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PRO-Active approach to Neurorehabilitation integrating air splints* and other therapy tools
(* Urias® Johnstone air splints)

URIAS® Johnstone air splints, an aid in neurological rehabilitation.

The inflatable splints or URIAS® Johnstone air splints can be an invaluable aid or tool to facilitate therapy sessions in neurological rehabilitation.

They have first been developed by Margaret JOHNSTONE, FCSP (Fellowship of the Chartered Society of Physiotherapy), and her sister Ann THORP.
These two Scottish physiotherapists felt that a therapist never has enough hands to optimise the therapy time of the stroke patient. That is why they started developing the idea of group therapy-sessions, family-involvement (quite innovative in the sixties), autonomous practice and importing tools and aids in their practice.[1]

The URIAS® Johnstone air splints are one of these tools; they are made of flexible PVC and blown up by mouth to a pressure of 40 mm Hg maximum. They come in different shapes and sizes.
There is a range of splints specifically developed for

They are often used dynamically in hands on therapy sessions, such as mat exercises, limb loading or weight bearing with adequate muscle alignment..., to facilitate a lot of trunk and shoulder / hip work at 'impairment level'.
They are also used at 'activity level' to offer additional security and stability ranging from elbow support to knee stabilisation or ankle support.
The URIAS® Johnstone air splints are ideal for hands off work , this is when the stroke patient is invited to work by himself or under supervision only. The pressure splints give additional stability / security and facilitate the handling (of a paralysed arm for example). They're a key element in a typical Margaret Johnstone tool: the Law Rocking Machine.[2]

These splints have become for many patients and therapists a precious rehabilitation-aid. The astute therapist will soon discover their use and their limits, regardless of the theoretical approach they favour.
The theoretical background of the Johnstone Approach[3] is eclectic.
In its contemporary version it is presented (since january 2007) as a PRO-Active approach to Neurorehabilitation integrating air splints and other therapy tools (PANat).[4]

To summarise:

URIAS® Johnstone air splints are developed to be used

  • Indoors
  • During 'hands on' or 'hands off' therapy sessions (depending on the splint you use maximum 20 minutes or 1 hour at a time for adult splints - with a pressure not exceeding 40 mm Hg)

Purpose :

  • Biomechanical advantages :
    • To influence muscle tone and length associated tissue changes
    • For stabilisation and mobilisation
    • For prevention and treatment of muscle contractions , especially in delayed treatment cases.
  • Dynamic boost to sensory input :
    • used dynamically, such as during weight bearing exercises/activities, the constantly changing pressure gives additional sensory input
    • weight bearing exercises also influence the proprioceptive receptors
    • in combination with the intermittent pressure pump [5]
  • Practical and psychological advantage :
    • To allow active participation + independent practice
    • To facilitate handling + to give additional stability/security

 

References:

  1. De Weerdt W et al, Time use of stroke patiens in an intensive rehabilitation unit : a comparison between a Belgian and a Swiss setting. Disability and Rehabilitation, 2000; vol 22, no 4, 181-186.
  2. * Feys H et al, Effect of a Therapeutic Intervention for the Hemiplegic Upper Limb in the Acute Phase After Stroke, Stroke, 1998; 29; 785-792.
    * Feys H et al, Early and Repetitive Stimulation of the Arm Can Substantially Improve the Long-Term Outcome After Stroke : A 5-Year Follow-up Study of a Randomiszed Trial, Stroke, 2004; 35; 924-929.
  3. * Margaret Johnstone was first of all, a brilliant clinician . The original literature gives a lot of practical exercises and food for thought. The reader must take into consideration that the theory building is based on scientific knowledge available in the 1970's.
    * Johnstone M, Restoration of Normal Movement after Stroke, Churchill Livingstone, 1995. ISBN 0-443-05247-6
    * Johnstone M, Home Care for the Stroke Patient : Living in a Pattern. Third edition, Churchill Livingstone, 1996. ISBN 0-443-05660-9
  4. Theoretical framework and clinical management of PANat - Gail Cox Steck (© 2009, revised 2015)
  5. Cambier DC et al., Treating sensory impairments in the post-stroke upper limg with intermittend pneumatic compression. Results of a preliminary trial. Clinical Rehabilitation, 2003 ; 17 : 14-20.

Little has been published in English.
Look out for names like : Wälder Franziska, Cox Steck Gail.
Courses are being organised in different countries, see webpages http://www.panat.info
or contact:
Anne-Marie VERSTRAETEN, Public Relations Officer PANat (Johnstone)
(amverstraeten@advalvas.be)