Managing Facial Palsy After Stroke: Results From an Online Survey of Health Professionals

Post-stroke facial palsy significantly impacts patients' communication, eating and overall quality of life. Despite its prevalence, standardised management guidelines are lacking and evidence for assessment and treatment approaches remains limited.

To describe UK clinical practice for assessing and treating post-stroke facial palsy and which healthcare professionals play a role.

A cross-sectional online survey was conducted using Qualtrics to collect data on participants' professional lives, assessment and treatment practices. UK healthcare professionals in stroke or facial palsy care were recruited through social media, conferences and professional networks.

Ninety-six out of 150 professionals completed the survey, mainly speech and language therapists (40%) and physiotherapists (43%), including 17 others (occupational therapists, nurses, doctors and orthoptists). Speech and language therapists and physiotherapists were the most likely professions involved in the collaborative management of post-stroke facial palsy. The most common assessment was clinical observation (84%). Some assessments were more favoured by certain professions, for example, 71% of nurses and doctors used the National Institutes of Health Stroke Scale; speech and language therapists and physiotherapists used the Sunnybrook Facial Grading System and clinical observational methods more than the 'Other group'. The most commonly used treatments were orofacial exercises (60%) and facial massage (52%).

The study describes current UK practice for managing post-stroke facial palsy and underscores the critical roles of speech and language therapists and physiotherapists. Now that we know what is used and by whom, we should explore the evidence underpinning this practice to guide assessment and treatment and improve outcomes for stroke survivors.

What is already known on this subject Post-stroke facial palsy affects 45%-60% of acute stroke patients, significantly impacting physical appearance, communication and quality of life. There are currently no clinical guidelines for managing post-stroke facial palsy, and it is notably absent from national stroke guidelines. Previous international research indicates uncertainty about which professionals should lead facial palsy management after stroke. What this paper adds to existing knowledge This is the first UK-specific survey examining how post-stroke facial palsy is managed across multiple healthcare professions. Speech and language therapists and physiotherapists are identified as the primary providers of post-stroke facial palsy care in the UK. The study reveals significant variations in assessment methods, with most clinicians relying on informal observational approaches rather than standardised tools. Common barriers to implementation include a lack of resources, confidence and clear clinical guidelines. What are the potential or actual clinical implications of this work? The findings highlight a need for standardised assessment tools and evidence-based treatment guidelines for post-stroke facial palsy. Healthcare professionals require specific training in facial palsy assessment and management. Future service development should focus on clarifying professional roles and promoting interdisciplinary collaboration in facial palsy care.