FAQ
This FAQ page provides answers to the most frequently asked questions about PANat, including its core principles, history, complication and a lot of answers for the practical application and use in rehabilitation.
The explanations expressed hereunder are given to support your own practice and not to replace anyone’s clinical thinking. Consequently, we can not, in anyway be held responsible, for your decision to and use of Urias Johnstone air splints.
These explanations have grown out of years of clinical experience, and feedback from the medical world. If you have different experiences, we would welcome your feedback.
Urias Johnstone air splints = JAS
Are Johnstone air splints (JAS) applied directly on the skin?
As a rule the JAS are NOT applied on the bare skin; a cotton sleeve or garment is protecting the skin. Exception: the hand and finger air splints and the single chamber foot air splint can be applied directly on the skin (for full explanations please refer to the User Guide )
Why can the air splint not be applied directly on the skin?
There are different preventive reasons for doing so: general hygiene, prevention of sweat rash and to avoid the sticking of the air splint to the limb, which gives undesired extra sensory stimulation (and so, stimulate undesired tone) when the air splint is removed.
Can I sit in the sun with the air splint on?
No, because the pressure in the air splint increases due the warming up of the air in the air splint and because there is a danger of sunburn due to a magnifying glass-effect (concentration of sunrays in PVC material).
Can Johnstone air splints (JAS) be used at night for positioning?
No, the JAS are not developed as resting air splints. They are to be used in training sessions and exercises. For correct use of the JAS, please refer to the User Guide.
How long can the Johnstone air splint (JAS) be left on?
When used dynamically in a training session the JAS can be used up to 45 minutes.
In adult rehabilitation, the air splint can be used passively for treating muscle stiffness and contractures (also in combination with intermittent pressure) for 30 minutes.
When longer time is needed: take of the air splint and re-apply.
What is the maximum pressure allowed in an air splint?
Maximum up to 36 mm Hg. But most of all, the patient must feel comfortable with it.
How to measure the pressure in the air splint?
The blown up air splint must always feel comfortable to the patient.
When blown up and gently squeezed, the air splint must give way.
Ideally every therapist should have checked his/her blowing capacity with a pressure gauge in order to familiarize himself with a pressure of 36 mmHg. (careful, some people easily go over this pressure)
Why is the use of a manual/electrical pump contraindicated to blow up a Johnstone air splint (JAS)?
Warm air from the lungs helps molding the plastic of the air splint around the limb.
Whilst blowing up gently, you should use both hands to apply the air splint correctly around the affected limb.
Also see User Guide.
Are Johnstone air splints (JAS) only used in stroke rehabilitation?
No, the JAS have been developed as therapy tools: they can be adopted wherever a therapist sees a need for them. They have been known to be part of the rehabilitation process of patients with multiple sclerosis, rheumatoid arthritis, swollen hands, and certain orthopedic problems. A range of children air splints have been developed for use with CP children.
Can the JAS be used with children with Cerebral Palsy?
Yes, a range of children air splints have been developed. These air splints are not exclusively for CP-children, they can also be used with other problems.
Can the JAS be used with rheumatoid arthritis?
Yes. As long as it feels comfortable to the patient and it is a helpful tool in preparation of mobilization..
Can the double chamber leg gaiter be used to stabilize the knee in walking?
No, the leg gaiter is developed for physiological alignment of the leg in standing. It is used for balance exercises and also for training of trunk and hip control.
Walking with the leg gaiter should be avoided.
Can the same air splint be used with different patients?
The air splints are to be disinfected with a hospital disinfectant between each use. If the patient has no specific contagious condition and the usual hygienic working conditions are respected, the same air splints can be used with several patients.
Can the same air splint be used by different therapists?
Yes, but only if each therapist uses his or her own filter or mouth piece to protect himself.
How long can the air filter be used?
Until it changes to the yellow color by absorbing the humidity of the expired air.
Why using Johnstone air splints ?
Margaret Johnstone, FSCP, introduced the use of air air splints when she needed extra hands to treat sensory motor problems due to stroke. Clinical experience showed additional benefits; for more information, see User Guide page 13.
Why has the name of this approach changed from Johnstone Approach to PANat ?
The change of the name to PRO-Active approach to Neurorehabilitation integrating air splints and other therapy tools (PANat) reflects the further development of the Johnstone approach by integrating contemporary theoretical considerations (e.g. System Model of Motor Control and theories of Motor Learning) and still maintains the basic philosophy of Margaret Johnstone : ‘ give neuroplasticity a chance’ after brain damage.
What is specific about the philosophy of Margaret Johnstone?
MJ liked to empower the patients and their carers in giving them simple means to work by themselves outside the therapy time; she would teach and encourage ‘good habits’ (quality of movement). Group therapy (also for patients with low motor recovery and neuropsychological problems) was only one of her ways to enhance therapy time and introduce fun and mutual encouragement.
Why is a course different from the information on the internet?
A therapy approach is not a recipe book: clinical reasoning, handling of patients and use of the PANat therapy tools can only be mastered in interactive situations.
Why using an air filter?
To keep the inside of the air splint as dry as possible; the expired air is humid and dampens the air splint.
For hygienic reasons the valve should be left open when the air splint it not being used (hanged up).
Why does the air splint or tube turn brown when used regularly?
Most probably the JAS is blown up by a smoker.
Can I fold the air splint and put it in a cupboard after use?
It is recommended to hang the air splint up, with the zip open after cleaning and for storing.
If necessary the air splints can also be kept flat on a shelf; folding can be necessary for transportation but may affect the seams and shorten the life of the air splint.
The JAS has a hole: can it be fixed?
Depending on the place of the hole, a special glue for plastic can do the trick. Usually when the hole is at the junction place of tube/air splint ca not be fixed. But a mended air splint will never be as strong as a new one.
What are the contraindications for using the JAS?
When there is a suspicion of deep vein thrombosis in the limb or a right heart insufficiency, explicit permission for using these therapy tools should be received from the medical doctor in charge.
What are the advantages of using JAS?
Margaret Johnstone, FSCP, introduced the use of air splints when she needed extra hands to treat sensory motor problems due to stroke. Clinical experience showed additional benefits; for more information, see User Guide.
Does PANat encourage the use of other therapy tools?
Yes, there are a lot of tools developed with the idea to help the patient to work safely by himself outside therapy time (a lot of specific repetition and repetition with variation). For correct and efficient use of the tools, we refer to workshops and courses.
Where can the Johnstone air splints be acquired?
The URIAS® air splints as they are officially called and manufactured by Arden Medical (UK), can be bought in a lot of countries. For the list of distributors refer to the necessary web pages. www.panat.info
What is the purpose of intermittent pressure?
To boost the sensory system. ‘Pump in sensation’ as Margaret Johnstone used to say. It can also have a positive effect on decreasing edema.
How are the JAS and intermittent pressure combined?
The JAS is correctly applied and blown up by mouth, then only the IP-machine is connected.
Can the JAS be used with patients with right heart insufficiency?
Not without explicit permission and supervision of the medical doctor in charge.
Can the JAS be used on a patient where a deep venous thrombosis is suspected?
Not without explicit permission and supervision of the medical doctor in charge.
Some patients complain of pain when the JAS is used?
The air splints are tools to help in rehabilitation.
The golden rule is to accept that for good cooperation the patient should feel comfortable with the air splint. It may help to find out where and why it hurts and decide accordingly whether it is appropriate to use the air splint:
- Before applying the air splint, check: is there a painful spot? i.e. a pressure soar on the heel : sometimes there is too much pressure from the padding which has to be reduced before applying the air splint.
- Is there too much pressure in the air splint? Although a pressure of 38 mmHg is not to be exceeded, some patients feel comfortable with less pressure.
- Is there a problem of sensory disturbance i.e. hyper sensation: it may help to use intermittent pressure to give time to the limb to adjust to that problem.
Can the JAS be used in water?
Yes, some therapists are known to use the air splints in hydrotherapy situations. Again sound clinical thinking is at the base of it.
One should be careful that the air splint is properly closed as to avoid water coming into the air splint and not to use those transparent air splints in a sunny environment.
What about using the air splint on an open wound?
The wound should be covered with thin protective material, and the pressure air splint should feel comfortable to the patient. Additional precaution is to be recommended: to disinfect the air splint thoroughly before and after use, or to keep the same air splint for that patient only.
What is intermittent pressure and what is it used for?
A simple intermittent pressure machine allowing a change in pressure from 10 to 36 mm HG and approaching the respiratory rhythm (3-5 seconds for blowing up and 3-5 sec for releasing air), linked to an JAS air splint (which has first been applied correctly to the limb and blown up), can be used as an extra sensory input.
What are ‘low motor recovery stroke patients’?
Low Motor Recovery refers to patients with very little or no motor control. Using the Chedoke-McMaster Stroke Assessment, impairment inventory, a score from 1 to 4 (out of 7) is classified as low motor recovery.
Which group of stroke patients benefits most of the PANat way of working?
PANat can be used with all types of sensory motor problems after stroke. It gives treatment possibilities for the group of patients with sensory problems and/or low motor recovery, be it over the whole limb or a local problem (proximally or distally).
Can the air splint be applied when a patient has severe hyper tone and /or contractions in elbow and hand?
Yes. After mobilizing the muscles and joints, a long arm air splint or combination of hand and elbow air splint can be applied respecting the alignment possibilities of the arm and hand. After 15minutes, the air splint(s) can be gently removed and reapplied: usually a beginning of correction and decrease in stiffness is noticeable.
It is usually a job of several weeks to improve the limb alignment step by step. This can be necessary indeed for hygienic reasons and general comfort of the patient.