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PANat
2009,
revised 02/2015, version 2017
8
PRO-Active
-
What is in the word?
P
RO-
A
ctive approach to
N
eurorehabilitation integrating
a
ir splints* and other
t
herapy tools (PANat
)
*Urias
®
Johnstone air splints
PRO-Active: Summarizes the clinical management process of PANat
PRO:
The decision making process and clinical reasoning to justify the use of air splints and other therapy
tools. (Who, what and why)
Active:
The training programme is based upon the principles of contemporary motor learning theories.
(How)
P: Pathology
PANat is primarily for stroke rehabilitation. It can also be used for other neurological problems e.g. multiple
sclerosis and acquired brain injury. The objective and emphasis of the treatment will depend on the
diagnosis.
R: Reframe
The International Classification of Functioning and Health (ICF)
[21]
is used as the underlying structure to
reframe the problems relating to pathology or diagnosis. Activities, participation and quality of life
(enablement) and underlying impairments (disablement) are taken into account.
The Upper Motor Neurone Syndrome (UMNS) is used to understand the relationship of primary motor
impairments to secondary motor impairments and their relationship to disability after stroke.
O: Objectives
Goal setting is used as a motivational technique to enable the patient to understand why training is
necessary
[22-23]
.
•
What is the patient’s goal?
•
What are the therapy objectives to meet this goal?
A: Acquisition of skills
The guidelines for acquisition of skills are integrated in the training programme
[15]
.
Emphasis is placed on the initial or cognitive phase of skill acquisition. Using the severely motor impaired
limb to learn a task in an adaptive situation is comparable to learning a new task.
c: carers
An integral part of PANat is the education of carers, family members and friends in understanding and
managing the disease process. Through training they develop skills to continue long term rehabilitation in
the home and to minimize anxiety, boost confidence and facilitate a successful discharge home and social
reintegration.
[24]
.
t: training
Training after damage to the CNS has been shown to improve functional return
[15]
. The aim is to maximize
recovery and prevent compensatory strategies. Integrating PANat into the rehabilitation process enables the
therapist to initiate early specific training to activate the appropriate muscle groups in a goal-directed, task
oriented context.
Evidence-based guidelines for training are incorporated into the programme
[13,16,31]
.
i: intensity
PANat allows intensive, repetitive, focused, self-directed movements of the hemi paretic arm, and the leg
with integration of the trunk by patients with severely impaired motor control. Air splints and tools can be
applied by all members of the team and carers. This allows on-going sensory-motor training at weekends or
in the home setting. Training can also be practiced in group sessions to encourage efficient use of time and
resources
[25-26]
.
v: variation
The air splints and tools are used as a part of the environment to constrain and promote quality of
movement in meaningful activities or goals
[6-8]
. This enables task modification or part task in an activity and
makes repetition in multiple variations possible. External focus is used as a form of feedback and instruction.
e: evidence
How effective has the intervention been for these patients? Progress must be continuously re-assessed; the
choice of assessment tool will depend on what is being evaluated.
•
Quantitative methods measure statistics (how much).
•
Qualitative methods assess planning and adaptive behavioural changes
[27]
.
•
Individual objective measures show changes in performance over time.
