Our last stop on the EHECADI interviews journey was in Galicia, Spain, speaking with Ines. Ines, a physiotherapist at Amicos, shared with us the kind of work she does, the importance of practical education, and the rewards of her line of work.

Amicos, an organisation which emerged in the year 2000, was started by a group of parents searching for a centre which addresses the needs of their children with severe intellectual disabilities. In 2004 the Day Centre of the Amicos Association opened its doors. Today, Amicos has an occupational centre as well as a special education centre and welcomes persons with both physical and intellectual disabilities.

• Where do you work and what is your role in your current organisation?

Ines: I work at the Amicos association, located here in Boiru, Galicia, Spain; and I serve as a physiotherapist within the association. My role involves providing physiotherapy services to the users here at Amicos.

• What do you do in your role on a day-to-day basis?

Ines: Depending on the day, I conduct individual sessions with some users, and we also engage in group activities that operate somewhat uniformly. We do adapted exercises and various therapies, mainly related to exercise. Other times, even if the group isn't as homogeneous, the facility is excellent, very spacious. So, some may come in for treadmill walking, others for different exercises, while I work one-on-one with someone on a mat... We try to cover all their needs this way. We cater to people with intellectual and physical disabilities. Then there are people who are more mobile, so they mostly come in for aerobic exercises. For instance, treadmill walking, cycling, using the machines. Whereas with those with more severe physical disabilities, we work on mats. We also have various devices to assist those with limited mobility.

We also have a standing frame. It's a device that helps a person who can't stand on their own to get into a standing position. They are secured in it, allowing us to work with them while they bear weight on their legs and feet, with their arms free for activities such as passing a ball. Being able to stand is always an incentive for them. In addition to the standing frame, we have a software that incorporates games, making therapy more engaging for them.

We also have an AI-assisted movement device, which helps people with severely limited leg mobility cycle. It aids in mobility, strength, circulation; so it helps with various aspects.

Furthermore, we have a harness system installed on the ceiling of the rehabilitation room. This harness provides support to individuals with lower limb mobility issues, helping them walk without the fear of falling. They feel secure knowing the harness is there to support them.

• And what did you study?

Ines: I studied physiotherapy, which is a degree here in Spain. It's a university degree. When I studied, it was a diploma, which lasted three years, and then it shifted to a degree, which is four years.

• Do you think your studies prepared you well for your job? What did it do well or what would you have liked to be a little different?

I’m very satisfied, to be honest. Physiotherapy is very broad, so the field of work can cover different areas. However, during the degree, you receive general insights into everything. But as professionals, we are in continuous training because there are always advancements, new techniques emerging, and new equipment coming up. So, it does require a lot of ongoing education.

The degree program is indeed good in the sense that it gives you a glimpse of everything you can cover, some topics in more depth than others. Also, it adapts to detected needs, even at the time you're studying. And then, of course, it requires continuous learning because it's impossible to see everything you need to see. Moreover, you specialize if there is a specific path which interests you.

But it's a very practical degree, at least where I studied it. We had theoretical classes, and then a lot of practical training, where we did rotations in hospitals. There, you would see real pathologies with real patients, and you could start applying what you learned, gradually seeing the results, always with a teacher guiding you.

I think it's well structured. Everything can always be improved, of course. But my experience was very positive. It's been a while since I graduated, so I don't know how things are now, if they've changed a lot, but I imagine it's still very practical. Professional experience is what teaches you the most, but we did see a lot during our rotations. Obviously, what you see during a short rotation, in a centre where you spend 15 days, is nothing compared to what you face in reality. But still, it's much more than what you would see just sitting in a classroom. So, we could observe many things there.

• Perfect. The next question I have is, what would you say are the biggest challenges and rewards in your line of work?

I would say the challenges encompass everything that comes up in your day-to-day work, things you aim to achieve that might be more difficult due to the capabilities of the individuals you work with. In terms of resources, I'm very satisfied with the physiotherapy facilities we have. It's a spacious room with a lot of equipment. The challenge mostly lies in what each day presents, in trying to ensure progress every day, although perhaps 'progress' isn't always the best term because many interventions here are related to neurological processes, and some also involve aging. So, you aim to maintain capabilities, perhaps not so much like in orthopaedics where there's a clear path of progressive improvement because, for example, you might have a person with a broken hand and you need to rehabilitate that hand. Instead, here it's more about maintaining capacities. And when you maintain, any improvement you can achieve is always welcomed.

The real rewards come from the interactions and the impact of the treatment. It's all about how appreciative and thankful people are, the genuine warmth they express, and the joy they show when you help them. That feeling of being valued and wanted, especially when they ask to be with you, is truly the greatest reward. And the achievements, of course, when you see a person who struggles the first time they use the harness to walk, who's afraid, and gradually gains confidence, all of that is very rewarding. We also go to the pool once a week, and it's beautiful to see how someone who was very scared at first gradually becomes more comfortable, starts floating, moving their arms—it's very gratifying."

• The EHECADI project will work to develop a course aimed at helping healthcare students better understand societal needs and enhance employability. What do you think should be taught to students in their studies now to prepare them to provide quality support in the coming years?

I believe that practical experience is fundamental; having hands-on training is crucial. The theoretical aspect is indispensable, of course, because without theory, you can't practice. It's fundamental and at the same time very motivating. For you to enjoy it, you have to see that what you're doing makes sense, that what you've studied, what you've memorised, has a purpose. Moreover, I think practical experience is paramount because it's what you'll end up enjoying the most, it's what you'll dedicate yourself to, and it's where you truly see the purpose of what you've been taught, where you can see it in action.

• Yes, I can also imagine it's important to feel that it's real, that it's useful.

Exactly, to feel like you're the one actually doing things. And then, in the field of physiotherapy, I imagine it's still the same: a lot of anatomy, a lot of pathology; it's an incredibly broad field that I understand needs to be condensed a bit so that once you start, you can pave your way towards what you find most interesting. It happened to me too; throughout your career, you might start with an affinity towards a specific field and then it changes, you discover things, and suddenly you say, 'now I want to focus on pelvic floor issues' or 'I want to help these moms who have urinary incontinence problems,' or 'I want to move towards neurology or sports.' We can intervene in so many things.

And the specialties in physiotherapy aren't fully developed yet; we're increasingly seeing more master's programs, more expert courses, more training opportunities, but for example, it's not like in Medicine where you can specialize in a specific branch afterward. That's not quite there yet, and perhaps it would also be useful to be able to specialize a bit more.

• It's very interesting. Thank you very much. We just have one more question. If that's the case, what did you notice was different from what you expected once you started practicing your profession?

Well, it's quite different. You see, you start from the basis of what I was mentioning earlier: the internships, despite being numerous, are short because they wanted us to cover a wide range of specialties. So, sometimes you would begin interventions but couldn't finish them because you had to change rotations or practice sites. Or sometimes you would arrive and have to pick up where someone else left off. So, what you find different is that, you start and finish, so to speak. And then, of course, different activities work for some but not for others, and you learn that through your own experience in the profession. It's a day-to-day learning process. And things that you might have considered to be very easy in theory, well, when put into practice, they're not always so easy, or you don't get the results you expected, and you have to try different approaches. But you know, I think that happens to some extent at all levels. You always end up somewhat surprised.