Malnutrition occurs in 49% of stroke inpatients, and up to 65% of stroke inpatients with swallowing disorders. Therefore, timely assessment of nutritional status should be performed. Many patients are undernourished due to their limited ability to ingest food via the mouth, when commercially available finished nutritional preparations are available, or dietary nutrition can be formulated in collaboration with the dietetic department. Careful consideration needs to be given to nutritional intake when abandoning transgastric tube nutritional supplementation and withdrawing non-enteral nutritional routes. I. Definition Swallowing disorders are physiological dysfunctions in transferring food through the mouth to the stomach, and also exclude transfer disorders after food reaches the stomach (e.g., duodenal leak). Second, why should we pay attention to swallowing disorder? 1, important function: healthy people need to swallow about 600 times a day, which is one of the basic components of the ability to perform daily activities. 2. High prevalence: 35% to 45% of patients in the acute phase of stroke have swallowing disorders. About half of these patients are unable to regain swallowing function within the first week after stroke onset, resulting in swallowing disorders that last for months or even for life after stroke. About 60% of patients with traumatic brain injury also have varying degrees of dysphagia after the acute phase. 3. Serious consequences: aspiration pneumonia, malnutrition and dehydration are the three major medical problems of swallowing disorders. Food invasion of the airway, malnutrition and dehydration are the three major risk factors for the development of pneumonia, which is responsible for about 34% of deaths caused by stroke. Among stroke patients who survive the acute phase with persistent dysphagia, about 20% die from asphyxia and 37% develop aspiration pneumonia within the first year. In stroke patients with dysphagia, malnutrition begins after one week in 48.3% of patients. Malnutrition can lead to low physical performance and decreased immunity, making it impossible to implement a functional physical rehabilitation program. Swallowing disorders may lead to a chronic state of dehydration as patients are afraid to drink or cannot drink water. Saliva production is reduced, predisposing to oral and pulmonary infections; leading to a state of weakness, lethargy and apathy, further affecting swallowing ability. In addition, there is the possibility of infection and dental caries due to food residue in the mouth, damage to soft tissues or teeth due to improper feeding and oral care, pain due to factors such as TMJ braking and dental caries, and psychosocial problems due to salivation and halitosis. All these complications significantly affect the quality of life of patients and increase the disability and mortality rate of patients. 4.Swallowing treatment is effective: swallowing treatment can effectively reduce complications, improve patients’ quality of life and prolong patients’ survival. Some patients can recover physiological swallowing function through swallowing therapy. C. Diagnosis of swallowing disorder Under what circumstances should we be alert to the possible presence of swallowing disorder? When the following red flags are present, please be alert to the possible existence of swallowing disorder and need further examination. 1. Inability to swallow food or medication; 2. Coughing and choking when swallowing, especially when drinking water; 3. Feeling that food stops in the esophagus or chest after swallowing; 4. Food remains in the mouth after eating or feeling that food returns to the mouth; 5. Frequent heartburn or bitterness in the mouth; 6. Change in voice; feeling a sense of wetness or a gurgling sound in the voice when communicating; 7. Frequent need to clear the throat, especially when eating. 8. Recurrent unexplained pneumonia; 9. Other related factors: persistent weight loss and malnutrition; 10. History of related diseases: stroke, traumatic brain injury, neuromuscular disease, diabetes, thyroid disease, dementia, recent history of botulinum toxin injection. It is important to be alert to the fact that some patients are not self-aware of swallowing disorders and some patients do not have obvious choking symptoms (silent misaspiration silent?aspiration) so the absence of complaints and choking symptoms does not mean that there is no swallowing problem. What physical examination is required when swallowing disorder is suspected? 1.General physical examination, including nutritional status, weight, vision, etc. 2.Wakefulness examination and mental intelligence examination: to determine the patient’s risk of swallowing and ability to cooperate with treatment. 3.Cranial nerve function examination of head and neck, especially V, VII, IX, X and XII pairs of cranial nerve examination. 4. Examination of the mouth, lips, teeth, soft palate and pharynx, as described in the rehabilitation assessment below. 5. Palpation of the neck for masses, auscultation for local murmurs and examination of the thyroid gland for abnormalities. 6. Auscultation of the lungs for dry and wet snail stringing L escape 7. Neurological signs also need to include examination of muscle strength, reflexes, motor coordination and postural posture. V. In the rehabilitation process of patients with clinical swallowing disorders, particular attention should be paid to the following points: ① Water intake and output should be balanced, as reduced salivation and oral dryness due to dehydration is one of the risk factors for pneumonia; ② Pay attention to electrolyte balance, as many patients have low potassium and sodium due to chronic underfeeding, which should be detected and supplemented; ③ Adequate supply of calories should be provided; ③ Protein nutritional status is easily neglected, especially when patients with immunity ③Protein nutritional status is easily overlooked, especially when patients have low immunity and recurrent infections or complications such as pressure sores, attention should be paid to timely checking of patients’ albumin and total protein levels; ⑤Don’t forget the nutritional problems of vitamins and minerals.