Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journa.
A Journal of Nursing Values.
Innovation.
Collaboration, and Global Impact Volume 12.
Issue 2.
April 2026 Published by STIKep PPNI Jawa Barat ISSN 2354-8428, e-ISSN 2598-8727 Review Article The Effect of Facial Expression Gymnastics and Oral Motoric Exercise in Supporting Communication in Stroke Patients: A Literature Review Viona Ardhya Pramita1.
Fahrun Nur Rosyid2 1Nursing Professional Study Program.
Faculty of Health Sciences.
Muhammadiyah University Surakarta.
Central Java.
Indonesia 2Department of Medical-Surgical Nursing.
Muhammadiyah University Surakarta.
Central Java.
Indonesia Abstract Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journa.
Volume 12 .
, 196-205 https://doi.
org/10.
33755/jkk.
Article info Received Revised Accepted Published February 15, 2026 April 20, 2026 April 23, 2026 April 24, 2026 Corresponding author Fahrun Nur Rosyid* Department of Medical-Surgical Nursing.
Muhammadiyah University Surakarta Jl.
Yani.
Mendungan.
Pabelan.
Kec.
Kartasura.
Kabupaten Sukoharjo.
Jawa Tengah 57169 Phone : .
717417 Email: fnr100@ums.
Citation Pramita.
, & Rosyid.
The effect of facial expression gymnastics and oral motoric exercise in supporting communication in stroke patients: A literature review.
Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journa.
, 12.
, 196Ae205.
https://doi.
org/10.
33755/jkk.
Website https://journal.
stikep-ppnijabar.
id/jkk This is an Open Access article distributed under the terms of the Creative Commons Attribu tionNonCommercial 4.
0 International License p-ISSN : 2354 8428 e-ISSN: 2598 8727 Background: Stroke is a neurological disorder that frequently leads to facial muscle weakness, dysarthria, articulation impairment, and reduced communication Rehabilitative interventions such as facial expression exercises and oral motor exercises are commonly used to stimulate orofacial muscles and support recovery of communication functions.
Objective: This literature review aims to analyze the effects of facial expression exercises and oral motor exercises on communication abilities in stroke patients.
Methods: A literature search was conducted across PubMed.
Scopus.
ScienceDirect.
CINAHL, and Google Scholar for studies published between 2000 and 2025.
Articles were selected based on predefined inclusion criteria, and twelve relevant studies were analyzed using a narrative synthesis approach.
Results: The findings indicate that facial expression exercises and oral motor exercises are associated with improvements in facial muscle strength, lip and tongue Some studies also report improvements in swallowing function.
however, these outcomes are distinct from communication measures.
Technologyassisted interventions, including speech therapy applications, show potential as complementary tools, although the evidence remains limited.
Conclusion: Orofacial exercises appear to be safe and feasible interventions that may contribute to improved communication outcomes in stroke patients.
However, the strength of evidence varies across studies, and further high-quality research is needed before recommending widespread or routine implementation.
Keywords: Communication.
Facial Expression Exercises.
Oral Motor Exercises.
Stroke.
Orofacial Rehabilitation causing rapid death of brain cells .
Stroke is defined as Aua sudden onset of focal or global neurological deficits due to impaired cerebral circulation lasting more than 24 hoursAy (AHA/ASA, 2.
This condition often leads to significant physical and cognitive disabilities .
INTRODUCTION
A stroke is a neurological emergency that occurs due to a disruption in blood flow to the brain, either due to a blockage .
schemic strok.
or a rupture of a blood vessel .
emorrhagic strok.
Jurnal Keperawatan Komprehensif.
Volume 12 Issue 2.
April 2026 Rosyid et al.
The WHO .
reports that more than 15 million cases of stroke occur each year, and about 5 million people experience permanent disability .
In Indonesia, the prevalence of stroke based on Riskesdas .
9 per 1,000 population, making it one of the noncommunicable diseases with the highest burden .
The disorders caused are not only in the body's motor skills, but also in facial expressions, speech articulation, and oromotor functions, which are very important in the daily communication process .
complications such as dysphagia, tongue weakness, and oromotor muscle coordination As a result, patients experience limitations in conveying verbal and nonverbal messages .
If rehabilitation is not carried out quickly and appropriately, these complications can become permanent and reduce the patient's ability to adapt to their social environment.
Post-stroke rehabilitation should not only focus on extremity motor recovery but also include improvement of facial and oromotor functions.
Facial Expression and Oral Motoric Exercise are non-pharmacological effective in reducing the impact of complications such as facial muscle weakness and articulation disorders .
These exercises consist of structured movements such as raising the eyebrows, moving the lips, blowing, moving the tongue, and strengthening the cheek muscles.
The repeated stimulation provided through these exercises helps increase muscle tone, improve facial symmetry, and strengthen phonation and articulation abilities .
Various risk factors play a significant role in the onset of stroke, including hypertension, diabetes mellitus, hypercholesterolemia, smoking, a history of heart disease, obesity, lack of physical activity, and advanced age .
Hypertension is the most dominant factor, with approximately 80% of ischemic stroke patients having a history of high blood pressure .
Lifestyle factors such as high salt intake, chronic stress, alcohol consumption, and a high-fat diet also increase the risk of stroke .
At the population level, demographic changes and increased life expectancy have led to an increase in the number of individuals with chronic diseases, so the incidence of stroke is predicted to continue to increase from year to year .
Several previous studies have shown that facial expression and oral motor exercise interventions communication function.
Destriana's .
study mentioned that subjects classified as H-B IV .
oderately sever.
using the Sunny Brook Composite Score experienced a decrease in face dropping to grade i .
ild dysfunctio.
after undergoing facial massage for 5 days.
Research by Septiasih et al.
showed an improvement in verbal communication skills, from a pre-test average of 5.
39 to a post-test average of 6.
Stroke complications often have long-term effects and affect various aspects of life .
addition to limb paralysis, patients may also experience cognitive impairment, balance disorders, dysphagia, dysarthria, and facial expression disorders due to damage to the motor center and cranial nerves .
Other complications such as aspiration pneumonia, swallowing disorders, and loss of oral control can worsen the patient's condition.
More than 30Ae 60% of stroke patients experience speech disorders, while facial muscle weakness is recorded in more than 70% of cases .
These disorders cause patients difficulty in producing sounds, moving their tongues, closing their lips, and expressing emotions through their faces, which significantly impacts the patient's ability to communicate and their quality of life .
This rehabilitation approach is in line with the concept of neuroplasticity, which is the brain's ability to reshape neural pathways through Facial Expression and Oral Motoric Exercises can activate healthy areas of the brain and encourage neural network reorganization.
Thus, these exercises not only improve muscle function but also enhance patients' ability to produce sounds, form words, and convey emotional expressions .
Due to its safe, inexpensive, and selfadministered nature, this intervention is a highly suitable option for both short-term and longterm rehabilitation.
Brain damage caused by stroke can affect the nerve pathways that control facial expressions, swallowing, and verbal articulation.
The motor cortex area that controls the muscles of the face and oral cavity is often affected, resulting in decreased muscle tone, facial asymmetry, drooling, and difficulty in forming basic This condition is exacerbated by Given the high incidence of communication disorders in post-stroke patients and the impact of complications on social functioning and quality of life, this literature review is important to Jurnal Keperawatan Komprehensif.
Volume 12 Issue 2.
April 2026 Facial and oral exercises in stroke communication This study aims to compile the latest scientific evidence on the effectiveness of Facial Expression and Oral Motor Exercises in supporting communication abilities, thereby providing a basis for the development of comprehensive and applicable rehabilitative interventions for stroke patients.
AND (AucommunicationAy OR Auspeech intelligibilityAy OR AudysarthriaA.
Reference lists of selected articles were also screened to identify additional relevant studies.
Study Selection Process All retrieved articles were exported into Mendeley reference manager, where duplicate records were identified and removed automatically and manually.
The study selection process followed the four stages of the PRISMA flow diagram.
Duplicate records were identified and removed using both automated and manual The study selection process followed the four stages of the PRISMA flow diagram.
the identification stage, all records retrieved from database searches were compiled.
During the screening stage, titles and abstracts were independently reviewed by two reviewers to exclude studies that were clearly irrelevant.
the eligibility stage, full-text articles were assessed against predefined inclusion and exclusion criteria.
Finally, studies that met all criteria were included in the analysis.
Any disagreements between reviewers during the screening and eligibility phases were resolved through discussion, and when consensus could not be reached, a third reviewer was consulted to make the final decision.
METHODS
This study employed a structured literature review approach to examine the effects of facial expression exercises and oral motor exercises on communication outcomes in stroke patients.
The review process was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2.
guidelines to ensure methodological transparency and reproducibility.
Search Strategy A comprehensive literature search was conducted across six electronic databases:
PubMed.
Scopus.
ScienceDirect.
CINAHL.
Cochrane Library, and Google Scholar.
The search covered studies published between January 2020 and March 2025 to ensure the inclusion of recent Search strategies were adapted for each database using controlled vocabulary and free-text terms combined with Boolean operators.
The core search string was as follows:
Exclusion Criteria Studies were excluded if they were not published in English, were review articles, editorials, conference abstracts, or case reports, focused exclusively on swallowing .
without reporting communication outcomes, or involved pediatric populations (Table .
(Aufacial exerciseAy OR Aufacial expression therapyAy OR Aufacial rehabilitationA.
AND (Auoral motorAy OR Auoromotor exerciseAy OR Auoral motor therapyA.
AND (AustrokeAy OR Aupost-stroke rehabilitationA.
Table 1.
Inclusion Criteria Based on PICOS
PICOS
Problem Intervention Control Outcome Study Design Criteria Stroke patients with communication disorders .
phasia, dysarthria, stroke-induced speech disorder.
, aged Ou 18 years Facial Expression Exercise.
Orofacial Exercise.
Oral Motoric Exercise.
Lip exercise.
Tongue exercise.
Neuromuscular oral training, other orofacial therapies aimed at improving communication No control group or comparative intervention Changes in verbal communication ability, articulation, speech ability, oromotor function, oral muscle strength, facial expression, or communication-related RCT, quasi-experimental, pre-experimental, clinical trial, cohort, case-control, and literature review Jurnal Keperawatan Komprehensif.
Volume 12 Issue 2.
April 2026 Rosyid et al.
Quality Appraisal in study designs, interventions, and outcome measures, a narrative synthesis approach was The findings were organized according to types of intervention and specific communication outcomes to facilitate structured comparison and interpretation.
The methodological quality of the included studies was assessed using standardized critical appraisal tools appropriate to each study design.
The Joanna Briggs Institute (JBI) Critical Appraisal Tools were applied for quasiexperimental and observational studies, while the Cochrane Risk of Bias Tool (RoB .
was used for randomized controlled trials.
Each study was evaluated independently by two reviewers.
The results of the quality assessment were used to inform the interpretation of the evidence, rather than as criteria for exclusion.
RESULTS
A total of 58 articles were found based on a search using predetermined keywords in the Google Scholar.
PubMed.
ProQuest.
Elsevier, and ScienceDirect databases.
After screening the titles and abstracts, there were 42 articles that matched the research topic.
The duplication removal process resulted in 22 articles for further review.
Based on a feasibility evaluation using the PRISMA approach, 12 journals were found to meet the criteria and were deemed suitable for further analysis.
Data Extraction and Synthesis Relevant data were extracted using a standardized data extraction form, including author, year of publication, study design, sample characteristics, intervention details, outcome measures, and key findings.
Due to heterogeneity Identification Records database searching .
PubMed = 8 Sciencedirect = 15 Google Scholar = 25 Duplicate articles .
Screaning Records After Removing duplication .
= .
Records Excluded .
Eligibility Records After screening by the title and abstract .
= .
Not relevant to the topic .
= .
Irrelevant population .
ot adult stroke patient.
= .
Full text not available .
= .
) Full-Text Articles Excluded, with Reasons (N = .
Include Studies included in Study .
= .
Interventions facial/oral/oromotor exercises .
= Outcomes communication/articulation abilities .
= .
Research design was not appropriate .
eview, meta-analysis, single case repor.
= .
Figure 1.
PRISMA Flow Chart Jurnal Keperawatan Komprehensif.
Volume 12 Issue 2.
April 2026 Facial and oral exercises in stroke communication The information obtained from the selected articles included the author's name, year of publication, country where the research was conducted, research design, intervention provided, duration of implementation, and research results summarized in Table 2.
Tabel 2.
Characteristics and Key Findings of Included Studies Title.
Year Method.
Sample Intervention Improving Verbal Communication After Lip Exercise and Blowing Pipe .
Preexperimental , pre-post.
Lip Efektivitas Mirror Therapy Kemampuan Bicara Pasien Pasca Stroke Afasia Motorik .
RCT.
patients with dysarthria .
, 8 contro.
Effects of Oromotor Exercises Dysarthric Speech .
Results .
esearch Duration minutes/day, 5 days/week for 2 weeks Improved articulation, breath control, and verbal effective and lowcost intervention Mirror therapy .
ongue, lip, and 2 weeks.
Significant speech ability.
therapy is effective for motor aphasia.
PreAepost , 4 patients Oro-motor .
ongue and lip 10 sessions, minutes/sessi on, 3 times a Improved decreased Formant Centralization Ratio Ie Efektivitas Terapi Wicara AuAiueoAy Dan Melodi Intonasi Terapi Terhadap Peningkatan Kemampuan Berbahasa Pasien Stroke Dengan Afasia Motorik Di Ruang Cherry RSUD Cengkareng .
Quasiexperiment.
two-group preAepost AIUEO.
Melody Intonation Therapy, and a combination of 3 months Significant language skills.
AIUEO MIT was .
<0.
Terapi Wicara Berpengaruh Kemampuan Komunikasi Verbal Pasien Pasca Stroke dengan Afasia .
Quasi One Group Pre-Post Test Design, n=28 Speech Therapy 6 months There increase in verbal communication skills .
re-test 39 Ie post-test The Paired tTest significant effect .
= Smartphone-Based Randomized Speech Therapy for Controlled Poststroke Trial Dysarthria:
Pilot Randomized Smartphonebased therapy app 1 hour/day, 5 days/week, for 4 weeks Significant speech intelligibility, articulation .
orrect Jurnal Keperawatan Komprehensif.
Volume 12 Issue 2.
April 2026 Rosyid et al.
Controlled Trial (EvaluatorEvaluating Efficacy blinde.
and Feasibility .
dysarthria severity, and improvement in Adherence 64%, high .
Efektivitas Terapi Wicara Stimulasi Multimodal untuk Meningkatkan Kemampuan Bahasa Ekspresif pada Pasien Afasia .
PreAepost test .
reexperimental ), 5 patients with aphasia Speech therapy Expressive language significantly from an average of 19% to The mainly in the ability to name words and form sentences.
Assessment of the Effectiveness of Facial Expression Exercises Stimulation Using Mirror Media Increasing Facial Muscle Strength in Hemiparetic Stroke Patients .
two groups .
=60.
30 contro.
Facial exercise using mirror media vs.
without mirror 5 weeks The greater improvement strength .
ean diff p=0.
NGain score 56.
31% Ie mirrors was more The effects of Oral Motor Facilitation Technique (OMFT) on oral motor function in stroke patients .
Randomized patients with .
36 contro.
OMFT
(Oral Motor Facilitation Techniqu.
minutes/day, 5y/week for 4 Both improved, but the OMFT group showed improvement in jaw, lip, cheek, and tongue Significant eating/drinking .
olid swallowin.
, voice, and overall oromotor function .
<0.
Comparison of 2 types of therapeutic exercise: jaw opening exercise and head lift dysphagic stroke: A pilot study .
Pilot study, patients with Opening Exercise (JOE) using resistance bar vs Head Lift Exercise (HLE) 6 weeks Both interventions suprahyoid muscle thickness & hyoid movement .
nterior & superio.
JOE had a lower exertion level Effects of resistive jaw opening exercise in stroke patients with dysphagia: A Double-blind
RCT,
Resistive Jaw Opening Exercise (RJOE) using a portable 4 weeks, 5 times/week RJOE increased hyoid decreased aspiration scores (PAS), and Jurnal Keperawatan Komprehensif.
Volume 12 Issue 2.
April 2026 Facial and oral exercises in stroke communication double-blind, controlled study .
patients with device vs.
sham device Pengaruh Oral Motor Exercise Terhadap Kejadian Aspirasi Pada Pasien Stroke .
Quantitative.
Quasiexperimental pretestAe posttest with group, n=34 Oral Motor Exercise increased oral intake (FOIS).
particularly effective for liquid-type PAS.
Duration unknown .
ot Oral motor exercise has a significant effect in reducing the aspiration in stroke patients in the stroke unit at Dr.
Yunus Bengkulu Regional General Hospital.
even provides more optimal results in improving expressive abilities.
DISCUSSION
A review of twelve articles analyzed in this literature review shows that facial expression exercises, oral motor exercises, and various other forms of orofacial exercises contribute significantly to improving communication skills in stroke patients .
In most studies, exercises that stimulate the facial muscles, lips, tongue, and jaw have been shown to increase muscle strength, improve articulation, and maximize oromotor function, which ultimately supports improved verbal and nonverbal communication These findings are consistent with the fact that stroke often causes facial muscle weakness, dysarthria, articulation disorders, decreased lip control, and drooling due to damage to the cranial nerves and motor cortex areas involved in speech mechanisms .
Technology-based interventions are also one of the promising modern approaches in post-stroke A study by Kim .
found that smartphone-based speech therapy applications can improve articulation clarity, consonant accuracy, and reduce the severity of dysarthria within four weeks.
The use of this technology is also considered practical and increases patient motivation to practice independently, making it an effective solution in conditions where access to rehabilitation services is limited.
In addition to affecting verbal aspects, facial expression exercises also have a significant impact on facial muscle strength and nonverbal communication skills.
Martono .
showed that facial expression exercises using mirrors enabled patients to improve facial movement symmetry through visual feedback.
This exercise significantly increases facial muscle strength compared to exercises without mirrors, thereby helping patients display clearer and more proportional emotional expressions .
Several studies emphasize that oromotor intervention has a direct impact on articulation and voice production.
Suyanto.
showed that regular lip and blowing pipe exercises over two weeks can improve breathing control and clarity of pronunciation, thereby helping patients to convey words and sentences more accurately.
These findings are reinforced by a study by Madathodiyil .
, which explains that structured tongue and lip movements result in increased speech intelligibility and a decrease in the Formant Centralization Ratio, an important indicator of articulation improvement in patients with dysarthria.
Vocal-based interventions such as AuAIUEOAy therapy and Melodic Intonation Therapy (MIT) have also been proven effective in improving the language abilities of stroke patients, as reported by Machmudah .
The combination of vocal and intonation methods Communication disorders in stroke patients are also often associated with swallowing disorders .
due to impaired oropharyngeal muscle coordination.
Oromotor exercises have been shown to help overcome dysphagia by increasing the strength and coordination of the jaw, tongue, and lip muscles.
Young-Su et al.
showed that Oral Motor Facilitation Techniques (OMFT) not only improve swallowing function but also enhance voice quality and speech ability.
Research by Choi and Park .
supports this by showing that jaw opening and resistive jaw opening exercises can improve Jurnal Keperawatan Komprehensif.
Volume 12 Issue 2.
April 2026 Rosyid et al.
CONCLUSION
hyoid movement and reduce the risk of The clinical implications are clear: the better the swallowing function, the more stable the voice production and articulation, resulting in more effective communication.
These findings are reinforced by the study by Anjelina .
, which confirms that oromotor exercises can reduce the incidence of aspiration, a complication that often hinders speech ability in stroke Based on the results of a review of twelve articles analyzed, it can be concluded that facial expression exercises and oral motor exercises are communication skills in stroke patients.
Both exercises have been proven to improve facial muscle strength, increase control of lip and tongue movements, improve articulation, and support stable voice production.
In addition, oromotor exercises also have a positive impact on swallowing function, which indirectly contributes to the quality of verbal Technology-based interventions, such as speech therapy applications, also show promising results in improving speech intelligibility and motivation for independent exercise.
Overall, structured, routine, and multimodal orofacial exercises have been shown to support the communication rehabilitation process in stroke patients through neuromuscular enhancement and neuroplasticity Despite some limitations, such as variations in study design, small sample sizes, and the use of different measurement instruments, the findings in this literature provide a strong scientific basis for recommending facial expression and oral motor exercises as part of the standard rehabilitation program for stroke patients.
In general, the results of all articles show a consistent pattern that orofacial exercises, both facial expression and oral motor, are effective in improving communication function in stroke Interventions that are carried out regularly, intensively, and structurally can improve neuromuscular function and support brain neuroplasticity in speech recovery .
Variations in approaches, ranging from manual exercises, mirror use, vocal therapy, to digital technology, provide flexibility that can be tailored to the conditions and limitations of each patient .
Implication The findings suggest that facial expression and oral motor exercises can be feasibly integrated into routine stroke rehabilitation to support communication recovery, including in resourcelimited settings.
These interventions are simple, low-cost, and can be delivered as part of multidisciplinary care, including nursing-led Technology-based approaches also show potential to enhance patient engagement and extend rehabilitation into home settings.
However, given the variability in study designs and outcomes, further high-quality research is needed to establish standardized protocols, optimal intervention intensity, and long-term Strengthening the evidence base will be essential for informing clinical guidelines and broader implementation in stroke rehabilitation programs.
Acknowledgement The author would like to thank all those who have helped in the process of writing this article.
Thanks are extended to the researchers and academics whose work served as the source of data in this literature review, as well as to the supervising lecturer who provided guidance, input, and corrections during the writing process.
Funding Statement This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Limitation However, some studies have limitations such as small sample sizes, inconsistent intervention assessment instruments, so the generalization of results must be done carefully.
Overall, the empirical evidence found supports that facial expression and oral motor exercises are safe, inexpensive, and effective interventions for improving communication skills in stroke patients, both in verbal and nonverbal aspects.
Author Contributions conceptualized the study, conducted the literature search, screened articles, extracted data, and drafted the manuscript.
methodological refinement, reviewed the analysis, and critically revised the manuscript.
Both authors approved the final version of the Jurnal Keperawatan Komprehensif.
Volume 12 Issue 2.
April 2026 Facial and oral exercises in stroke communication Conflict of Interest The author has no conflicts of interest.
REFERENCES