What is Physical Therapy and How Does it Intersect with Applied Behavior Analysis?

Physical movement—from the largest of movements that allow us to jump, run, and balance, to the smallest of movements that allow us to pick up a pencil or hold a fork, our ability to adequately move without pain, limitation, or restriction is vital to our health, well-being, and quality of life.

Physical therapy is at the heart of physical movement and is solely focused on restoring, maintaining, and promoting our optimal physical function. The objectives of physical therapy can look quite different from one patient to the next, but its goal is always the same: to restore, maintain, and improve physical health.

Physical therapy deals with any limitations, restrictions, or impairments related to the body’s cardiovascular, pulmonary, musculoskeletal, neuromuscular, and integumentary systems.

However, physical therapy involves not just accomplishing physical goals, but also pushing past fears, doubts, and anxieties that stand in the way of achieving those goals. Through the integration of applied behavior analysis (ABA), physical therapists can address these feelings, emotions, and behaviors and make use of ABA strategies that help optimize outcomes.

What is a Physical Therapist?  – Where They Work and What They Do

Physical therapists (PTs) are doctoral-trained, board-certified, and state-licensed healthcare professionals who serve as leaders in physical rehabilitation, health maintenance, and prevention.

PTs are autonomous healthcare providers whose work often overlaps or intersects with other therapies, including ABA, occupational therapy, and speech-language therapy. These movement experts work with patients across the lifespan to prevent injury, restore function and movement, and maintain physical health. Their work includes hands-on therapy, prescribing exercises, and educating patients, their families, and the community about the importance of physical therapy for minimizing pain, preventing disability, and achieving a better quality of life.

Physical therapists develop comprehensive therapy plans that address a patient’s physical condition, implement techniques that promote physical movement and function, and prescribe exercises for the patient to complete at home. Many times, their work is focused on prevention, which includes developing fitness and wellness routines that encourage physical activity while also preventing loss of mobility or range of movement and/or the onset or progressions of physical ailments that result from specific diseases, conditions, or injuries.

Their role as clinicians involves diagnosing and assessing patients and performing tests designed to identify or measure physical ailments or conditions that result in physical pain or loss of movement. Using a patient’s medical history and data resulting from the tests, physical therapists are able to determine what physical therapies (if any) can be implemented. They then develop an appropriate course of treatment that involves frequently assessing the patient’s progress and making modifications to the therapy plan, as necessary.

A medical exam performed by a physical therapist may involve assessing muscle function, joint flexibility, range of motion, strength, balance, posture, motor function, respiration, and more. Upon assessing a patient and developing an appropriate PT plan, these hands-on professionals perform any number of exercises and techniques, including:

  • Manual therapy
  • Traction
  • Exercise
  • Ultrasound/electrotherapy
  • Vestibular training
  • Motor learning and development

Their practice also includes educating both the patient and the patient’s family on the implementation of at-home exercises, the use of adaptive and assistive devices like crutches, wheelchairs, and prosthetics, and strategies for supporting the rehabilitation process.

The plans developed by physical therapists are often implemented by physical therapist assistants (PTAs), although physical therapists will still oversee the plan of care, making changes when necessary.

The work of physical therapists often takes place in devoted physical therapy clinics, although they also provide care in:

  • Homes
  • Inpatient rehabilitation facilities
  • Skilled nursing care facilities
  • Assisted living facilities
  • Schools
  • Occupational environments
  • Fitness centers
  • Sports training centers

On any given day, physical therapists may treat a newborn with poor head control resulting from a birth injury, an athlete recovering from Tommy John surgery, and a senior struggling with a loss of hand strength to advanced arthritis. The following is just a sampling of the many conditions, diseases, and ailments treated by physical therapists:

Pediatrics

Physical therapy with babies and toddlers may focus on developmental delays, birth injuries, congenital disorders like cerebral palsy or muscular dystrophy, or developmental disorders like autism.

Cardiopulmonary

Physical therapy with cardiopulmonary patients may include rehabilitation with patients recovering from heart surgery or heart attacks, or it may include working to combat physical decline and improve strength and stamina in patients with asthma, COPD, ALS, multiple sclerosis, or cystic fibrosis.

Musculoskeletal

Physical therapists frequently treat patients with musculoskeletal disorders or injuries, such as sciatica, chronic lower back pain, arthritis, osteoporosis, spinal stenosis, bulged discs, and rotator cuff tears.

Neurological

Many neurological injuries, conditions, or diseases benefit from physical therapy. Physical therapy in this area may treat patients with spinal cord injuries, those recovering from strokes or traumatic brain injuries, or those living with conditions such as Parkinson’s disease, Alzheimer’s disease, and multiple sclerosis.

Sports Injuries

The recovery from sports injuries often demands a comprehensive physical therapy plan. Physical therapy may help patients recovering from concussions, strains/sprains, knee injuries, shin splints, fractures, dislocations, or ligament injuries.

Surgeries

A comprehensive recovery program for a wide array of surgeries often includes a course of physical therapy. Just some of the surgeries that often demand post-op physical therapy include hip, knee, and shoulder replacements, spine and back surgeries, cancer surgeries, carpal tunnel surgery, foot and ankle surgery, and brain surgery.

Implementing ABA into a Physical Therapy Program

As an emerging therapy, applied behavior analysis (ABA) continues to evolve and grow, with the number of human services practitioners implementing it into their clinical practices growing along with it. While ABA has been traditionally used by behavior therapists to treat children with autism, the medical community has come to realize its value in a number of other domains, including physical therapy.

Like behavior analysts, physical therapists observe behaviors and how they are influenced by the environment, making the fusion of the two a natural fit. Implementing ABA techniques into a physical program allows the physical therapist to motivate the patient through positive reinforcement that ultimately leads to better outcomes.

For example, when working with a small child to achieve better muscle tone and strength, a physical therapist may employ ABA techniques to encourage the child to continue performing certain exercises designed to increase strength, stamina, and balance. One such example would be the physical therapist introducing a toy that can only be reached when the child performs a specific physical therapy exercise. The toy serves as both the motivation and the reward, with the child being able to play with the toy once he reaches it. The task may also be broken down into manageable parts, with each part earning the child a reward.

Sometimes the reward of being able to physically accomplish something is all that is needed for positive reinforcement in physical therapy. This may something as simple as reminding the patient that once a specific goal is accomplished, she will be able to walk independently, without a walker. The reminder of the reward serves as the positive reinforcement.

How to Become a Physical Therapist: Degree, Residency, Certification and Licensing

Regardless of where you practice and if you choose a generalist or specialist focus for your career, a physical therapist must complete a doctoral-level physical therapist program and earn both board certification and state licensure in order to practice.

To become a physical therapist, you’ll need to complete a physical therapy program that’s accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE). There are currently about 250 physical therapy programs in the U.S.

All professional (entry-level) physical therapist programs are designed as Doctor of Physical Therapy (DPT) degrees. The DPT is usually about three years long and consists of classroom, lab, and clinical experience requirements. Coursework in these programs is broad, covering areas such as:

  • Biology/anatomy
  • Physiology
  • Exercise physiology
  • Biomechanics
  • Kinesiology
  • Neuroscience
  • Pharmacology
  • Pathology
  • Ethics/values
  • Clinical reasoning
  • Evidence-based practice

Most DPT programs require a bachelor’s degree for admission, while others offer a 3+3 curriculum that also includes three years of undergraduate coursework that is completed before transitioning to the professional program. The final clinical experience of a DPT program is about 27 weeks long.

Upon graduation from a DPT program, graduates must take and pass the National Physical Therapist Exam that’s administered through the state in which they are seeking licensure.

All physical therapists must be state licensed to practice. More information on licensure requirements in your state can be found here.

Options for Further Education

Advancing your knowledge and clinical expertise in a specific area of physical therapy may be the ideal way to focus your career and gain the reputation as an authority in your field.

Clinical Fellowship/Residency Options

After graduation, you may choose to complete a clinical fellowship/residency. A clinical residency is designed to prepare a physical therapist in a specific area or specialization within physical therapy, while a clinical fellowship is aimed primarily at board-certified PTs who want to gain clinical expertise in a specific area.

You can learn more about completing a fellowship or residency by visiting the American Board of Physical Therapy Residency and Fellowship Education.

Specialty PT Certification

Physical therapists often choose to focus their careers on a specific area of physical therapy. While voluntary, a specialty certification through the American Board of Physical Therapy Specialties allows practicing physical therapists to develop a greater foundation of knowledge in a specific area of physical therapy.

Physical therapists can achieve specialty certification in the following areas:

  • Cardiovascular and Pulmonary
  • Clinical Electrophysiology
  • Geriatrics
  • Neurology
  • Orthopaedics
  • Pediatrics
  • Sports Physical Therapy
  • Women’s Health

You can sit for one of the specialist certification examinations once you have earned at least 2,000 hours of clinical practice in your chosen specialty area (25% of which must have occurred in the last three years).

ABA Education/Certification

Completing a course of education in applied behavior analysis is an excellent way to position yourself as a specialist in the field of ABA. The Behavior Analysis Certification Board (BACB) offers professional certification in ABA; however, it is currently limited to only those candidates who have completed a master’s degree in psychology, education, or behavior analysis. But in 2022, the BACB will remove these degree restrictions and open up the Board Certified Behavior Analyst (BCBA) credential to master’s prepared practitioners from any number of human services fields who have completed a verified course sequence (VCS).

In anticipation of this change, many schools that offer the VCS (either as a stand-alone course sequence or as a graduate certificate) have already removed the degree restrictions, allowing physical therapists and other human services practitioners to complete this comprehensive course of study in ABA.

Complete the VCS now and you can begin implementing ABA techniques into your practice. Then, in 2022, you’ll have the option of completing the experiential and exam requirements and earning the BCBA.

How Much Do Physical Therapists Make?

According to the American Physical Therapy Association’s 2016-2017 Practice Profile Survey, the more than 209,000 licensed physical therapists in the U.S. earn a median salary of $85,000.

The U.S. Bureau of Labor Statistics (BLS) reports the following, average salaries for physical therapists at the 25th, 50th, 75th, and 90th percentiles, as of May 2018:

  • 25th: $71,670
  • 50th: $86,805
  • 75th: $101,790
  • 90th: $122,650

Physical therapists earned the highest mean salaries in the following states:

  • Nevada: $102,860
  • New Jersey: $99,220
  • Alaska: $97,150
  • Texas: $95,920
  • California: $95,570

The top-paying metropolitan areas for physical therapists, according to mean salary, were:

  • Merced, CA: $128,040
  • Hammond, LA: $123,430
  • Morristown, TN: $117,110
  • Victoria, TX: $114,620
  • Longview, TX: $108,970
  • Las Vegas-Henderson-Paradise, NV: $108,290

 

Salary and employment data compiled by the United States Department of Labor’s Bureau of Labor Statistics in May of 2018 – (https://www.bls.gov/oes/2017/may/oes291123.htm . BLS salary data represents state and MSA (Metropolitan Statistical Area) average and median earnings for the occupations listed and includes workers at all levels of education and experience. This data does not represent starting salaries. Employment conditions in your area may vary.

Individual job listings with educational requirements and salary information accessed directly from internet job boards and directly from the sites of employing agencies and do not constitute offers of employment.

All salary and job growth data accessed in October 2019.