Validation of the objective assessment of facial movement with a new software-based system.

BACKGROUND: Most used subjective Unilateral Peripheral Facial Palsy (UPFP) grading systems are characterized by high variability and low reproducibility and doesn't allow a separate evaluation of single facial regions. OBJECTIVE: To assess the reliability of a new objective method for classification of UPFP, comparing it with House-Brackmann (HB) and Sunnybrook facial grading (SFGS) systems. METHOD: Forty-seven patients affected by UPFP of different HB grade were included. Each patient underwent a blinded examination by three different operators, via the two subjective methods (HBGS and SFGS) and a newly proposed objective one, that was obtained from a digital video-analysis, named SMART FACIAL system. Results were converted by validated conversion scales into HBGS grades and statistically compared. RESULTS: In 87,23% (n° 41 pts) consistency was found between the grades obtained with all the three evaluation methods; in 10,41% (n°5 pts), between HBGS and SFGS grade and in 2,08% (n°1 pt) between HBGS grades and SMART-FACIAL system. Statistical analysis showed significant correlation among the three systems (p < .000). CONCLUSIONS: The SMART FACIAL system presents high reliability also in comparison with the most frequently used subjective methods. SIGNIFICANCE: This method represents a fast, simple and thorough way to analyze UPFP, especially during physical rehabilitation.

Proposal of a Video-recording System for the Assessment of Bell's Palsy: Methodology and Preliminary Results.

HYPOTHESIS: To propose a new objective video-recording procedure to assess and monitor over time the severity of facial nerve palsy. BACKGROUND: No objective methods for facial palsy (FP) assessment are universally accepted. METHODS: The face of subjects presenting with different degrees of facial nerve deficit, as measured by the House-Brackmann (HB) grading system, was videotaped after positioning, at specific points, 10 gray circular markers made of a retroreflective material. Video-recording included the resting position and six ordered facial movements. Editing and data elaboration was performed using a software instructed to assess marker distances. From the differences of the marker distances between the two sides was then extracted a score. RESULTS: The higher the FP degree, the higher the score registered during each movement. The statistical significance differed during the various movements between the different FP degrees, being uniform when closing the eyes gently; whereas when wrinkling the nose, there was no difference between the HB grade III and IV groups and, when smiling, no difference was evidenced between the HB grade IV and V groups.The global range index, which represents the overall degree of FP, was between 6.2 and 7.9 in the normal subjects (HB grade I); between 10.6 and 18.91 in HB grade II; between 22.19 and 33.06 in HB grade III; between 38.61 and 49.75 in HB grade IV; and between 50.97 and 66.88 in HB grade V. CONCLUSION: The proposed objective methodology could provide numerical data that correspond to the different degrees of FP, as assessed by the subjective HB grading system. These data can in addition be used singularly to score selected areas of the paralyzed face when recovery occurs with a different timing in the different face regions.