Q&A with Todd Henkelmann, PT, MS, CCTT, Facial Dysfunction Specialist at Allegheny Chesapeake Physical Therapy in Pittsburgh
Todd Henkelmann, PT, MS, CCTT, graduated from California State University with a BS in Physical Therapy. He received his master’s degree in Physical Therapy with a neurological emphasis from the University of Pittsburgh in 2004. He is a certified Cervical and Temporomandibular Therapist, a member of the American Physical Therapy Association, and an affiliate member of both the American Academy of Otolaryngology Head and Neck Surgery and the American Academy of Orofacial Pain. Currently, Henkelmann is a full-time Facial Dysfunction Specialist at Allegheny Chesapeake Physical Therapy in Pittsburgh, Pennsylvania.
Q: What motivated you to become a physical therapist?
A: I was exposed to PT in high school due to a springboard diving-related sports injury and a family friend who mentored me in diving was also the PT who helped me recover. The hands-on aspect of the treatment and being able to help people rehabilitate were influences. My father, a physician, also encouraged me to go into this medical field.
Q: What kind of facility is Allegheny Chesapeake Physical Therapy?
A: It is a medium-sized, privately owned practice. Allegheny Chesapeake has 12 locations throughout Western Pennsylvania. I work in an outpatient office with three other physical therapists. Our location is primarily focused on orthopedic and sports medicine. My specialty focuses on temporomandibular disorder (TMD), headache, facial, and neuromuscular retraining (NMR). We have a fitness gym staffed by physical trainers that both post-therapy patients and the general public can join. Our staff members participate in many community events and offer educational talks and presentations to community groups.
Q: When and how did you start at ACPT?
A: I started working for this company in February 2008, following my work at the Facial Nerve Center associated with the University of Pittsburgh Medical Center (UPMC). I was looking for the opportunity to continue and expand my practice in facial NMR and TMD/headache treatment, and was successfully recruited by the Clinic Director, Nancy Foley, PT, DPT, OCS.
Q: Typically, what are your day-to-day responsibilities as a PT at ACPT?
A: As a full-time Facial Dysfunction Specialist, I do not treat a general caseload. I treat individuals with Bell’s palsy, facial palsy secondary to acoustic neuroma and other tumor excision, and facial palsy from stroke, congenital disorders, trauma, and Lyme disease. I also treat TMD, trismus, occipital and tension headache, and myofascial pain disorder of the head and neck. I am responsible for marketing my specialty to physicians, other therapists, medical professionals, and the general public. I also act as a consultant to other therapists in our practice regarding questions or issues related to Bell’s palsy and TMD.
Q: Are there other areas of interest for you as a physical therapist, either clinically or educationally, that you plan to pursue?
A: I plan to write more articles and contribute to a book on the treatment of facial palsy, and hope to research how to successfully treat trismus conditions in conjunction with doctors at UPMC and other area hospitals. I will also be seeking more continuing education in the area of cervical spine disorders.
Q: Have you been involved in any recent special projects?
A: The technique that is considered the most effective for treating facial palsy conditions is facial NMR, which combines the use of mimicry, mirror, and surface electromyographic biofeedback, as well as some manual techniques, such as stretching and massage.
It surprisingly does not include electrical stimulation, which has been found to cause unexpected problems when used on the face (e.g. hyperkinesia, synkinesis). Unfortunately, there are few physical, speech, or occupational therapists interested enough to learn the technique. For this reason, patients often come to us from out-of-town or out-of-state due to the dearth of specialists closer to home. I have had a chapter published on this subject in a medical textbook, The Facial Nerve, May’s 2nd edition, on facial nerve disorders.
Q: What are the greatest challenges you face in your job?
A: Primarily, it is staying abreast of the latest techniques and research in order to achieve the most successful outcome possible in my patients, who tend to have fairly complicated conditions. Also, I must keep up with the documentation that is required.
Q: What do you like the most about your job?
A: I like working with our friendly and dedicated staff in a positive and patient-focused facility. Our company is dedicated to excellence and it is a privilege to be part of.
Q: Do you feel that the role of PTs has changed over recent years? If so, how?
A: We have become better educated, now requiring a doctoral degree at entry-level. We are also becoming more specialized, with certifications now available in multiple areas of specialty practice (e.g. orthopedic, neurological, pediatric, geriatric, cardiopulmonary, cervical, and TMD). Lastly, we are assuming more of a role as gatekeepers, where someone will come first to us for assessment, and if their medical condition is beyond our scope of practice, we will then refer them to the appropriate physician or specialist.
Q: What do you feel is of the greatest concern to PTs today?
A: I think there are three issues:
• The loss of, or reduction in, reimbursement from insurance companies, both private and governmental, for our rendered services;
• Having chiropractic and physical therapy services bundled together by insurance plans. This will cause patients to use up their allotted number of visits more quickly if they have been seen by a chiropractor prior to physical therapy;
• Having physical therapists work for physician-owned practices, so that there is a financial incentive for the doctor to refer more patients to PT, even when not needed. This creates the possibility of fraud and excessive expense to the system.
Q: What is the most rewarding part of your job?
A: I like being able to help a person regain their facial function (e.g. a full smile or pucker), regain the ability to eat without pain, and/or restore a functional mouth opening.
Q: What is the most important thing you’ve learned over the course of your career?
A: The importance of continuing to learn and refresh your knowledge; to stay up with current research in order to provide the best and most effective treatment. This has the added effect of preventing boredom and burnout.
Q: What advice do you have for others thinking of becoming Facial Dysfunction Specialists?
A: Seek out the best physical therapist(s) to guide you in your journey and work to gain a comprehensive understanding of head and neck anatomy, physiology, and neuroanatomy, and keep returning to it; as this is the foundation for everything else.
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