Via Research Recognition Day Program VCOM-Carolinas 2025

Clinical Educational Research

Does this ring a bell? Examining unilateral facial paralysis: Can the general population identify the difference between Ischemic stroke & Bell’s palsy? Makenzie Logue, Gabrielle Montgomery, Mary Price, Kelsey Vineyard, Kaytlyn Harms, Taylor Carman, Jessica Claar, Dr. David Jaynes PhD .

Background

Results

Results

. Greenville County, located in northwestern South Carolina, has a total population of 547,950 individuals, with 76.1% of individuals identifying as white. 1 Greenville County is included in the stroke belt, an area of the United States where there is a higher incidence of stroke and cardiovascular disease. 2 Greenville County’s stroke rate is 41.0 per 100,000 people. 3 Due to the successful American Heart Association’s (AHA) “BE FAST” campaign, many members of the general population have begun to recognize facial droop as a sign of a stroke. 4 Facial droop is also a sign of a lesser- known condition, Bell’s palsy. The hallmark symptom of Bell’s palsy is unilateral paralysis of both upper and lower facial quadrants. 5 This symptom is often confused with that of an ischemic stroke, which presents with “forehead - sparing” unilateral lower quadrant facial paralysis. 6 Since the advent of the COVID-19 vaccine, there has been special media attention placed on Bell’s palsy as a vaccine -related adverse event. 7, 8, 9 Bell’s palsy is a condition recognized amongst health care professionals, 6 but, unlike the aforementioned “BE FAST” campaign for stroke, Bell’s palsy has not been a target of any widespread public health-oriented prevention/recognition campaigns. The presentation of stroke & Bell’s palsy can be extremely ambiguous to even the most experienced healthcare provider. 6 This presents a unique problem to the education of both medical professionals and the general public, who may rarely encounter this disease outside of media portrayals. As such, we sought out to determine the general public’s ability to identify Bell’s Palsy and stroke facial asymmetries. Participants were recruited from the Travelers Rest Farmers Market. Participants were provided a consent form and asked non-identifying demographic information. ● Participants were randomized by gender into one of three groups: ○ Bell’s Palsy, Stroke, or Normal ● Each participant was presented with the assigned image, and asked to identify areas with facial asymmetries within a 1 minute time frame. ● Participant responses were recorded, indicating “yes” or “no” for identifying facial abnormalities of the nasolabial folds, asymmetrical smile, absent forehead wrinkles, and widened palpebral fissures. ● Participants were then asked if the image was demonstrating a stroke, Bell’s palsy or a normal affect Finally, participants were given the correct answer to their task, and educated on stroke and Bell’s palsy symptom presentation with the American Academy of Family Physicians patient education sheets on stroke and Bell’s palsy. Following completion of this data collection, all data was taken from REDCap, and analyzed utilizing the statistical equations within Microsoft Excel. Methods

Figure 3. ● Percentage of facial abnormalities that were correctly identified within the stroke or Bell’s palsy randomization groups ● The most detected facial asymmetries were the mouth and palpebral fissures at 94.12% and 88.24%, respectively ● Nasolabial folds were the least detected facial features at 50% ● Forehead wrinkles were only detected 64.71% of the time

Education Level

Ethnicity/Race

Gender

Percentage of Facial Features Correctly Identified

Figure 1. ● 53 total study participants categorized by gender, education level, and race/ethnicity ● The majority of our participants identified as female and Caucasian with a high school or equivalent level of education

Figure 2. ● Participants who answered with the correct diagnosis, further categorized by their ability to identify all correct facial asymmetries within that diagnosis ● 11 participants were able to identify a normal photo with all facial features correctly identified ● 0 participants correctly identified all facial asymmetries in the Stroke group ● 1 participant in the Bell’s palsy group identified all asymmetries

Number of Correct Diagnosis and All Facial Features Identified

Diagnosis Response by Assignment

Figure 4. ● Number of participants who were

randomized to the stroke or Bell’s palsy image and whether they identified the image as stroke, Bell’s palsy, or normal ● 12 of the 17 participants randomized to the Bell’s Palsy photograph identification group incorrectly identified the image as a stroke ● 5 participants randomized to the Bell’s palsy picture identified the image correctly

Discussion

Conclusion Overall, this study demonstrates that facial asymmetries associated with stroke and Bell’s palsy are difficult to identify and distinguish from one another by an average member of the public. On a basic level, this study suggests that individuals are able to identify when there are facial asymmetries present. This data reflects the conclusions of previous literature and suggests that there is a need for community education regarding the specific facial asymmetries associated with Bell’s palsy versus stroke. References

As Greenville County lies within the stroke belt, awareness of the facial asymmetries associated with stroke versus Bell’s pa lsyis knowledge relevant for members of the general public. Individuals attending the Travelers Rest Farmers Market were able to identify a normal image, lacking facial asymmetries, more often than the stroke and Bell’s palsy images. Participants were aware that there was something abnormal with the images associated with Bell’s palsy & stroke (Figure 4). However, participants were unable to distinguish which abnormalities belonged to which conditions indicating their ability to recognize that the images were abnormal, but unable to determine which condition they were presented with. While forehead wrinkles are the most distinguishing feature between stroke and Bell’s palsy, the asymmetry was only identified correctly 64.71% of the time (Figur e 3). The general population appeared to be unaware of this difference, a possible reason for the difficulty in distinguishing between the diagnoses. The mouth was identified most often as abnormal, followed by asymmetry of the palpebral fissures, another major distinguishing feature (Figure 3). These findings, along with a larger number of participants who were able to correctly identify a stroke, suggest the success of the AHA's “BE FAST” campaign. While there is a clear distinction between the presentation of Bell’s palsy and stroke, our findings also sol idify the research that states distinguishing the difference between Bell’s palsy and stroke presentation is difficult even for the highly educated. 6 Our study is the first of its kind to carry this into a general population involving participants located in the Southeastern United States. Of our 53 study participants, the majority identified as female and Caucasian with a high school level or equivalent level of education (Figure 1). While these demographics are similar to the demographics of Greenville County, they represent the two major limitations of this study: the lack of diversity and the small sample size. Any further research should be done with a larger sample size and a more diverse population to overcome these limitations. Such a study could be implemented in more locations within the stroke belt 2 to further assess the general public’s knowledge regarding stroke compared to Bell’s palsy as well as provide more community education on identifying these conditions.

Bell’s palsy

Normal

Stroke

REFERENCES

BELL’S PALSY EDUCATION

STROKE EDUCATION

2025 Research Recognition Day

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