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PANat
2009,
revised 02/2015, version 2017
9
Appendix
Johnstone air splints
The Urias
®
Johnstone air splints were specifically developed and designed since 1966 for training stroke
patients with severely impaired motor control. The choice of air splint or therapy tool is dependent on the
level of motor recovery, performance capability of the patient and the specific task or activity.
When training according to PANat-principles ONLY the Urias
®
Johnstone air splints are recommended for
following reasons:
Margaret Johnstone and other PANat instructors designed a variety of air splints to fit the different
training programmes
The material of the Johnstone air splints is made from flexible PVC (according to European
standards), double-layered and transparent. The air splints are designed to be inflated by mouth to
a maximum pressure of 40 mm Hg and for training the stroke patient with severely impaired motor
control.
For further information of application and some practical examples of use of the air splints, please read the
user guide
[6].
Self-directed training (´hands-off´)
Self-directed training combined with air splints promotes autonomous practice, incorporating repetitive and
intensive training strategies of the hemiplegic limbs in a defined activity. The starting position for any
activity must be in accordance with the level of motor recovery and functional ability of the patient.
Therapeutic assistance is required to position the patient, mobilize joints and soft tissue prior to applying air
splints
´hands-on´
, and in setting up the task to enhance the learning environment. The task, environment
and exercise sequence are adapted to promote an autonomous, problem solving process of planning,
initiation, carry through, completion and evaluation of the movement sequence
´hands-off´.
The aim of
training is to promote the quality and quantity of functional activities of the hemiparetic limbs in uni/bi-
lateral and bimanual movements whilst preventing detrimental compensatory strategies. The choice of
activity in the session is based on the impairments that constrain the patient from performing or completing
a task.
Severely impaired motor control
The patients most appropriate for this training are those whose symptoms range from no selective
movement to pronounced weakness with minimal of muscle activity. This approach should be considered for
those patients who have developed secondary negative musculoskeletal and neurological behaviours (soft-
tissue contractures). The Chedoke McMaster Stroke assessment
[29]
would classify this patient group on the
impairment inventory: Stages 1-4. These patients and particularly those with no selective movements and
with cognitive impairment have difficulty participating in evidence based training methods such as
Constrained Induced Movement Therapy
[30]
.
Degrees of freedom of movement: N.A. Bernstein
[
21]
This refers to a motor control problem in how to co-ordinate and regulate movement (in the body). The
process of mastering co-ordination and control of movement is managed by reducing the degree of freedom
of movement of a specific joint or a limb thus preventing inappropriate movement.
External Focus of attention
[32]
External focus of attention is the focus that is directed at the effect of one’s movement in relation to the
environment.
PANat therapists structure the environment with visual, auditive and tactile cues to enable quality of
movement for strokes with severely impaired motor control. Air splints and therapy tools can be used in the
training session for additional external focus of attention.
Author’s comments
This document will be reviewed regularly and any changes will be acknowledged as the scientific framework
for movement analysis, motor control and motor learning in rehabilitation evolves and clinical expertise
develops. It is recommended that clinical trials are undertaken to assess and evaluate the clinical response
to the use of PANat with this client group.
