Speech Pathology — Transfer to Inpatient Rehabilitation for Post-Laryngectomy Voice
An acute care speech-language pathologist transfers a 58-year-old man who has had a total laryngectomy and tracheoesophageal puncture (TEP) to a specialist inpatient rehabilitation speech pathologist. The proficient challenge is presenting the current TEP and voice prosthesis status accurately while cutting the oncological history that is not SLP-relevant.
Letter type
Transfer
Write to
Inpatient Rehabilitation Speech Pathologist
Target length
210–240 words
The case notes
Patient: Mr Francis Okello, 58 years old; worked as a secondary school science teacher
Procedure: Total laryngectomy + TEP (primary, day of surgery) for T3N1M0 laryngeal squamous cell carcinoma; surgery 12 days ago
TEP status: TEP in situ; voice prosthesis (Provox Vega 22.5 Fr) fitted on day 8; valve patent and voice-capable; currently producing short phrases (2–4 words); requires effortful occlusion to initiate voice
Swallowing: Oral feeding resumed day 7 via video fluoroscopic swallowing study: no anastomotic leak; on IDDSI Level 7 (regular, easy to chew); no dysphagia; will advance to regular diet under SLP guidance
Current SLP programme: TEP hygiene education (daily cleaning, catheter care); voice production exercises (effortful occlusion technique, voicing with vowel prolongation); patient can demonstrate TEP cleaning independently but still practices with support
Stoma: Laryngectomy stoma — covered with HME (heat and moisture exchanger) filter; changed daily; written instructions provided to patient and wife
Communication mode: Electrolarynx available as backup; patient prefers TEP voice; written communication for difficult environments
Goals: Progress to connected speech (sentences); reduce effort for voice initiation; independence with TEP care; return to communicative function sufficient for classroom interaction (long-term)
Task: Write a transfer letter to the inpatient rehabilitation SLP, Ms Fiona Gallagher, providing the TEP and voice prosthesis status needed to continue rehabilitation.
Writing task
Write a transfer letter to the inpatient rehabilitation SLP, Ms Fiona Gallagher, providing the TEP and voice prosthesis status needed to continue rehabilitation.
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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TEP in situ, Provox Vega 22.5 Fr fitted day 8, valve patent and voice-capable
The receiving SLP needs the exact prosthesis type and size to manage any prosthesis-related issues. A TEP handover without the prosthesis specification is a clinical safety gap.
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Current voice production: short phrases (2–4 words) with effortful occlusion; the specific exercises in progress
The rehabilitation SLP starts from this baseline. Knowing that effortful occlusion is the current technique tells them the skill level and what to advance from.
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That the patient can demonstrate TEP cleaning independently but still practices with support — and that the HME is self-managed
Independence hierarchy for TEP care is critical for discharge planning from the rehabilitation unit. Knowing what he can do alone vs with support tells the receiving SLP the training gaps that need closing.
Leave out
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The oncological staging and lymph node status
T3N1M0 staging is one clause of context: 'laryngeal squamous cell carcinoma requiring total laryngectomy.' The oncology team manages the oncological aspects; the SLP transfer covers communication and swallowing rehabilitation.
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The swallowing in detail beyond current IDDSI level
Swallowing is stable on regular diet. State this: 'currently on IDDSI Level 7 (regular diet), no dysphagia, advancing to full regular diet.' The VFSS report is attached.
Criterion in focus · Content
Post-laryngectomy SLP transfer letters are assessed on whether the receiving clinician can safely continue TEP care and voice rehabilitation from the letter. Three non-negotiables: (1) prosthesis type and size, (2) current voice production level and the technique in use, (3) TEP care independence status. A letter missing the prosthesis specification requires the receiving SLP to check the device before every session — a preventable clinical inefficiency that becomes a safety issue at a device change.
Now write the letter — and find out what is blocking your Grade B
Write a 210–240 words transfer 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.