What is PANat
PANat = Pro-Active approach to Neurorehabilitation integrating air splints and other therapy tools
PANat is a structured, evidence-based treament approach to neurorehabiliation, that integrates Urias® Johnstone air splints and PANat-Laptool® to facilitate active, functional, and goal-directed movement in individuals with severe neurological impairments.
PANat can be used in all stages of recovery – 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 methods.
It provides therapists with a approach to promote early activation, restoration of movement, and self-directed training in patients with stroke, traumatic brain injury, multiple sclerosis, other neurological and musculoskeletal conditions and limitations.
Theoretical Foundation
PANat is guided by the systems theory of motor control, which highlights the continuous interaction between three systems:
- The Individual – cognitive, sensory, and motor abilities affected by neurological injury
- The Task – the goal-oriented activity to be performed
- The Environment – the context and setup supporting movement
Effective rehabilitation requires the integration and retraining of all three systems simultaneously.
Caption: Stepwise facilitation of arm flexion using a Urias Johnstone elbow air splint to promote elbow extension, combined with patient self-guided training using the Double Grip Trainer.
Caption: Applying the trained movement to daily life: carrying a bag while walking down the stairs.
The 5 Core Components of PANat
Restorative Emphasis
Focuses on training the affected (hemiparetic) side to prevent compensatory overuse of the unaffected side and reduce secondary complications.
Behavioural Neuroplasticity
Based on the “use it and improve it” principle — repetitive, meaningful training stimulates cortical reorganization and strengthens weakened motor pathways.
Motor Learning Principles
Exercises are structured using task-specific practice, external focus of attention, feedback, and variable task design to optimize learning and retention.
Motivation
Therapy emphasizes autonomy, goal-setting, and self-efficacy, often incorporating group-based and engaging environments to sustain effort and enjoyment.
Self-Directed Training
Encourages independent and group practice with Urias® Johnstone air splints and PANat-Laptool® to enhance intensity, repetition, and carryover into daily activities.
The success of PANat is measured not only in physical improvements, but in the person’s ability to live, act, and participate fully in meaningful roles and contexts.
Clinical Implementation
Therapists use Urias® Johnstone air splints and PANat-Laptool® to provide mechanical stability, reduce compensations, and create an environment that allows the weaker side to participate in task performance.
This promotes graded, “hands-off” facilitation, improving patient confidence and safety during practice.
The therapist’s role is to design learning environments that enable patients to plan, initiate, and execute specific and intensive functional movements, integrating motor control with motivation and cognitive engagement.
A Modern Evolution
Occupational therapist Fransizka Wälder developed the PANat-Laptool®, a set of low-tech, task-oriented therapy tools that can be combined with Urias® Johnstone air splints to optimize graded, hands-off facilitation and support safe, structured self-directed training.
The international PANat Teacher Group, led by Gail Cox Steck, continues to advance the method with updated theoretical frameworks, research-based principles, and clinical applications — maintaining PANat as a proactive, evidence-based approach to neurorehabilitation.
Interested in more information? Read under “Theory and evidence”