What is PANat
What is PANat?
PANat is a structured, evidence-based neurorehabilitation approach that integrates Urias® Johnstone air splints and PANat-Laptool® to enable active, functional, and goal-directed movement in individuals with severe neurological impairments.
PANat proactively addresses moderate to severe sensory-motor paralysis, empowering patients to train functional movements, regain function, and prevent secondary complications across all recovery phases – from the early hospital phase to long-term rehabilitation.
Building on the pioneering work of Margaret Johnstone (1919–2006), PANat translates modern movement science, systems theory of motor control, and motor learning principles into practical clinical strategies.
It provides therapists with an approach to promote early activation, restore movement, and support self-directed training in patients with stroke, traumatic brain injury, multiple sclerosis, and other neurological and musculoskeletal conditions and limitations.
Theoretical Foundation
PANat is grounded in the systems theory of motor control, emphasising the interaction between the individual, the task and the environment.
- The Individual – cognitive, sensory and motor abilities following neurological injury
- The Task – meaningful, goal-directed activities
- The Environment – the physical and social context that supports movement and learning
Within PANat, the learning environment is optimised to support self-directed, task-specific practice and functional skill acquisition through the interaction of all three systems.
Reaching numbered targets using an elbow air splint, a double-grip trainer, and a fist glove to enable self-directed functional movements. Progression: sequence variation, tempo, eyes closed, altered foot position, with/without foot air splint
Transferring trained movements into daily life: carrying a bag with the hemiparetic hand, while descending stairs outside the clinic."
The 5 Core Components of PANat
Restitutive Emphasis
Focuses on creating training conditions that enable practice with near-physiological movement patterns on the hemiparetic side, supporting functional skill acquisition while reducing compensatory movement strategies and secondary complications.
Behavioural Neuroplasticity
Based on the “use it and improve it” principle, meaningful and repeated task-specific practice promotes behavioural neuroplasticity and supports the development of functional movement strategies.
Contemporary Motor Learning Principles
Training is designed using task-specific practice, external focus of attention, feedback and variable practice conditions to optimise learning, adaptability and retention.
Motivation
PANat promotes autonomy, self-directed practice and meaningful goal-setting within engaging learning environments that support participation and sustained motivation.
Self-Directed Training
Self-directed and group-based practice with air splints and PANat-Laptool supports graded, hands-off training with high repetition and carryover into everyday life.
PANat focuses not only on movement, but on enabling meaningful participation in everyday life, supporting people to live, act and engage in roles and activities that matter to them.
Clinical Application
Therapists use air splints and PANat-Laptool to provide biomechanical stability, reduce compensation, and create an environment that enables the hemiparetic side to participate in task performance. This promotes graded, “hands-off” practice, improving patient confidence and safety.
The therapist’s role is to design learning environments that enable patients to plan, initiate, and execute specific, intensive functional movements, integrating motor control with motivation and cognitive engagement through targeted feedback.
Advancing the Approach: An Innovative Addition
Occupational therapist Franziska Wälder developed the PANat-Laptool®, a set of low-tech, task-oriented therapy tools that can be combined with air splints to optimise graded, hands-off support and enable safe, structured self-directed training.
The international PANat Teacher Group, led by Gail Cox Steck, continues to advance the approach with updated theoretical frameworks, research-based principles, and clinical applications, thereby maintaining PANat as a proactive, evidence-based approach to neurorehabilitation.
Interested in more information? Read under “Theory and evidence”