3rd week in Voimala

Introduction

This week, was my last week in Voimala, because next week, i would start my traineeship in Fysiotikka. Well, I was in the same groups as last week, and in two new groups, one in Senioripiha, which was a place with people with memory diseases and one in IkaONT group, which was a discussion about thesis of some students from nursery, social servises and physiotherapy department.

Main part

1. Customer's Home visit

My last time was in the customer's home. I felt sad, because this elderly woman, didn't have other physiotherapists or nurses to take care and help her to increase her muscle strength and endurance. She really liked us and wanted from us to continue coming to her home. This time, we measured her functionality with SPPB Test (Short Physical Performance Battery), which is an objective assessment tool for evaluating lower extremity functioning in older persons.

So, this test included timed squats on chair, timed upright balance with a) Anatomy support base with legs at shoulder height b) Small anatomy support base c) Small gait possition d) Possition with one leg in front of the other and timed 4 metres walking. 

a) Anatomy support base with legs at shoulder height
b) Small anatomy support base
c) Small gait possition
d) Possition with one leg in front of the other

The customer had quite much difficulties in that test, especially in the timed chair squats and the timed balance in upright possition. Although, she tried for her best!

2. Hip fractures group (Letkeät lonkat)

1st visit:

This weekend, we did planty exercises to the 3 elderly customers. First of all, they were asked a quiz, associated with:

• some kind of obstacles inside of different rooms into the house 
• the types of different helping of special home equipments
• the disadvantages of carpets that act negative to client's falls
• preventing falls
• improvement of safety at home

After that quiz, we went to the gym and did again exercises as the previous week, for increasing their physical condition, muscle strength and endurance. I had one client, and gave her her own programm. The programm included the following:

Warming up with static bicycle

Level: 1

Sets & Repeats: 5 minutes

Adduction

Level: 20kg

Sets & Repeats: 3x10

Abduction

Level: 10kg & 13kg

Sets & Repeats: 2x10 & 1x10

Kinesis Row exercises

Level: 1kg

Sets & Repeats: 3x12

Leg curl (Hamstrings)

Level: 15kg & 18kg & 20kg

Sets & Repeats: 1x10 & 1x10 & 1x10

Leg extension (Quadriceps)

Level: 10kg

Sets & Repeats: 3x10

Abdominals

Level: 13kg & 15kg

Sets & Repeats: 1x10 & 2x10

With all the exercises, my client felt very good and was quiet strong and patient. After the dynamic exercises, she did some stretching with theraband to the suleus and gastrocnemious,  flexion/extension of knee dragging her leg on the floor,  flexion/extension of the core (right/left side) and breathing exercises.

2nd visit:

The second time, the customers where given again a questionaire about the equipment of their houses, like fire alarm etc. Everything was in Finnish language, as always, so i did not understand a lot of things, but the students tried to translate to me in English!

After that questionaire, we went to a room with some exercise equipments, and did balance exercises to the clients. They did the same balance exercises as the previus week. So, we started with anatomy support base with legs at shoulder height, small anatomy support base, small gait possition, possition with one leg in front of the other (with open and closed eyes). Then, they did the Berg Test and some functional and balance exercises on soft pedal balance trainer yoga mat. My client was quiet good with that exercises, but she needed to have support from somewhere, to prevent from falling.

soft pedal balance trainer yoga mat

Then, we finished with a small cool down and some stretching exercises for relaxation.

3. "Good Heart" group (Hyvä Sydän)

In this group, we went to a room, where the clients were sitting either on chairs, either on big yoga balls. I was with nursing students, who gave questionaires to the clients. This questionaire included questions about 

1. The dairy of the clients nutrition, and if it effects on their choise. 
2. The time between their meals, and if it was good or bad.
3. What were the good points of their nutrition.
4. What was their biggest dilemma.
5. Which things they could eat better.
6. Which kind of situations do they have when they are eating (for example, are they busy or calm during the meal etc.)
7. Their situation in rush and calm hours.

Finally, after all this questions, the 14 elderly people did cooling down exercises on the yoga ball, listening to a tradition finnish song (hummani hei), and in the end some stretching.

It was really enjoyable!

4. Senioripiha

Senioripiha was a place in the city center of Joensuu, in which where some elderly people with memory diseases like alzhaimer. Our purpose was to try on them a new electronics, and especially a new kind of GPS. This GPS is very important and helpful for finding people with memory diseases, on the map. So, we tryed that system. We went outside for walk with an elderly woman who had alzhaimer, wearing this new electronic and her relatives where watching from the phone where we were going with her. The system worked and showed all the route that we went!
This program which is called IkäOTe, is a program that is at cooperation with Karelia-UAS, and belongs to Joensuu city. That system was an innovation to the people with memory diseases and was really exciting!

5. Perheentalo

I went to Perheentalo 2nd time during my traineeship in Voimala, with other physiotherapy students. We took care of children and especially for me, I had a 5 years old girl, and was playing and entertaining her. Our purpose was to notice the motor control and motor learning of the children and if something was strange in their development. Nothing exciting in this visit, because we did not do anything as physiotherapists, only taking care of the children!

6. Memory diseases group (Muistin virrassa)

At this weekend, we went to the Gym with 3 elderly women and 3 elderly men. In the warming time, each of us showed his own exercise, either dynamic, either static (like stretching). Then, me and other 2 physiotherapy students, showed balance exercises to our clients. These exercises included:

1. static stabilazation on the ground with 1 and 2 legs
2. static stabilazation on the soft pedal balance trainer yoga mat or on the balance disc with 1 and 2 legs
3. dynamic stabilazation on the ground with 1 and 2 legs, doing squats
4. dynamic stabilazation on the soft pedal balance trainer yoga mat or on the balance disc with 1 and 2 legs

After that, we continued with strenght exercises for the upper limbs. The clients did rowing holding a stick with some kg, from 4-8kg.
At the end, we did stretching on the muscles of whole body (upper-lower-core).

NOTE!!! There was only one client (elderly man), who was not interested to all the exercises, and did not do almost nothing. He was sitting on the chair all the time, because he was bored and did not want to try the exercises. Only when I motivated him to do the exercises he did some of them, but not for long time, because after a while he quited and was sitting again on the chair, just watching us. I was really surprised of that behavior, because I wanted the best for him, but he did not.

Conclusion

In conclusion, my traineeship in Voimala was a good and interesting experience. I did lots of things, in different groups, with students from other departments also, and with different kind of clients. In general, we had a very good cooperation and in my opinion, the treatments went smoothly and with care!

2nd week in Voimala

Introduction

The second week in Voimala was quit busy but interesting also. I was in five groups this time. The three groups were like the 1st week. Two more new groups, were added in my schedule, the Hyvä sydän group, which means "good heart" and was a group of people with heart diseases, and the Perheentalo which was a family house, that offers support to families with children.

First, I went again to the customer's home with another student from physiotherapy and nursery department. The physiotherapy treatment was similar to the previous week.

Main part

1. Physiotherapy treatment at customer's home

1st visit:

The begging of our customer's physiotherapy treatment was with plantar/dorsi flexion with resistance, with purpose to increase the circulation of blood and the blood return to the heart. Our customer did the exercises better than last week, as her gastrocnemius and frontal tibial were stronger.

Secondly, we continued with flexion/extension with resistance of her knee, 2 sets of 10 repeats and 2 isometric contractions on quadriceps with 15 seconds at the end of the exercises, on each of the legs. This time her quadriceps and hamstrings were stronger than the previous week, especially her quadriceps.

Thirdly, our customer did flexion/extension of her hip again with resistance, 2 times of 12 repeats.

We continued with squads on the chair, as the last time. 2 sets of 7 repeats. Our customer felt tired with this exercise, both on the body and her breathing. Then, she tried to keep her balance in upright position. Although, i did to her weight transfers from right to left and forward/back. She really enjoyed this transfers, because she felt like dancing!
Our treatment finished with breathing and stretching exercises, with purpose to increase the flexibility and the relaxation of muscles and the whole body.

NOTE!!! This time, our client was more concentrate than the previous times, and did the exercises better!


2nd visit:

The 2nd visit this time was more extreme! We went for a walk with our client out of her house. She walked with her walker, because she is not able to walk without any support. After several steps, she felt tired and sat on her wheelchair to relax. When she relaxed, she got up, and walked back to home. It was really nice that she agreed to go outside, because the previous days she denied to go anywhere. I also enjoyed that the sun was shinning on her, and she got a lot of energy from that.

When we arrived at client's home, she relaxed for a while, and did stretching with the teraband for the gastrocnemious, hamstrings & back muscles and without teraband for the major thoracic and abdominals. In the end, she did breathing exercises, for increasing the air of the lungs and the relaxation of the the brain and the body.

2. Physiotherapy treatment in the group of hip fractures (Letkeät lonkat)

1st visit:

This weekend i participated again in the group of hip fractures.

This time, we did different things than the previous time. In our group were again students from the nursery department. The treatment started with some general meanings of sleep. For example, the students emphasized on the quality of the sleeping time that depends on:

• The clothes we wear during the sleep (as minimum clothes is possible, and it is also important in some cases to wear socks to keep the feet warm, for better sleep)
• The food that we eat before the sleep (light food is suggested and not energetic drinks like coffee, energetic drinks etc.)
• The environment we sleep (must be colder than our body)

After the student's briefing about the quality of sleep, we played a game that is associated with sleep.
The game was the sleep-bag with music. In the sleep-bag, were things that related to the sleep, like a bed, a glass of milk, a clock, pictures of physical exercises, a medicine, a glass of alcohol, an apple etc.. So, when the music started, everyone passed this sleep-bag to the others. When the music stopped, the one who was holding the bag, clutched one of the things, and said what it reminded and how it effects on their sleep.

After the ending of the game of sleep-bag, we went to a room, to do balance exercises with the clients. We separated on 3 groups. Each of groups had their own client. So, i had the same client as the precious weekend.
We began with diaphragmatic breathing with inhalation from the nose and exhalation from the mouth. Afterwards, we began the balance exercises. The clients should keep their balance in the upright position (Anatomy support base with legs at shoulder height, Small anatomy support base, Small gait position, Position with one leg in front of the other) with closed and open eyes. Our client did successfully all the exercises, but sometimes was holding me to prevent herself from falling. Then, she did Berg balance exercises holding the ballet bar, and tried to flex her upper body and core up to the point she could. When she finished with that exercises, she did squats on the chair and then breathing exercises . Finally, the 3 clients sat on a chair one next to the other and tried to approach the target which was a ball, with their balls. The ball that was closer to the target, won the game. The purpose was to be concentrated on the target.


2nd visit:

At the second visit, the main purpose of treatment, was the relaxation. The clients were asked and informed from nursery students about the physiological effects of relaxation and the different techniques for relaxation. Some of them answered that they relax with music, my walking in the forest, going to the nature generally, sleeping, thinking something positive and relaxing, having a shower etc.. After that, they did diaphragmatic breathing, to relax their brain and body.

Then, we went at the gym, and the clients did some physical exercises. I had the same client as the previous times. So, the exercises she did were the following:

1. Warm up with static bicycle:

• Level: 5-6
• Time: 5 minutes
• Feelings: She felt tired on breathing, strong heart beat and little pain on her knees 

2. Exercises on upper body-row:

• Level: 5 kg
• Sets & Repeats: 3x15
• Feelings: Good feelings. In the last set, she felt tired with her breathing

3. Exercises on abdominals:

• Level: 10 kg & 12 kg
• Sets & Repeats: 2x15 & 1x15 
• Feelings: Good!

4. Exercises on back muscles:

• Level: 10 kg
• Sets & Repeats: 3x10
• Feelings: Good!

5. Exercises on hamstrings-leg curl:

• Level: 15 kg & 18 kg
• Sets & Repeats: 2x10 & 1x10
• Feelings: Good! The hamstrings were warm.

6. Adduction:

• Level: 10 kg
• Sets & Repeats: 3x10
• Feelings: Pain in adduction muscle on left leg (because of the hip surgery in the past).

7. Abduction:

• Level: 5 kg & 8 kg
• Sets & Repeats: 1x10 & 1x10
• Feelings: The pain was worse in the left adduction muscle.

3. Treatment on the group of heart diseases (hyvä sydän)

I was not actively participated in this group, because it was based on theoretical knowledge of the good and healthy nutrition, in Finnish language, so it was very difficult for me to understand everything. 

Well, this day a nutritionist came to inform a group of 10 elderly people, about the healthy food, what to eat and what not to eat, the liquids of different kind of food, the salt, the sugar, the different types of oil (the worse and the best), the butter, the dairy products, the main meals that should be included in the daily diet (more fish and less meat). 

At the end of briefing, the clients were given a questionnaire about the quality and quantity of food they eat daily, and according to the total score, they should follow concreteness nutrition.

4. Treatment on group of Perheentalo (taking care of children)

This was a totally different group from the others. The placement was in the city center of Joensuu. Specifically, it was a place for families, where the parents left their children, while the were working or occupying with other things.

  The smallest age in Perheentalo was at least 6 months, and the older one was up to 5 years old. 

Our purpose was to notice the motor learning of the children and if there was something strange in their development. Especially, it was important to notice any hypotenuse, hypertonus, if the sides of the children were symmetric, the way of walking and how should they walk. There was only one child, that used only the one of the two sides to crawl (the right side), and did not move the left leg.

By the way, me and other two physical-therapy students, took care of 4 children and were playing with them. They did not had any development problems and were very healthy and vibrant.

  In my opinion, this visit to the Perheentalo was not useful for us, because we were just staring at the children and playing with them, and didn't participate as physiotherapists. We did not do anything physical-therapy, so I think that this was unnecessary! 

  Although, i enjoyed my time in Perheentalo, because i loved to stay with children, observe their movements and reactions, and playing with them!

5. Physiotherapy treatment on the group of memory diseases (Muistin virrassa)

This weekend, we did a totally different kind of treatment to the clients of the Muistin Virrasa group. It was very enjoyable and relaxing by the way.

Well, the clients (3 elderly women and 3 elderly men), came into Voimala, and presented themselves holding 2 small music instruments and playing the music the wanted, and also narrated their history in music. Me and two other students from nursery and physiotherapy department, did the same.

When the presentation, finished, we went to a musical room (first with the women and then with the men), where were different musical instruments. There was a musician, who learned them how to play a traditional Finnish musical instrument called Kantele, then she played traditional Finnish music with the harmonica and in the and, she played the guitar, and we sang all together Finnish traditional songs.

Kantele

Kantele

Harmonica

guitar

NOTE!!! The men, didn't try enough to play the Kantele, and one of them, gave up because maybe he didn't like it. From the other side, the women really enjoyed the Kantele, and tried a lot of times to learn how to play. Although, everyone liked the musical atmosphere, especially the harmonica and singing the traditional Finnish songs. It was really enjoyable for everyone of us. It was nice experience for me to be aware of the traditional Finnish culture!

6. Physiotherapy treatment on Gym group (Saliparit)

This weekend, we went again to the gym of Voimala with 8 elderly people (4 women with 4 men). I had a customer with Alzheimer, and it was quite difficult to communicate with her, because sometimes she did not want to do or continue the exercises, or she was getting angree. Although, she was very good with the exercises and did them with many kg. 
The exercises that she did, were the following:

Type of exercises: Warm up with Hand cycling machine.
Level: 6
Sets & Repeats: 3 minutes
Feelings: Good!

Type of exercises: Leg extension.
Level: 10kg
Sets & Repeats: 3x10
Feelings: Good!

Type of exercises: Leg curl.
Level: 15kg
Sets & Repeats: 3x15
Feelings: Good!

Type of exercises: Lat Pull.
Level: 11kg
Sets & Repeats: 2x10
Feelings: Good!

Type of exercises: Leg press.
Level: 6kg & 15kg
Sets & Repeats: 1x10 & 1x10
Feelings: Good!

Type of exercises: Abdominals.
Level: 13kg & 15kg
Sets & Repeats: 2x10 & 1x10
Feelings: Good!

Type of exercises: Back muscles.
Level: 15kg
Sets & Repeats: 1x10
Feelings: Good!

NOTE!!! The client was very strong for her age. Unfortunatelly we did not had enough time to finish the last exercise, because we had to do the stretching for all the muscles that the customer used in exercises.

Conclusion

In conclusion, this weekend went well and interesting as the last week. I enjoyed it!

Introduction

My beginning in Karelia Ammattikorkeakoulu as an exchange student and trainer on the subject of Physiotherapy. My schedule was multiple and very interesting. Each of days I was in different groups of students, with different  type of clients. We arranged the days and the hours of traineeship and also physiotherapy treatment on each of the clients and the program of groups every day.

Voimala projects - 1st week

First, I had a meeting with my supervisor who explained me everything about traineeship in Voimala and gave me the program with details about it. My schedule, included 4 groups at the 1st week. The 1st group, was the ''Letkeät lonkat'', which was group with hip fractures. In this group were not only physiotherapy students, but also students from the nursery department. At the 2nd group, I went to a client's home, with two students from Voimala (one from the physiotherapy department, and the other from the nurcery department) and did some exercises for the whole myoskeletal system, and also entertainment activities. The 3rd group, was the "Muistin virassa", which was a group with memory diseases and where also students from the social servises department. Finally, the 4th group was the "Saliparit", which was the Gym group, in which where 8 elderly participants (4 men and 4 women) with memory diseases and other myoskeletal problems.

Main part

1. Physiotherapy treatment on the group with hip fractures (Letkeät lonkat)

In this group, three elderly women came to Voimala to have physiotherapy and memory treatment. Especially, each of these clients, had had a hip fracture in the past, and made a surgery on their hips.

1st visit of clients:

Knowledge and memory exercises:

The treatment started with some questions from the nurse students to the women, like quiz.
This quiz included general knowledge about osteoporosis, diabetes, cholesterol and some specific questions like their experience in hip fracture, their feelings, changes of their life etc.

Myoskeletal exercises:

Then, we went to the gym, and were separated on 3 groups, and each group had their own client. Each of the clients did muscle exercises for strength, capacity and resistance.
In my group, i was with another student from the nursery department.

1st exercise: Our client started with warm up on the static bicycle,

                      on level 3-5, for 5 minutes. 

                      She felt a little bit tired with that exercise.

                                           

2nd exercise: Exercises for latissimus dorsi with 3 kg and 3 sets of 15 repeats. In this exercise, the client felt tired with her breathing, but was feeling good.

                                                                         

3rd exercise: Exercises on abdominal muscles with weight 15kg and 3 sets of 10 repeats. She felt a little bit hard breathing, but was feeling good.

                                                                         

4th exercise: Back muscles exercise where she did 2 sets of 10 repeats with 15kg in which she felt sweating and 1 set of 10 repeats with 18kg, in which she felt good.

                                                                                           

5th exercise:  Biceps exercise with flexion of knee.
                     She did 3 sets of 10 repeats with 15kg. She felt good.

                         

6th exercise:  Quadriceps with extension of knee.
                      The client did 3 sets of 10 repeats with 5kg and
                      said that she felt good in front of hair patella.

                      

7th exercise: Abduction exercise with 8kg of 2 sets and 10 repeats.
                     The client said that she felt good after that exercise.







2nd visit of clients:

Knowledge and memory education:

This day, the clients came again to Voimala, but we did other kind of exercises. First, they were asked some knowledge questions about the actions of opioid and the effects on the body and the brain, and were advised for the right dosage of paracitamon.
Then, we played a memory game with them. In the game, where 20 cards upturned on the table, with different icons, and the basic concept was about founding the 2nd pair of the card, which was upturned. If the clients found the right pair of the card, they took the winning cards. The winner was the person with the most cards.

Myoskeletal exercises:

We went to a different room, in which our clients did balance exercises in front of the mirror.  Each group, had their own client. My group, included me and a student from the nurse department.
Each of the balance exercises, had a stage of progressivity.

1st exercise: Anatomy support base with legs at shoulder height.
2nd exercise: Small anatomy support base.
3rd exercise: Small gait possition.
4th exercise: Possition with one leg in front of the other.

5th exercise: Berg balance test. The Berg Balance Scale (BBS) was developed to measure balance among older people with impairment in balance function by assessing the performance of functional tasks.


6th exercise: Progressive lifting of objects from the chair, the steps and the floor.

2. Physiotherapy Treatment at client's home

1st visit:

Visiting in a patient's home with other two students from physiotherapy and social services department.
This patient had multiple problems. For example, the main problem was that she had high levels of sugar (diabetic patient) and cardiac failure. She also had low movement in the hole body and urine problems. She had had a surgery 10 years ago on her left hip after a fracture on the hip, so the muscles on the left leg, especially the quadriceps, were very weak. She also had low movement in the joint of both shoulders, and especially on the left shoulder and also she had her upper body in flex position. So, she did some exercises for improving her situation.


1st exercise: plantar-dorsi flexion  with resistance in each leg, and 3 sets of 10 repeats.


2nd exercise: knee flexion-extension with resistance. 2 sets of 10 repeats and 1 set of 15 repeats



3rd exercise: Abduction exercises with teraband 3 sets of 10 repeats.



4th exercise: Stretching exercises for back extension on the chair.

 

5th exercise: Breathing exercises.



6th exercise: Shoulder exercises.




NOTE !!! A lot of difficulties and pain with stretching exercises because of the flex position of the upper body and core. Her left quadriceps was very weak, but after resistance exercises, was getting stronger. Also, the shoulder joints were very stiff because of immobility, so it was necessary to make the traction of both of the shoulders, to decompress the joint and to relieve from the pain.

2nd visit:

The physiotherapy treatment was almost the same with the first visit. The purpose is to improve the muscle strength of the hole body, and especially of the legs, because our client cannot walk without the walker, and also to improve the extension of her upper body and core.

So, this time she did again leg exercises: 

• plantar/dorsi flexion 
• knee flexion/extension
• hip flexion/extension

We added a new exercise for the legs (quadriceps):

• seats in chair and
• rising from a chair

Squats on chair

We also added balance exercises:

• Transfers of client's weight forward/back and right/left (with stabilization of her pelvis with my hands)

This exercise improves the activation and the proprioception of muscles in the lower limbs and prevents from falls.

In the end, she did stretching exercises at upper body and core muscles (as at the first visit), and also assisted mobilization of the shoulders.

3. Physiotherapy Treatment on the group with memory diseases ("Muistin virassa")

This group was separated in two groups. The first one was with 4 elderly women and the second one, was with 3 elderly men. Each of the two groups, did myoskeletal and balance exercises at the gym.

More specifically, each of the groups started with warm up for 5 minutes. So, some of the clients did warm up on the: 

• cross trainer machine
• static bicycle
• rowing machine

cross trainer machine

static bicycle 2

static bicycle 1

rowing machine

After the warm up, each of the groups, did exercises at the machines in a circule. For example, they did exercises for:

• abdominals (rectus abdominis) 
• muscles of back (latissimus dorsi) 
• row and 
• shoulder muscles 
• abdactions 
• quadriceps 
• hamstrings
• major thoracic
• diceps

Every one of the participants were in good condition of doing each of exercises, and some of them quiet strong, but only one woman couldn't do all the exercises, because of her dizziness and weakness.
In the end, we were separeted in groups of 2 people, and did squats, holding a ball (3-4kg). Everyone enjoined and had good time. Especially the men, were full of energy and active!

4. Physiotherapy Treatment on the Gym group ("Saliparit")

In this group, were 8 elderly people. 4 men and 4 women. Everyone had came with their wives and husbands. In the begining of the program, they did warm up 5 minutes. 

Then, we created some colourfull spots (pink, blue and green) on the ground, and the client's had to step on these spots, after our orders. This exercise was very usefull for training the brain of the clients, because they had to remember the colours of the spots and step on them. Everyone enjoined and was entertained!

After that, me and a student from the physiotherapy department, took a 75th age client, and show to him some muscle exercises. 

1. First of all, he did cross trainer on 5 level and for 5 minutes.
2. Then, he did leg press with 70kg and 3 sets of 12 repeats. 
3. After that, he did row exercises with 10kg and 2x12 repeats, and then with 11kg with 1x12 repeats.
4. He continued with the machine of internal external oblique abdominals with 30kg and 3x12 repeats.
5. Finally, he did the machine of back muscles (latissimus dorsi). The first set was with 45kg of 12 repeats, the second set was with 50kg of 12 repeats, and the third set was with 55kg of 12 repeats.

In the end, he did stretching on the muscles of:

• gastrocnemius
• hip external rotation
• gluteal
• quadriceps
• hamstrings
• wrist flexors
• wrist extensors
• major thoracic

Stretching

1. Gastrocnemius

2. Hip external rotation and gluteal

                                                       

3. Quadriceps

4. Hamstrings

5. Wrist flexors

                                         

6. Wrist extensors

                                            

7. Major Thoracic

                                            

NOTE !!! The client was extremely strong and in a great condition. He could do all the exercises without any problem, and with many kg. I was very surprised because i had't seen before, so strong elderly men! The only thing that he had a difficulty to do, was stretching at hip external rotation and gluteal muscles because of the 8th years old hip replacement surgery, but he tried to do the stretching as much as he could and in my opinion it had a good effect.

Conclusion

In conclusion, the first week was very busy and interesting. I learned a lot of things about the way of client's treatment in Finland. I liked that Finnish people do not rely only on one specific problem of clients, but they are based on the whole system of the human's body. I also liked that they also rely on International Classification of Functioning Disability and Health (ICF), which is used for functional status assessment, goal setting & treatment planning and monitoring, as well as outcome measurement. This was a very exiting beginning of my traineeship!