Purpose The present study examined whether Tongue Sensory Feedback Training (TSFT) combined with action observation improves tongue strength, swallowing performance, and penetration–aspiration severity in patients with chronic post stroke dysphagia (PSD). Methods A randomized controlled pretest–posttest design was applied to twenty patients with chronic PSD who were hospitalized at a hospital in Gyeonggido, Republic of Korea. Participants were randomly assigned to either an experimental group (EG) receiving TSFT combined with action observation (n = 10) or a control group (CG) receiving tongue motor exercise training combined with action observation (n = 10). Over a period of five weeks, participants received 30minute treatment sessions on three occasions each week. Effectiveness of the intervention was determined by changes in maximal tongue strength, swallowing transit times derived from VFSS analysis, and Penetration–Aspiration Scale ratings. Results Following the intervention period, the experimental group demonstrated significantly greater gains in maximal tongue strength and oral transit time than the control group (p < 0.05). Although no significant betweengroup differences were observed in pharyngeal transit time or penetration–aspiration scale scores, overall trends toward improvement were noted in the EG. Conclusion These findings suggest that TSFT combined with action observation is an effective intervention for enhancing tongue strength and oralphase swallowing efficiency in patients with chronic PSD. Furthermore, the results indicate that an occupational therapybased approach integrating sensorybased intervention and action observation may contribute to swallowing function recovery even in the chronic stage after stroke.