House-Brackmann Scale Explained: Grades I to VI in Plain English

Keywords: House-Brackmann scale, facial nerve grading, facial palsy assessment, facial symmetry score, how to measure facial paralysis

If you have been to a neurologist, ENT specialist or physiotherapist for Bell's palsy, you may have heard "grade III" or "House-Brackmann". It is the most widely used way to describe how well the facial nerve is working. Knowing what the grades mean helps you understand your own reports and ask better questions.

The six grades

Grade	Name	In plain English
I	Normal	Normal facial movement
II	Mild	Slight weakness only noticeable up close. Eye closes fully with little effort. Smile slightly uneven with maximum effort
III	Moderate	Obvious difference between sides, but not disfiguring. The eye closes completely with effort. Some linked movement may be visible
IV	Moderately severe	Obvious weakness and/or disfiguring asymmetry. The eye does not close completely
V	Severe	Only barely noticeable movement. Asymmetry at rest
VI	Total paralysis	No movement

What the scale is good for, and what it is not

• It is a clinical grading done by a trained professional, which makes it consistent between doctors.
• It is a rough, whole-face summary. It does not say which part of the face is recovering faster, and it changes in big steps.
• It does not capture small improvements between visits.

Tracking the gaps between appointments

Recovery often happens between visits. Many people want a way to see small changes in the eyebrow, the eye or the smile, week by week. Objective measurements beat memory, because you see your own face every day and gradual change becomes invisible.

Bell's Palsy Exercises & Log records nine standard movements with the front camera, compares the left and right sides, and gives a 0-100% symmetry score for each movement and overall. It also:

• Picks the best frame of each movement, so your before-and-after photos line up
• Plots a recovery trend and compares any two assessments side by side
• Counts days since onset
• Exports a multi-page PDF (Pro) with scores, photos and training history for your follow-up

Important: the app's symmetry score is a self-tracking measure and is not a House-Brackmann grade or any other clinical rating. Use it to see your own trend and to start conversations with your clinician, not to grade yourself.

Bell's Palsy Exercises & Log is a self-tracking and home-exercise companion. It does not diagnose or treat any condition, and its symmetry score is not a clinical grade. New facial weakness can be a sign of stroke, so seek medical help immediately.