Summary; Introduction - PANat Urias Johnstone User Manual

Keywords: PRO-Active, hemiplegie, repetitive, Johnstone air splints, self-directed
training, low motor recovery, external focus of attention

Summary

This document gives an overview of the theoretical framework and clinical management
of PANat.
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PANat: PRO-Active approach to Neurorehabilitation integrating Urias Johnstone
air splints and other therapy tools. PANat is a further development of the Johnstone
[1]
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. This concept has
been updated by integrating contemporary principles of movement science and evidence
based guidelines into the theoretical and practical framework of PANat. It incorporates
low-tech therapy tools in training sessions developed by therapists and ideas of stroke
patients to meet their specific needs.

Introduction

Movement is necessary for the individual to participate and enjoy life at home, in the
community and workplace.
Many stroke patients with low sensory-motor recovery use the unaffected side to
accomplish daily tasks; as such they reinforce failure to integrate the severely impaired
hemiplegic limb into meaningful functional activity. As a consequence they may develop
learned non-use, muscle stiffness, contractures and pain.
Studies have shown that using the air splint for repetitive and early stimulation in
training the upper hemiplegic limb of the stroke patient, with pronounced muscle
weakness or a severely paralyzed arm, can have an effective long lasting effect on motor
[4-5]
function .
Interventions encouraging specific and intensive training with the hemiplegic limbs are
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made possible by adapting the task and the environment using Urias Johnstone air
1 [6-8]
splints and other therapy tools ( e.g. rocking chairs, PANat-Laptool ) This adapted
situation becomes a learning environment, to motivate patients to train selectively
control of movements with their severely impaired hemiplegic limbs in a part task
activity. This can then contribute over time to a better performance of the agreed upon
goal task.
The PRO-Active approach is particularly suited to treat stroke patients with severe
sensory motor impairments. Incorporating the principles of PANat using interventions
with the hemiplegic limb that are repetitive, intensive and selective in all phases of
stroke rehabilitation, is one method with the potential to enhance the mechanism of
neuroplasticity and to promote effective and efficient goal-directed motor training.
Emphasis is placed on giving the individual an opportunity for self-directed practice with
the hemiplegic limbs both during and outside supervised therapy sessions and in the
home setting.
1
www.panat-laptool.ch
4
© Rights reserved PANat 2009, revised 02/2015, version 2017