Dysphagia consists of producing difficulty in the swallowing maneuver (oropharyngeal dysphagia) and a feeling of food or liquid being blocked on its way to the stomach (esophageal dysphagia). Therefore, dysphagia is a hindrance to the normal passage of swallowed material. The swallowing process is produced by the coordination of the swallowing center in the medulla and the enteric nervous system in the wall of the heavily distal esophagus, and is mainly controlled by autonomic reflexes. 1. Assessment of dysphagia The goals of dysphagia treatment in stroke patients are to prevent aspiration pneumonia and to avoid fluid deficiencies and malnutrition due to inadequate dietary intake, as well as to reestablish swallowing function and improve the patient’s ability to eat independently. All stroke patients should be determined to be at risk for dysphagia or aspiration before diet is given. Patients are generally screened for swallowing function by bedside examination (e.g., water swallowing test). Patients who do not pass the initial screening test should be further evaluated for swallowing function using fluoroscopy, fiberoptic endoscopy, and other tests. Treatment of dysphagia For stroke patients with dysphagia, it is important to determine whether oral feeding can be maintained and whether an alternative route of feeding is needed: this requires a combination of factors such as nutritional status, risk of aspiration and aspiration pneumonia, and the discomfort of inserting a nasogastric tube to make the diagnosis. Behavioral treatments, including dietary modifications and the use of specific body positions, are the mainstay of treatment for patients who are still able to maintain oral intake. Fatigue may increase the risk of aspiration, and rest should be taken before eating. To facilitate swallowing, food is usually made into “pill” size and placed at the base of the tongue. Patients with dysphagia should not drink through a straw, as it requires complex oral muscle function and can lead to aspiration. To avoid increasing the risk of aspiration by the patient looking down, the cup should be kept at least half full when drinking from a cup. Patients should sit up when eating, and to prevent esophageal reflux, they should remain in a sitting position for more than 0.5 to 1h after eating. Dysphagia that occurs after stroke can usually be recovered relatively quickly. Nasogastric feeding is commonly used for patients who need to take an alternative route of feeding. 2.2 Rehabilitation treatment 2.2.1 Functional recovery training (1) Functional training of swallowing-related muscle groups such as cheeks and lips: different measures should be adopted according to the difference of the obstacles, such as using interphalangeal clasp machine, striking the periliptic area with ice cubes, short-term muscle pull and anti-muscle movement, and massaging, etc. The jaw movement can promote mastication and chewing, which is the most important factor in the recovery of swallowing. Jaw movements can promote the rotational movements needed for mastication, and lip movements can improve the leakage of food or water from the mouth. (2) Promote tongue movement: Have the patient perform horizontal, retracted and lateral active movements of the tongue and dorsal tongue elevation movements, and give resistance with a spoon or tongue depressor. (3) Sensory stimulation: cold stimulation, tactile and pressure stimulation are commonly used. (4) Swallowing reflex regulation: breath-holding reflex regulation and suction reflex regulation are more commonly used. (5) Vocal fold inward training: vocal fold inward training to achieve vocal fold atresia during breath holding. (6) Laryngeal elevation training: its purpose is to improve the closing ability of the laryngeal inlet, expand the space of the pharynx, and increase the passive traction force of the upper esophageal sphincter opening. (7) Pharyngeal contraction training: the purpose of this training is to improve the function of pharyngeal closure and enhance the pharyngeal clearing ability. (8) Empty swallowing: in order to transition the above functional recovery training to a complex swallowing pattern. Swallowing maneuvers are done after each treatment, and empty swallowing maneuvers are done for patients at risk of aspiration, because the most important training for improving swallowing function is swallowing. (9) Mobility training of the neck: move the neck to enhance neck muscle strength, breath control, tongue movement and laryngeal movement, use neck flexion and extension activities to help the patient elicit the gag reflex, and raise the larynx in a rounded way to prevent aspiration. (10) Respiratory training: breathing training: deep inhalation, breath holding and coughing out, aiming at elevating coughing ability and preventing aspiration; cough training: coughing hard to establish a variety of defense reflexes for expelling foreign bodies from the trachea.