rehabilitation nutrition is a combination of both rehabilitation and nutrition care management , and this concept is used with international classification of functioning , disability and health guidelines to evaluate nutrition status and to maximize functionality in the elderly and other people with disability .
rehabilitation nutrition may further improve physical and mental function , activities of daily living , and quality of life .
the term  rehabilitation nutrition  is quite different from that of  nutritional rehabilitation . 
in contrast , rehabilitation nutrition not only refers to nutritional improvement but also to rehabilitation in people with disability [ 1 , 2 ] .
the key aims of rehabilitation nutrition assessment   are to assess the following : ( 1 ) the presence and cause of malnutrition ; ( 2 ) the presence and cause of sarcopenia ; ( 3 ) the presence and cause of dysphagia ; ( 4 ) the adequacy of nutrition care management with prediction of future nutritional status ; and ( 5 ) whether rehabilitation for functional improvement , such as resistance training and endurance training , can be conducted .
the prevalence of malnutrition in rehabilitation settings is high . in elderly patients hospitalized for rehabilitation ,
the prevalence of compromised nutrition status was estimated to be 4967  % . in australia , 33 and 51.5  % of patients admitted to rehabilitation hospitals
were classified as malnourished and at nutritional risk using the mini nutritional assessment ( mna ) and the mna short - form ( mna - sf ) .
one study using pooled mna data found that the prevalence of malnutrition in elderly people was highest in rehabilitation settings ( rehabilitation , 50.5  % ; hospital , 38.7  % ) .
another study using the mna - sf revealed a 40.8  % prevalence of malnutrition in rehabilitation settings .
a systematic review found that malnutrition in older adults admitted for rehabilitation has a negative effect on functional recovery and quality of life following discharge to the community .
furthermore , rehabilitation outcome has been shown to be poor in malnourished patients with stroke , hip fracture , hospital - associated deconditioning [ 10 , 11 ] , and a variety of other diseases .
the prevalence of sarcopenia in rehabilitation settings is also high : 1030  % in community - dwelling elderly   and 40  % in ambulatory rehabilitation facility - dwelling elderly 60  years and older .
another study revealed that 46.5  % patients admitted to a subacute geriatric care unit who underwent a rehabilitation intervention met the diagnostic criteria for sarcopenia .
the european working group on sarcopenia in older people categorized sarcopenia into primary sarcopenia ( age - related sarcopenia ) and secondary sarcopenia ( i.e. , activity- , disease- , or nutrition - related sarcopenia ) . assessment of the multifactorial causes of primary and secondary sarcopenia is indispensable because rehabilitation nutrition for sarcopenia differs depending on its etiology .
treatment of age - related sarcopenia includes resistance training , protein and amino acid supplementation , smoking cessation , and pharmaceutical therapies [ 16 , 17 ] .
pharmaceutical therapy of sarcopenia is likely to advance in the near future because our understanding of the role of regulators in sarcopenia has increased [ 18 , 19 ] .
early ambulation , exercise , and avoiding bed rest are important for preventing and treating activity - related sarcopenia .
treatment of disease - related sarcopenia includes therapies for advanced organ failure , inflammatory disease , malignancy , and endocrine disease , while treatment of nutrition - related sarcopenia includes appropriate nutrition management to increase muscle mass [ 16 , 17 ] . in cases of age- , activity- , disease- , and nutrition - related sarcopenia ,
stroke , hip fracture , and hospital - associated deconditioning are major causes of disability in inpatient rehabilitation facilities . in the usa ,
the six largest diagnostic impairment categories receiving inpatient rehabilitation include stroke , lower extremity fracture , lower extremity joint replacement , debility , neurologic disorders , and brain dysfunction .
hip fracture is a leading cause of disability in lower extremity fracture patients , and debility is synonymous with hospital - associated deconditioning . in japan ,
common causes of inpatient rehabilitation in convalescent rehabilitation wards are stroke ( 47.9  % ) ; orthopedic diseases , including hip fracture ( 35.2  % ) ; disuse syndrome ( 10.5  % ) ; and traumatic brain and spinal cord injury ( 5.4  % ) .
these data indicate that management of patients with stroke , hip fracture , and hospital - associated deconditioning is an important part of inpatient rehabilitation .
the term  sarcopenic dysphagia  refers to difficulty swallowing due to sarcopenia of generalized skeletal muscles and swallowing muscles [ 22 , 23 ] .
age - related loss of the tongue and geniohyoid muscle mass has been studied in the elderly [ 24 , 25 ] .
sarcopenic dysphagia is an important current and future public health issue , because it is common in the elderly and can lead to aspiration pneumonia , the prevalence of which is increasing with the aging of society .
therefore , we review rehabilitation nutrition for stroke , hip fracture , hospital - associated deconditioning , and sarcopenic dysphagia , and then assess the level of research interest in rehabilitation nutrition .
more than 60  % of patients remain disabled , 50  % of patients suffer from hemiparesis , and 30  % remain unable to walk without assistance . as the benefits of rehabilitation are beyond doubt , rehabilitation strategies play center stage in optimizing functional recovery after stroke [ 27 , 28 ] .
both malnutrition and obesity are nutritional problems in stroke . according to a recent systematic review ,
malnutrition and dysphagia respectively occur in 8.249.0  % and 24.352.6  % of subjects following stroke . in subgroup analysis ,
the odds of malnutrition were significantly increased during the rehabilitation stage ( odds ratio ( or ) , 2.445 ; 95  % confidence interval ( ci ) , 1.0095.925 ) .
tissue wasting , sarcopenia , and cachexia may impair and delay poststroke rehabilitation and worsen the prognosis , and increasing evidence suggests that patients who are overweight and mildly obese may actually have a better outcome .
analysis of data from the china national stroke registry on patients grouped according to their body mass index ( bmi ) into underweight ( < 18.5  kg / m ) , normal weight ( 18.522.9  kg / m ) , overweight ( 2327.4  kg / m ) , obese ( 27.532.4  kg / m ) , or severely obese ( 32.5  kg / m )   found that overweight was independently associated with favorable 3-month functional recovery ( or , 1.24 ; 95  % ci , 1.121.38 ) , but severe obesity was independently associated with higher 3-month mortality ( or , 2.01 ; 95  % ci , 1.103.69 ) . in
stroke patients admitted to a rehabilitation hospital , the underweight group had the lowest functional independence measure ( fim ) efficiency , followed by the obese and normal - weight subgroups .
the overweight group had the highest fim efficiency ( p  =  0.05 ) when compared with the obese subgroup .
these results indicate that outcome is better in overweight stroke patients than in underweight stroke patients .
skeletal muscles are the main effector organs impacted by disability in stroke , but little attention is paid to structural , metabolic , and functional alterations of muscle tissue after stroke [ 27 , 28 ] .
stroke - induced sarcopenia is difficult to differentiate from hemiparesis in terms of evaluating muscle strength and physical performance .
therefore , diagnosis of stroke - induced sarcopenia is a challenging task . in a systematic review of loss of skeletal muscle mass after stroke ,
lean tissue mass was significantly less in the paretic than the nonparetic lower limb ( median , 342.3  g ; 95  % ci , 247.0437.6  g ) and upper limb ( median , 239.9  g ; 95  % ci , 181.7298.2  g ) , and midthigh muscle cross - sectional area ( median , 15.4  cm ; 95  % ci , 13.816.9  cm ) was significantly less in individuals at least 6  months poststroke .
mechanisms of muscle wasting in stroke - related sarcopenia include disuse atrophy , spasticity , inflammation , denervation , reinnervation , impaired feeding , and intestinal absorption .
a randomized study comparing intensive nutritional supplementation to routine nutritional supplementation was performed in 116 undernourished stroke inpatients .
compared with those on standard nutritional supplements , patients receiving intensive nutritional supplementation improved more on measures of motor function ( total fim , fim motor subscore , 2 and 6-min timed walk tests , p  <  0.002 ) . in a randomized , controlled trial comparing routine care with individualized , nutritional care aiming to prevent weight loss in acute stroke patients at nutritional risk , 20.7  % of the intervention group lost 5  % weight compared with 36.4  % of the control group ( p  =  0.055 ) at follow - up .
the intervention group had a significantly higher increase in qol score ( p  =  0.009 ) and in handgrip strength ( p  =  0.002 ) . in a cochrane database of systematic review ,
nutritional supplementation in acute and subacute stroke was associated with reduced frequency of pressure sores ( or : 0.56 ; 95  % ci : 0.320.96 ) , and increased energy intake ( mean differences ( md ) , 430.18  kcal / day ; 95  % ci , 141.61718.75 ) and protein intake ( md , 17.28  g / day ; 95  % ci , 1.9932.56 ) .
these results indicate that nutrition support for stroke rehabilitation patients at malnutrition or nutritional risk seems to improve nutrition intake and rehabilitation outcome .
hip fractures are associated with more disability , health care costs , and mortality than all other osteoporotic fractures combined . in 2005
, hip fractures in the usa were estimated to account for 14  % of total fractures but 72  % of total fracture - related health care costs . compared with its pre - fracture level , post - fracture function is deteriorated in 60  % of patients with hip fracture .
the demographic trend worldwide is that more and more people are suffering from hip fracture .
the number of hip fractures is expected to rise from 1.6 million in 2000 up to 6.3 million in 2050 .
malnutrition prevalence was lowest when assessed by bmi ( 13  % ) , followed by mna - sf ( 27  % ) , international classification of disease , 10th revision , australian modification ( icd10-am ) ( 48  % ) , albumin ( 53  % ) , and geriatrician individualized assessment ( 55  % ) .
malnutrition prevalence in hip fracture was 37.5  % using icd10-am criteria in another study .
nutrition status assessed by mna in one hip fracture study revealed that 8.8  % of elderly patients were undernourished , 43.7  % at risk of malnutrition , and 47.5  % well - nourished .
nutrition status in another hip fracture study revealed that 11.6  % were malnourished , 44.2  % at risk of malnutrition , and 44.2  % were well - nourished .
serum albumin level ( p  =  0.0004 ; or , 5.8541 ) and bmi ( p  =  0.0192 ; or , 1.1693 ) significantly influenced mortality after hip fracture .
malnutrition and being at risk for malnutrition are common in patients with hip fracture and seem to affect rehabilitation outcome .
the prevalence of sarcopenia in patients with hip fracture is high . in the sarcopenia and hip fracture study ,
another study in women with hip fracture revealed that 58  % were sarcopenic . using normative data from the new mexico elder health study , 64.0  % of female hip fracture inpatients and 95.0  % of male hip fracture inpatients admitted to rehabilitation wards had sarcopenia .
analysis of other data revealed that 21.8  % of female hip fracture patients and 86.7  % of male hip fracture patients had sarcopenia .
in 357 japanese patients immediately after hip fracture , 44.7  % of women and 81.1  % of men had sarcopenia , and the presence of sarcopenia was independently associated with the occurrence of hip fracture . on the other hand , only 4 of the 71 hip fracture patients ( 5.6  % )
a cochrane database systematic review of nutritional supplementation in elderly patients with hip fracture found weak evidence for the effectiveness of protein and energy supplements .
one trial of multinutrient intravenous feeding followed by oral supplements found a reduction in the number of participants with complications ( rr , 0.21 ; 95  % ci , 0.100.46 ) , but not in mortality rate ( rr , 0.11 ; 95  % ci , 0.012.00 ) . a controlled prospective cohort study in patients with hip fracture found a significant association of multidisciplinary postoperative nutritional care with a decline in the number of malnourished patients and a decline in the euroqol ( p  =  0.004 ) after 3  months of the intervention . in a randomized , controlled study , nutritional support actively supervised by a dietician and guided by repeated measurements of resting energy requirements was achievable and improved outcomes in geriatric patients following surgery for hip fractures .
multidisciplinary nutritional care reduced nutritional deterioration during admission ( 5.4 vs. 20.5  % ; p  =  0.049 ) , and increased the rate of discharge directly back to the community ( 48.0 vs. 17.6  % ; p 
=  0.012 ) in a pragmatic intervention study . a high - protein nutritional intervention - based study on -hydroxy--methylbutyrate , vitamin d3 , and calcium in obese and lean aged patients with hip fractures and sarcopenia will be implemented .
these results indicate that nutrition support for hip fracture patients may improve nutrition status and rehabilitation outcome .
hospital - associated deconditioning is characterized by the functional decline that occurs during acute hospitalization due to illness or injury , or both , and is unrelated to a specific neurological or orthopedic insult , or both .
several concepts have been proposed to explain the consequences of inactivity and disuse in the hospital , and include debility , disuse syndrome [ 10 , 21 ] , hospital - associated deconditioning [ 11 , 55 ] , hospitalization - associated disability , and post - hospital syndrome . during hospitalization ,
patients are commonly deprived of sleep , experience disruption of normal circadian rhythms , are nourished poorly , have pain and other discomfort , confront a baffling array of mentally challenging situations , receive medications that can alter cognition and physical function , and become deconditioned by bed rest or inactivity .
hospitalization - associated disability occurs in approximately one - third of patients older than 70  years of age and may be triggered even when the illness that necessitated the hospitalization is successfully treated .
malnutrition is associated with poor rehabilitation outcome in hospital - associated deconditioning . in an acute rehabilitation setting , obese patients with deconditioning show greater improvement in fim scores , compared with patients whose bmi is in the normal range or lower ( bmi  18.5 ) .
this lower bmi group shows the smallest increase in fim motor scores with rehabilitation . in elderly patients with deconditioning
, admission norton scale scores were correlated with discharge walking fim scores ( r  =  0.32 ; p  =  0.003 ) , discharge transfer fim scores ( r  =  0.30 ; p  =  0.005 ) , and length of rehabilitation ( r  =  0.37 ; p  <  0.0001 ) . in our previous prospective cohort study ,
87.6  % of patients were malnourished , 12.4  % were at risk for malnutrition , and there were none with normal nutritional status . in multiple regression analysis , the mna - sf score , albumin level , and cachexia status were significantly associated with the barthel index score at discharge .
these results indicated that patients with hospital - associated deconditioning may experience not only activity - related sarcopenia but also nutrition - related and disease - related sarcopenia .
nutrition management and sarcopenia treatment in patients with hospital - associated deconditioning may lead to improvement of disability , although further studies are required .
sarcopenic dysphagia is characterized by the loss of swallowing muscle mass and function associated with generalized loss of skeletal muscle mass and function .
the prevalence of dysphagia has been reported to be 11.438  % in community - dwelling elderly individuals [ 6064 ] and 4068  % in nursing home residents [ 6567 ] .
dysphagia management is important because dysphagia is common in the elderly and increases the risk of related complications such as aspiration pneumonia , choking , dehydration , malnutrition , and a lower quality of life following the loss of the joy of eating .
furthermore , sarcopenic dysphagia is not only the result of aspiration pneumonia , but also an important cause of recurrent aspiration pneumonia .
age - related loss of swallowing muscles has been studied [ 24 , 25 ] . swallowing muscles include the intrinsic muscle of the tongue and the mimic , masticatory , suprahyoid , infrahyoid , palatal , pharyngeal , and esophageal muscles .
tamura et al .   evaluated thickness of the central part of the tongue in the elderly using ultrasonography and showed mid - arm muscle area and age were associated independently with tongue thickness .
these results indicate that tongue muscle mass is associated with generalized skeletal muscle mass and aging .
a decrease in the cross - sectional area of the geniohyoid muscle has been shown to occur with increasing age , with this area being significantly smaller in aspirators compared with non - aspirators , but only in older men .
these findings suggest that geniohyoid muscle atrophy may be a component of decreased swallowing safety and aspiration in older adults with presbyphagia or frailty of swallowing . mid - upper arm circumference and calf circumference were correlated with dysphagia [ 22 , 68 ] .
the circumference of the mid - upper arm in older japanese adults with suspected swallowing disorders was correlated significantly with swallowing function .
it is likely that the general reduction in lean body mass , including the swallowing muscle mass , is responsible for the association between mid - upper arm circumference and swallowing function , and indicates the presence of sarcopenic dysphagia .
another study revealed that swallowing measures had significant correlations with the functional and nutritional measures including serum albumin levels , mid - upper arm circumference , and calf circumference but not with age . given that sarcopenia is exacerbated by disease , inactivity , and malnutrition , sarcopenia involving the swallowing muscle mass and its function may account for this result .
malnutrition results in both increased adductor pollicis muscle fatigability and an altered pattern of muscle contraction and relaxation which are reversible by nutritional supplementation .
however , deglutition muscles that have a moderate to high percentage of type ii fibers may be among the first to atrophy at malnutrition because malnutrition affects type ii muscle fibers to a much greater extent than it does type i fibers [ 69 , 70 ] . furthermore , malnutrition was associated with dysphagia and head lifting strength which reflects the strength of the suprahyoid muscles in frail older adults . therapy for sarcopenic dysphagia includes dysphagia rehabilitation , treatment of sarcopenia , and nutrition improvement .
the core components of dysphagia rehabilitation are oral health care , rehabilitative techniques , and food modification .
therefore , nutrition management to increase muscle mass is indispensable for sarcopenic dysphagia rehabilitation , and the concept of rehabilitation nutrition is useful .
further research on sarcopenic dysphagia is required , although consensus diagnostic criteria for sarcopenic dysphagia have been proposed .
we searched seven major rehabilitation journals cited in the article  publishing in physical and rehabilitation medicine    and indexed by pubmed .
these rehabilitation journals were the archives of physical medicine and rehabilitation , clinical rehabilitation , journal of rehabilitation medicine , the european journal of physical and rehabilitation medicine , the american journal of physical medicine and rehabilitation , disability and rehabilitation , and international journal of rehabilitation research .
of 24,214 pubmed entries for these seven journals , 185 ( 0.8  % ) and 8 ( 0.03  % ) , respectively , contained the words  nutrition  and  sarcopenia  on 25 april 2014 ( table  1 ) .
four articles ( one editorial and three reviews ) published in the european journal of physical and rehabilitation medicine contained the word 
sarcopenia  and were about sarcopenia and muscular modifications in disabling pathologies [ 7477 ] . though the importance of nutrition in rehabilitation was already recognized in the 1940s , interest in nutrition and sarcopenia in rehabilitation medicine has remained very low.table 1number of pubmed entries retrieved in a search of seven rehabilitation journals for the terms  nutrition  and  sarcopenia .
 accessed on 25 april 2014 from www.pubmed.gov 
 journal nametotal no . of entriesnutritionsarcopeniaarchives of physical medicine and rehabilitation11,856962clinical rehabilitation1,768101journal of rehabilitation medicine1,49960european journal of physical and rehabilitation medicine52355american journal of physical medicine and rehabilitation3,123300disability and rehabilitation3,638270international journal of rehabilitation research1,807110total24,214185 ( 0.8  % ) 8 ( 0.03  % ) number of pubmed entries retrieved in a search of seven rehabilitation journals for the terms  nutrition  and  sarcopenia .
 accessed on 25 april 2014 from www.pubmed.gov 
  in japan , interest in rehabilitation nutrition has increased in recent years . using the japan medical abstracts society database , we searched for articles in four major japanese rehabilitation journals including the japanese journal of rehabilitation medicine , sogo rihabiriteshon , journal of clinical rehabilitation , and medical rehabilitation . of the 38,898 entries of these four journals , 1092 ( 2.8  % ) and 55 ( 0.1  % ) , respectively ,
contained the words  nutrition  and  sarcopenia  on 25 april 2014 ( table  2 ) .
when the search was limited to entries after 2010 , 4.4 and 0.7  % , respectively , contained the words  nutrition  and 
sarcopenia.table 2number of japan medical abstracts society database entries retrieved in a search of four japanese rehabilitation journals for the words  nutrition  and  sarcopenia .
 accessed on 25 april 2014 from http://www.jamas.or.jp/about/english.html 
 entire periodfrom 2010journal nametotalnutritionsarcopeniatotalnutritionsarcopeniathe japanese journal of rehabilitation medicine24,457545174,41913615sogo rihabiriteshon7,75913681,100315journal of clinical rehabilitation4,6021809839538medical rehabilitation2,080231217789720total38,8981,092 ( 2.8  % ) 55 ( 0.1  % ) 7,136317 ( 4.4  % ) 48 ( 0.7  % ) number of japan medical abstracts society database entries retrieved in a search of four japanese rehabilitation journals for the words  nutrition  and  sarcopenia . 
accessed on 25 april 2014 from http://www.jamas.or.jp/about/english.html 
  we established the japanese association of rehabilitation nutrition in 2011 ; its membership in april 2014 had increased to more than 3300 people and included physical therapists , registered dietitians , speech - language - hearing therapists , etc .
moreover , 629 people attended the 3rd congress of the japanese association of rehabilitation nutrition held in 2013 .
interest in rehabilitation nutrition is increasing in japan because of the emergence of a rapidly aging society , high number of convalescent rehabilitation beds , and high number of nutrition support teams in hospitals .
the aging rate in japan is the highest in the world ( i.e. , 25.1  % in october 2013 ) .
the number of convalescent rehabilitation beds available under the japanese medical insurance system has increased since 2000 to 68,316 in march 2014 .
these data suggest that the number of disabled elderly with malnutrition and sarcopenia is increasing at an accelerated pace .
the number of hospitals that have nutrition support teams certified by the japan council for nutritional therapy was 1001 in 2013 .
many physical therapists , occupational therapists , and speech - language - hearing therapists are actively involved in nutrition support teams and interested in nutrition care management .
collaborative studies of rehabilitation nutrition have been undertaken by the japanese association of rehabilitation nutrition .
furthermore , the japanese society for sarcopenia , cachexia and wasting disorders was established in 2014 .
further , more focused , research on rehabilitation nutrition will be needed because the number of elderly with disability is expected to increase in developed countries as the population ages [ 79 , 80 ] .
the prevalence of malnutrition and sarcopenia in physically disabled elderly patients who undergo rehabilitation is high . in contrast , the amount of research focused on nutrition and sarcopenia in rehabilitation medicine is very low .
the major causes of disability in inpatients of rehabilitation facilities , including stroke , hip fracture , and hospital - associated deconditioning , are often complicated by malnutrition and sarcopenia .
sarcopenic dysphagia is common in the elderly population and is not only the result of aspiration pneumonia , but also an important cause of recurrent aspiration pneumonia . because primary and secondary sarcopenia often coexist in people with disability , rehabilitation nutrition can be used to improve their functionality ( fig .  1 ) .
further studies on rehabilitation nutrition are important in a rapidly aging society , where the number of elderly with disability is expected to increase.fig .
frail elderly with stroke or hip fracture becomes sarcopenia with disability because of hemiparesis , dysphagia , immobilization , catabolism due to acute inflammation , and undernutrition .
rehabilitation for hemiparesis , dysphagia , immobilization , and nutrition care management for catabolism due to acute inflammation and undernutrition are usually provided separately .
sarcopenia with disability induces sarcopenic dysphagia which is characterized by the loss of swallowing muscle mass and function associated with generalized loss of skeletal muscle mass and function .
rehabilitation nutrition can be used to improve functionality in people with sarcopenic dysphagia and sarcopenia with disability mechanism of sarcopenia with disability in frail elderly with stroke and hip fracture .
frail elderly with stroke or hip fracture becomes sarcopenia with disability because of hemiparesis , dysphagia , immobilization , catabolism due to acute inflammation , and undernutrition .
rehabilitation for hemiparesis , dysphagia , immobilization , and nutrition care management for catabolism due to acute inflammation and undernutrition are usually provided separately .
sarcopenia with disability induces sarcopenic dysphagia which is characterized by the loss of swallowing muscle mass and function associated with generalized loss of skeletal muscle mass and function .
rehabilitation nutrition can be used to improve functionality in people with sarcopenic dysphagia and sarcopenia with disability
 malnutrition and sarcopenia often occur in rehabilitation settings . 
 the prevalence of malnutrition and sarcopenia in older patients undergoing rehabilitation is 4967  % and 4046.5  % , respectively . 
 malnutrition and sarcopenia are associated with poorer rehabilitation outcome and physical function . 
 therefore , a combination of both rehabilitation and nutrition care management may improve outcome in disabled elderly with malnutrition and sarcopenia . 
 the concept of rehabilitation nutrition as a combination of both rehabilitation and nutrition care management and the international classification of functioning , disability and health guidelines are used to evaluate nutrition status and to maximize functionality in the elderly and other people with disability . 
 assessment of the multifactorial causes of primary and secondary sarcopenia is important because rehabilitation nutrition for sarcopenia differs depending on its etiology . 
 treatment of age - related sarcopenia should include resistance training and dietary supplements of amino acids . 
 therapy for activity - related sarcopenia includes reduced bed rest time and early mobilization and physical activity . 
 treatment for disease - related sarcopenia requires therapies for advanced organ failure , inflammatory disease , malignancy , or endocrine disease , while therapy for nutrition - related sarcopenia involves appropriate nutrition management to increase muscle mass . because primary and secondary sarcopenia often coexist in people with disability , the concept of rehabilitation nutrition is useful for their treatment . 
 stroke , hip fracture , and hospital - associated deconditioning are major causes of disability , and inpatients of rehabilitation facilities often have malnutrition and sarcopenia . 
 we review the concept of rehabilitation nutrition , the rehabilitation nutrition options for stroke , hip fracture , hospital - associated deconditioning , sarcopenic dysphagia , and then evaluate the amount of research interest in rehabilitation nutrition . 