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APA in rehabilitation – case study Satakunta/Finland Print E-mail

Author: Senior Lecturer, PhD Tarja Javanainen-Levonen, Satakunta University of Applied Sciences
Aims: The aim of this article is to explore the role of physical activity within rehabilitation and to give examples of APA practice in various forms of rehabilitation.

This survey was a part of the EUSAPA project preliminary inventory and needs analysis. A purposive sampling was carried out spring 2009 in Western-Finland, in Satakunta region (Fig.1). The survey was sent to 47 institutions. Institutions included formal rehabilitation settings: rehabilitation centres and re74 habilitation wards in local hospitals, as well as settings that are more informal. Informal settings covered institutions aiming at total rehabilitation of the clients. More informal settings included service-homes and departments for the elderly (for example war veterans), and for clients with particular needs (intellectual disability, psychiatric disorders, alcohol abuse etc.).
Thirty-four institutions filled in the EUSAPA rehabilitation questionnaire. The response rate was 72.3 %. Based on the results of SPSS-analysis, four interesting cases were selected for further interviews with APA experts or other professionals. The characteristics of these four intitutions are described more detailed in Table 1.


Fig.1. The location of Satakunta, region number 10 in Finland

Table 1. Characteristics of the four institutions in the interview data


More than 91 % of all institutions organised physical activity for their clients. At least four physical activity programmes were organised in 59 % of the institutions. Physical activity programmes were: 75 mostly group activities (aquatics, chair gymnastics, balance training), individual activities (for example aquatics for severely disabled clients with intellectual disabilities, gym training or bicycling for psychiatric patients etc.), as well as specific programmes for each ward (for example in child or adult psychiatric clients),sports happenings and even activities for out-patients – for example in psychiatric cases. Physiotherapists (53 % of cases), apa-instructors (12 %), as well as other professionals (71 %) were responsible for physical activity. The classification for "other professionals" covered for example assistant physiotherapists [a lower level education in physiotherapy] and assistant nurses [lower level education in nursing). One third of the respondents considered human resources and time as restrictors for organising physical activity. Attitudes of the professionals were rarely mentioned.

Kankaanpaa1 Kankaanpaa2 Kankaanpaa3

Photos 1–3. Physical activity options offered in Kankaanpää rehab center

Implementation of physical activity in formal rehabilitation settings (i.e., rehabilitation centres or wards in hospitals) seems to be based on structured planning. According to the interviews of professionals in the field, the implementation of physical activity as part of rehabilitation in formal rehabilitation settings is based on thorough written plans: year-plans, period plans, as well as on planned service delivery packages sent to wards (the client’s own caretaker with a team selects the activities). Work is carried out within teams (doctors, nurses, psychologists, social experts etc.). It is not always the APA expert who decides the placement in physical activity programmes: it might be the client office, medical doctor or client’s own caretaker as well. Nevertheless, the placement can be changed during the rehabilitation process. APA experts take a lot of responsibility in planning and implementing the programmes. Usually they belong to the rehabilitation team. All documentation is carried out electronically in formal rehabilitation settings. APA experts are usually allowed to see patient documents and are supposed to do evaluation and documentation in accordance with the aims of rehabilitation. In some cases, they have the responsibility to work under a certain budget.
In rehabilitation, physical activity instructors run a counselling session in the beginning of the programme (according that discussion the programme might be changed). Furthermore, they carry out process evaluation as well as final interview with the client. They might consult the client’s home community for assistive aids and devices as well as for service-delivery in physical activity. According to the interviews, after rehabilitation period, the instructors also do the marketing for physical activity in client’s local community. Earlier days they did it more – more time to do it.
Various physical activities were included in the weekly programme of some of the more informal settings even without APA experts. Monituote, a rehabilitative work centre for adults with intellectual disabilities is a good example of those institutions. Monituote runs weekly and seasonal activities, as well as collaborates in projects in physical activity for their clients (Photos 4–6).

Monituote1 Monituote2 Monituote3

Photos 4–6. Physical activity options offered for Monituote clients

The results showed that not all rehabilitative settings have APA experts. However, in Finland, "rehabilitative approach" should be presented in everyday practice. This means that empowerment and physical activation of all clients should be carried out by all professionals working with the client. Therefore, instructors in general, nurses, public health nurses, custodians (responsible for specific equipment in institutes) were mentioned in many answers. Physical activities are not always that organised, but physical activity is facilitated by institutions. Concurrently, every professional working in rehabilitation is supposed to activate the clients – physically as well. Therefore, more focus should be addressed to the training of a broad scope of professionals in order to include and develop physical activity as a part of rehabilitation for all clients.

Javanainen-Levonen, T., Heinola, J. & Kärki, A. (2010) Adapted physical activity as a part of rehabilitation in Satakunta, Finland. Eucapa 2010, European Congress of Adapted Physical Activity. Book of Abstracts. May 6–8, Jyväskylä, Finland, p.67.
Järvikoski, A. (2005) Disability, rehabilitation and research: some introductory remarks. In S. Mannila and A. Järvikoski (eds.) Disability and Working life. Rehabilitation Foundation. Working papers 32. Helsinki: University Press, 1–4.
Kuntoutusselonteko [Report on Rehabilitation]. (2002) Ministry of Social Affairs and Health.
RIFI, Rehabilitation International in Finland (2002) Rehabilitation in Finland.
WHO (2001). International classification of functioning, disability and health. World Health Organnisation. Geneva.

This research is focused on the profesionals competences of rehabilitation workers. It draws attention not only to the developed competences, but mainly the working application and practical need for experts in APA in rehabilitation. You must notify legislative limits during employing of experts in APA in the implementation of rehabilitation programmes. Neccesery is required of all those competences, skills and knowledge.

Example of good practice was described by Tarja Javanainen-Levonen from Satakunta University of Applied Sciences. 



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