**3. Use of nasogastric tube or gastrostomy tube for feeding**

This method is justified in severe dysphagia or the absence of sufficient fruitful contact with the patient. Of course, tube feeding is also necessary for acute illness. However, tube feeding disrupts the digestion process in the oral cavity, disrupting synchronization of the secretion of the digestive glands and the entry of the food lump into the lumen of the stomach and intestines, and significantly reduces the quality of life. Moreover, tube feeding does not improve the survival rate of patients with chronic neurological diseases (for example, with dementia) [11, 25–28].

Percutaneous endoscopic gastrostomy (PEG) has several advantages over the nasogastric tube for dysphagia, notably after strokes and severe traumatic brain injury. The gastrostomy tube is more convenient from the point of view of care, and its unconscious or spontaneous removal is less likely. Also, according to several studies, patients with PEG usually receive a sufficient amount of enteral nutrition and, accordingly, have better indicators of nutritional status in comparison with a nasogastric tube [29]. In addition, prolonged standing of the nasogastric tube has a high risk of complications (such as pressure ulcers of the nasal mucosa, esophagus), significantly limits the volume of speech therapy, and may even contribute to the progression of dysphagia. Therefore, it is essential for the timely placement of gastrostomy tubes in such patients. According to clinical guidelines, the placement of a gastrostomy is necessary no later than 4 weeks of using a nasogastric tube or earlier if it is evident that the patient will not be able to return to eating through natural routes soon [5, 7, 30]. Introducing a gastrostomy tube facilitates the work of a speech therapist, increases the effectiveness of rehabilitation measures, and can accelerate the positive dynamics of dysphagia treatment.
