History and mission
Mission Statement of the PANat teacher group
The PANat teacher group is a group of physiotherapists and occupational therapists with a special interest in evidence based neurorehabilitation (mainly for stroke patients), initially inspired by Margaret Johnstone
We want the PANat teacher group to be a group of team players acting as a sounding board for its members, with principles of integrity, with open mindness and with holistic thinking (level of the individuals in the group)
We want PANat to be known as a proactive and ongoing approach, where prevention is just as important as the therapy itself (level of the theoretical foundation)
We want PANat to be an entrance door to neurorehabilitation for patients and carers
We use the air splints and other low-tech therapy tools to give patients the opportunity to be active in an ongoing rehabilitation process in their environment. (level of practice)
We are conscientious in all our publications and presentations (level of communication to the outside world)
The History of PANat – From Margaret Johnstone to a Modern Evidence-Based Approach
Margaret Johnstone, FCSP, was a Scottish physiotherapist whose pioneering ideas laid the foundation for what would eventually become the PANat approach. Widely recognised in the field of neurological rehabilitation, she was appreciated for her commitment to active participation, functional recovery, and the essential involvement of relatives, nurses, and helpers in the rehabilitation process. Her dedication was formally acknowledged in 1990, when the Chartered Society of Physiotherapists awarded her a Fellowship for her clinical innovations and influential publications.
Johnstone’s career began during World War II, working with young head-injured soldiers under Professor Norman Dott—an experience that shaped her clinical reasoning and understanding of neurological damage. She later spent 17 years in orthopaedics, further refining her practical problem-solving skills. These two chapters of her early career profoundly influenced the rehabilitation concepts she would develop later.
From 1965 onwards, Johnstone devoted herself to long-term stroke patients. To work closely with severely impaired individuals, she deliberately accepted a basic-grade post on a long-stay ward, convinced that even the most disabled patients could make meaningful progress if given the right opportunities. Her conviction was simple yet radical for its time: active, supported use of the affected side could restore function and improve quality of life. This philosophy guided the creation of her most influential innovation — the inflatable air splints, which enabled safe, structured, and repeatable movement practice even when voluntary control was minimal.
Her work gained international resonance, leading to extensive teaching travels — often together with her sister and lifelong collaborator Ann Thorp, also a physiotherapist. Even in retirement, Johnstone continued writing, teaching, and working with young patients with head injuries. Over her career, she published five books, with Restoration of Normal Movement after Stroke (1995) summarising her method. Her book Home Care for the Stroke Patient (1996) later inspired a CD-ROM to help therapists promote autonomous home-based training — long before self-directed practice became standard in rehabilitation.
Margaret and Ann also contributed to paediatric neurorehabilitation, supporting therapists who adapted her ideas for children. To ensure the continuity of her work, they appointed Gail Cox-Streck, physiotherapist at Bürgerspital Solothurn (Switzerland), as Senior Instructor. Supported by a network of accredited teachers across Europe, the team worked to preserve Johnstone’s methods while updating them with new scientific knowledge. Margaret Johnstone passed away on April 13, 2006, leaving a legacy that continues to inspire therapists worldwide.
In 2007, her original ideas were formally expanded and modernised into what is now known as PANat — “Proactive Approach to Neurorehabilitation integrating air splints and other therapy tools”, led by Gail Cox-Streck and an international group of physiotherapists and occupational therapists. The group integrated Johnstone’s practical approach with contemporary research in motor control, motor learning, neuroplasticity, and motivation psychology, creating a coherent, evidence-based framework for neurological rehabilitation across all recovery stages.
A key development during this period was the introduction of PANat-Laptools®, designed by occupational therapist Fransizka Wälder. These low-tech therapy tools were created to enable more active, hands-off and self-directed training, providing stable surfaces, controlled movement channels, and clear sensory cues. When used alone or in combination with the Urias® Johnstone Air Splints, PANat-Laptools® help structure highly intensive and safe practice aligned with principles of motor learning.
Today, PANat stands as a modern, proactive, and adaptable approach, honouring Margaret Johnstone’s visionary work while integrating decades of scientific progress. Its ongoing mission is to strengthen academic partnerships and contribute to the growing evidence base supporting restorative, activity-driven neurorehabilitation.