Inclusion Criteria:  aged 78-99 years old CFS rating of 4-7 able to sit out of bed able to follow at least 2-step directions (even for patients with cognitive condition e.g. dementia ) diagnosed with dysphagia by the ward speech therapist and assessed to be suitable for therapy have not been admitted for more than 2 days  Exclusion Criteria:  acute neurological conditions such as traumatic brain injury or stroke history of head and neck cancer, surgery or radiotherapy to head and neck region and 3) patients on long term tube feeding