S  B  P  S


Scottish Bell's Palsy Study


How to Refer a Patient

What is Bell’s Palsy?

What is the S B P S?

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The Patient’s Experience

Graeme’s Story

House-Brackmann Scale

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House-Brackmann Scale

Measuring the severity of an attack

Our main measuring instrument is the House-Brackmann grading scale which goes from I (normal) to VI (no movement). The grading is achieved by expert viewing and assessment of the photographs taken during the patient visits.


House, J.W. and Brackmann, D.E. (1985) Facial nerve grading system. Otolaryngol. Head Neck Surg., 93, 146147.




Normal symmetrical function in all areas


Slight weakness noticeable only on close inspection
Complete eye closure with minimal effort
Slight asymmetry of smile with maximal effort
Synkinesis barely noticeable, contracture, or spasm absent


Obvious weakness, but not disfiguring
May not be able to lift eyebrow
Complete eye closure and strong but asymmetrical mouth movement
                                                                           with maximal effort
Obvious, but not disfiguring synkinesis, mass movement or spasm


Obvious disfiguring weakness
Inability to lift brow
Incomplete eye closure and asymmetry of mouth with maximal effort
Severe synkinesis, mass movement, spasm


Motion barely perceptible
Incomplete eye closure, slight movement corner mouth
Synkinesis, contracture, and spasm usually absent


No movement, loss of tone, no synkinesis, contracture, or spasm