat 2009, revised 02/2015, version 2017...
  • Page 44 The choice and usage of the air splints in a therapeutic setting will depend on your clinical reasoning and the therapist/patient goal. The usage of the tools as part of an effective neurological rehabilitation program is the responsibility of the clinician. © Rights reserved PANat 2009, revised 02/2015, version 2017...

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