Speech Pathology — Advice Letter on Safe Swallowing after a Stroke
A speech-language pathologist writes an advice letter to a 77-year-old stroke patient and her family on safe swallowing strategies at home following a hospital admission. The letter must explain the texture prescription, positioning, and the warning signs of aspiration in patient-accessible language.
Letter type
Advice
Write to
Patient and Family
Target length
190–210 words
The case notes
Patient: Mrs Violet Huang, 77 years old; left MCA stroke 2 weeks ago; mild right facial weakness and dysphagia confirmed on clinical swallowing assessment
Diet texture: IDDSI Level 5 (Minced and Moist): soft foods minced to no more than 4 mm pieces; no hard pieces, no separate thin liquid in food; acceptable: minced chicken, scrambled eggs, soft tofu, soft cooked vegetables, ripe banana mashed
Fluids: IDDSI Level 2 (Mildly Thick): fluid needs to be thickened to 'nectar consistency' using thickening powder (1 scoop per 200 mL); no unthickened water, tea or coffee; thickening powder: Nutilis Powder (provided); demonstration given at bedside
Positioning: Always eat and drink sitting upright (90 degrees); remain upright for 30 minutes after eating; head slightly forward (chin-tuck position)
During meals: Small teaspoon-sized bites; pause between each mouthful; no talking while swallowing; do not rush; meals may take 30–45 minutes
Warning signs: Coughing or choking during/after eating or drinking; wet or gurgly voice after swallowing; recurrent chest infections; breathing difficulties during meals — contact the speech pathologist or GP immediately
Review: SLP review in 4 weeks to reassess texture requirements; diet may be upgraded if swallowing improves
Task: Write an advice letter to Mrs Huang and her daughter explaining the texture prescription and safe swallowing strategies at home.
Writing task
Write an advice letter to Mrs Huang and her daughter explaining the texture prescription and safe swallowing strategies at home.
What to include, what to cut
The hardest mark to win is selection. The same case notes contain decision-relevant facts and distractors. Here is what an examiner expects to see in a Grade B letter for this scenario, and what should be left out.
Include
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IDDSI Level 5 for food and Level 2 for fluids — with a practical food example and the thickening powder instruction
The family must be able to prepare the correct consistency at home. An IDDSI level number without a food example is not actionable; a food example without the thickening powder instruction is incomplete.
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The positioning: 90 degrees upright, head slightly forward, 30 minutes upright after meals
Aspiration risk is highest when swallowing occurs in a reclined position. The chin-tuck position is the most important single swallowing compensation strategy.
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The warning signs of aspiration and what to do
Aspiration pneumonia following dysphagia is life-threatening. The family must be able to recognise the signs and know the action without delay.
Leave out
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The clinical swallowing assessment findings and the stroke neurology
This is a patient and family care letter, not a clinical handover. One sentence of plain context: 'The stroke has temporarily affected the muscles you use to swallow.' The clinical assessment detail is for the medical record.
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All acceptable and unacceptable foods in full
The family has the IDDSI texture card and food guide. The letter provides the key principles and the most important examples. An exhaustive food list creates an overlong letter that is harder to follow at the dinner table.
Criterion in focus · Genre & Style
An advice letter addressed to both a stroke patient and their family requires careful register calibration. The patient (77, post-stroke) may have some cognitive fatigue; the daughter (primary carer) is the operational implementer of the advice. Write in plain language addressing both: 'When Mrs Huang/you eat...' is ambiguous — instead address the patient and note the family in a brief line: 'This letter explains the safe eating approach for Mrs Huang; please read it together.' Then write in second person to Mrs Huang with the family as active supporters.
Now write the letter — and find out what is blocking your Grade B
Write a 190–210 words advice letter from these notes, paste it into the free checker for an instant read, then submit it for a human grade against all six criteria. Dr Mariam's team returns line-by-line feedback, from $12.