Dysphagia is a common impairment after stroke. Because dysphagia is associated with increase in medical complications including pneumonia and mortality, it requires close medical attention from the onset of stroke and timely clinical decision. A clinician should decide whether to feed orally or via enteral tube from the stroke onset, based on the clinical examination or routine bedside screening. In a patient who requires enteral tube feeding at the early stage of stroke, a clinician may need to consider until when the enteral tube feeding should be continued and the appropriate timing to consider percutaneous gastrostomy placement. Some patients will require further instrumental assessments for swallowing. If dysphagia is prolonged, rehabilitation for dysphagia has to be provided. In this phase, a clinician may want to get an answer for what kind of swallowing treatment should be provided based on the current evidence. For example, as the process of swallowing recovery has been revealed based on neuroplasticity, neuromodulation with noninvasive brain stimulation (NIBS) has been actively studied in recent clinical trials. Clinicians want to know if NIBS can be recommended according to the current evidence level. In this chapter, the current evidence level and quality of evidence are reviewed in the following topics and recommendations are suggested based on this review: (1) Dysphagia screening, (2) Instrumental assessment of dysphagia, (3) Treatment of dysphagia including behavioral interventions, neuromuscular electrical stimulation, noninvasive brain stimulation, and oral hygiene, and (4) Enteral tube feedings.
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