Speech Pathology — Referral to MND Specialist SLP for AAC Assessment
A community speech-language pathologist refers a 54-year-old woman with motor neurone disease and progressive dysarthria to a specialist MND SLP for proactive augmentative and alternative communication (AAC) assessment. The intermediate challenge is conveying the clinical urgency of proactive AAC assessment — before speech is lost — without the patient herself feeling that her speech is being given up on.
Letter type
Referral
Write to
Specialist MND Speech Pathologist
Target length
200–220 words
The case notes
Patient: Mrs Claire Donnelly, 54 years old; motor neurone disease (bulbar-onset ALS) diagnosed 9 months ago; retired solicitor
Current speech: Dysarthria severity: mild-to-moderate (UPDRS speech subscale equivalent); intelligibility 70% to unfamiliar listeners in a quiet room; intelligibility drops to approximately 40% in noise; short phrases clear; multi-sentence speech increasingly effortful; rate of deterioration: moderate (intelligibility declined from 85% to 70% over 3 months)
Voice: Vocal quality: slightly hypophonic and strained; reduced range; no nasal air escape at this stage; does not fatigue rapidly with short conversation but struggles after 30 minutes
Swallowing: Mild pharyngeal dysphagia — on IDDSI Level 7 (regular) diet; no aspiration on clinical assessment at last review; monitored
Current communication: Uses smartphone for messages; voice banking underway (ModelTalker — approximately 120 phrases banked to date); aware of and open to AAC discussion
Why proactive AAC now: Window for high-quality voice banking and early AAC learning is closing as speech deteriorates; proactive AAC provision recommended before communication is significantly impaired — preserves quality of voice banking, allows learning while cognitively and physically able, reduces crisis referral at point of speech loss
Task: Write a referral letter to the MND specialist SLP, Ms Karen Hughes, requesting proactive AAC assessment and continued voice banking guidance.
Writing task
Write a referral letter to the MND specialist SLP, Ms Karen Hughes, requesting proactive AAC assessment and continued voice banking guidance.
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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Current intelligibility: 70% to unfamiliar listeners in quiet, 40% in noise — and the rate of decline (85% to 70% over 3 months)
The decline rate is the most important datum in a progressive condition referral. 70% intelligibility is the current level; the 15-point drop over 3 months is what tells the specialist that the proactive AAC window is now.
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That voice banking is underway (ModelTalker, approximately 120 phrases) and the patient is open to AAC discussion
The specialist needs to know the voice banking status to continue it effectively — how far along it is, which system, and whether the patient has the correct approach for the remaining recording window.
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The reason for proactive referral: the window for high-quality voice banking closes as speech deteriorates; learning AAC while speech is still functional is clinically recommended
This is the clinical argument that needs to be made explicitly. The specialist team needs to understand this is a proactive referral, not a crisis — and why acting now is in the patient's best interest.
Leave out
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The swallowing assessment in detail
Swallowing is a separate clinical stream being monitored. Brief mention: 'mild pharyngeal dysphagia on IDDSI Level 7 diet, monitored.' The MND SLP referral focuses on the communication programme.
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The MND diagnosis history and disease progression beyond the communication context
'Bulbar-onset ALS diagnosed 9 months ago' is the one-clause context. The MND team has the full neurological record; the SLP referral covers the speech and AAC picture.
Criterion in focus · Genre & Style
A referral letter for a patient with a progressive terminal illness requires particular care with register. The letter is professional — it should convey urgency without being alarming and should not use language that frames the referral as a sign of imminent speech loss. 'To ensure Mrs Donnelly has the best possible communication options as her condition progresses' is the correct framing — it positions the referral as proactive planning, not crisis management. The receiving specialist will communicate with the patient using their expertise; the referral letter sets the clinical context without overstepping into prognostic language.
Now write the letter — and find out what is blocking your Grade B
Write a 200–220 words referral 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.