Authors (including presenting author) :
Tsui KYV(1), Tsang SHC(1), Soo WLA(1), Yuen PYS(1), Chan MFE(1), Kwong SFS(1), Mok KL(2), Chan YME(2), Siu YCA(2)
Affiliation :
(1)Physiotherapy Department, Ruttonjee and Tang Shiu Kin Hospitals,(2)Accident and Emergency Department, Ruttonjee and Tang Shiu Kin Hospitals
Keyword 1: :
Bell's palsy
Keyword 2: :
Sunnybrook Facial Grading System
Keyword 3: :
Physiotherapy
Introduction :
Bell’s palsy causes unilateral facial muscle weakness and functional impairment. Physiotherapy management comprised facial exercises, soft tissue techniques, pain relief, electrical neuromuscular stimulation and patient-specific care education. Physiotherapists primarily assess facial muscles by using Manual Muscle Testing (MMT), which often fails to capture subtle changes due to its limited sensitivity to fine motor nuances. Standardized assessment and documentation for objectively tracking recovery and communication were lacking. Sunnybrook Facial Grading System (SFGS), a gold standard for evaluating functional outcomes, has been utilized since January 2025.
Objectives :
(1) To standardize assessment and documentation for Bell’s palsy
(2) To evaluate clinical outcomes
(3) To enhance interdisciplinary communication
Methodology :
SFGS was applied to Bell’s palsy patients attending the outpatient physiotherapy department of RTSKH beginning in January 2025. From September 2025, a self-developed mobile application was used to capture patients’ facial movement and generate a comprehensive report, which was uploaded and made retrievable in CMS. The report was promulgated to the main referrer, A&E clinicians, and a survey was conducted in December 2025.
Result & Outcome :
From Jan – Dec 2025, 28 patients (M/F: 11/17; mean age: 51.2) were recruited. 24 cases (86%) were referred by the A&E Departments of RTSKH and QMH; while 4 cases (14%) by the Family Medicine Clinics. 13 cases (45%) had subsequent follow-up in the Otorhinolaryngology, Head and Neck Surgery Department. The mean number of physiotherapy sessions was 4.64 (range 1-21). The SFGS score improved from 45.3/100 to 76.8/100, with a mean improvement of 31.5 (95% CI 20.7 to 42.3), which was statistically significant (p< 0.001). Subjective improvement on the Numeric Global Rate of Change Scale (NGRCS) was 8.6/10 (SD 0.94). There were 8 cases adopted the standardized documentation. 7 A&E clinicians completed the survey. They agreed that the SFGS is a comprehensive and sensitive evaluation tool for tracking Bell's palsy (mean=4.14/5). They also agreed that the standardized report is clear and informative (mean=4/5), and easily retrievable in CMS (mean=4.57/5).
