Objective To identify the challenges and multidimensional rehabilitation needs of young and middle-aged patients with post-stroke dysphagia through the use of journey mapping, and to provide support for optimizing comprehensive rehabilitation care across the entire patient journey.Methods Descriptive qualitative research was conducted from July 2024 to February 2025.Sixteen young and middle-aged post-stroke dysphagia patients were selected for semi-structured interviews.Directed content analysis was used to analyze the data, and a patient journey map was created.Results Along the timeline of diagnosis and treatment, patients′ rehabilitation needs were summarized across three dimensions (tasks, emotions, and touchpoints) resulting in 28 themes, including screening and specialized assessment, shared decision-making between doctor and patient, patient education needs, adherence to rehabilitation training, risk of financial toxicity, and coping with oral frailty.Conclusion The rehabilitation needs of young and middle-aged post-stroke dysphagia patients are dynamically changing and multidimensionally intertwined.Future interventions may incorporate intelligent screening and remote follow-up systems and design personalized rehabilitation strategies to improve patient outcomes.