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!