Post-stroke dysphagia across the care continuum: a full-cycle framework for rehabilitation, supportive care, and community follow-up

Post-stroke dysphagia is a common and clinically consequential complication of stroke, associated with aspiration pneumonia, malnutrition, dehydration, impaired functional recovery, mortality, and increased healthcare use. Although acute dysphagia screening and aspiration-risk management are increasingly embedded in organised stroke care, long-term reassessment, discharge transition, caregiver education, community follow-up, and digitally supported continuity of care remain less clearly defined. This Review synthesises current evidence on post-stroke dysphagia management within a full-cycle clinical framework extending from hyperacute screening to long-term community care. High-consensus practices include standardised screening before oral intake, timely escalation to clinical swallowing examination and instrumental assessment in high-risk patients, and early supportive decisions regarding feeding route, hydration, medication administration, positioning, oral hygiene, nutrition support, and pulmonary surveillance. Standard swallowing rehabilitation remains the platform from acute rehabilitation through the subacute phase; targeted exercise, electrical or brain stimulation, respiratory muscle training, and biofeedback are optional phenotype-based intensification modules, not universal treatments. Beyond the inpatient episode, care pathways should specify swallowing status, aspiration risk, diet and fluid recommendations, feeding route, oral-care instructions, warning signs, reassessment timing, responsible services, caregiver support, and escalation rules. Palliative care supports preference-sensitive prognosis, symptom, or feeding decisions; community implementation must address access, caregiver capacity, and loss to follow-up. Future research should move beyond isolated short-term swallowing outcomes and evaluate integrated hospital-home-community models using clinically meaningful endpoints, including pneumonia, nutritional recovery, readmission, mortality, patient-reported outcomes, social participation, and caregiver burden. Managing post-stroke dysphagia as a cross-stage, cross-setting, and multidisciplinary stroke-care problem may improve safety, continuity, and long-term recovery.