What is PANat
PANat = Pro-Active approach to Neurorehabilitation integrating air splints and other therapy tools
PANat is a structured, evidence-based neurorehabilitation approach that integrates Urias® Johnstone air splints and PANat-Laptools® 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 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: 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.
Caption: Transferring trained movements into daily life: carrying a bag while descending stairs outside the clinic."
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 Application
Therapists use Urias® Johnstone air splints and PANat-Laptools® 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-Laptools®, a set of low-tech, task-oriented therapy tools that can be combined with Urias® Johnstone 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”