OET letter for a stroke patient: describing deficits, swallowing and rehabilitation
In an OET Nursing letter about a stroke patient, state the type and date of the stroke in one sentence, then describe the remaining deficits in functional terms (which side is weak, speech, swallowing, continence, mobility), the current diet and medicines, and the rehabilitation goals the reader must continue. Leave out the minute-by-minute emergency story and normal test results that do not change the plan.
What the reader needs after a stroke
Stroke case notes are often long: the emergency presentation, scans, treatment times, daily neurological observations, therapy notes, swallowing assessments and family meetings. The reader is usually a rehabilitation unit, a community team or a residential facility. Their question is simple: what can this patient do now, what is the risk, and what should we continue?
That means most of the acute story can shrink to a sentence, while the functional picture gets most of the space.
What to include and what to leave out
| Usually include | Usually leave out |
|---|---|
| Type and date of stroke, in one sentence | Exact arrival and scan times |
| Main deficits: weakness (side and limb), speech or understanding, vision, swallowing, continence | Daily neurological observation scores |
| Swallowing status and diet or fluid texture | Normal blood test results |
| Mobility and transfers, with aids and level of help | Every therapy session |
| New medicines started for prevention, and any changes | Medicines that are unchanged and unrelated |
| Mood, if the notes raise a concern | General comments such as "patient pleasant" |
| Communication tips that help (yes/no questions, writing board) | Hospital routines the reader does not use |
| Rehabilitation goals and progress | Detailed scale scores unless the reader needs them |
| Family involvement and plans | Unrelated past history |
Describing deficits in functional terms
Clinical labels are acceptable, but the reader plans care around function. Pair the label with what it means for the patient.
| Notes | Letter sentence |
|---|---|
| R hemiparesis, UL > LL | "She has right-sided weakness, worse in her arm than her leg." |
| Expressive dysphasia | "She understands speech well but has difficulty finding words, so she responds best to yes/no questions." |
| SLP: mildly thick fluids, soft diet | "Following a swallowing assessment, she is on a soft diet with mildly thickened fluids." |
| 1 assist transfers, 4WW 10 m | "She transfers with the help of one person and walks about 10 metres with a four-wheeled walker." |
| Incont urine nocte | "She is incontinent of urine at night." |
| Low mood, tearful | "She has been tearful and low in mood since the stroke." |
Write the texture of food and fluids exactly as the notes give it: changing "mildly thick" to "thick" could cause harm. See case notes to full sentences for the general method.
Ordering the letter
A clear order for a stroke transfer or discharge letter:
- Purpose: who the patient is, why you are writing ("to request ongoing rehabilitation").
- Event in brief: type and date of stroke, main treatment in one clause.
- Current function: weakness, mobility, swallowing and diet, communication, continence.
- Medicines: what was started for secondary prevention, and any monitoring.
- Social and family: home situation, family plans or concerns.
- Request: what the reader should continue or arrange.
Put the safety-critical points (swallowing, falls risk) where the reader cannot miss them. See Organisation & Layout for paragraphing.
Worked example (invented case)
Case summary (invented): Mrs Grace Mbeki, 71, retired librarian, right-handed. Admitted 2 September with left-sided ischaemic stroke; received clot-dissolving treatment on arrival. CT and blood results recorded. Now: right arm weakness (can lift arm but weak grip), mild right leg weakness; walks 15 m with four-wheeled walker and one person supervising; expressive dysphasia, understands well. Swallow assessment 4 September: soft diet, mildly thickened fluids. Started aspirin then clopidogrel, atorvastatin. Atrial fibrillation not found. Tearful at times. Continent. Lives with husband in a two-storey house; husband keen for her to return home. Hysterectomy 1998. Transfer to rehabilitation unit 12 September. Task: write to the nurse unit manager of the rehabilitation unit.
Selection decisions:
- In: stroke type and date, treatment in one clause, arm and leg weakness, walking and help needed, dysphasia and how to communicate, swallowing plan, new medicines, low mood, home and husband's goal.
- Out: CT details, normal blood results, negative atrial fibrillation search, hysterectomy, occupation.
Sample letter body:
Dear Nurse Unit Manager,
Re: Mrs Grace Mbeki, aged 71
I am writing to transfer Mrs Mbeki to your unit today for rehabilitation following a left-sided ischaemic stroke on 2 September, for which she received clot-dissolving treatment.
Mrs Mbeki has weakness in her right arm, with a weak grip, and mild weakness in her right leg. She walks about 15 metres with a four-wheeled walker and one person supervising. She understands speech well but has difficulty finding words, so yes/no questions are helpful. Following a swallowing assessment, she is on a soft diet with mildly thickened fluids.
She has been started on clopidogrel and atorvastatin. She has been tearful at times since the stroke.
She lives with her husband in a two-storey house, and they both hope she will return home.
I would be grateful if you could continue her mobility and speech rehabilitation, maintain her modified diet, and monitor her mood. Please contact me if you need further information.
Yours sincerely,
Want to see how your own stroke letter scores against the six criteria? Practise a case at /writing/ or check your letter.
Mistakes to avoid
- Retelling the emergency. Times and scan findings rarely help a rehabilitation reader.
- Labels without function. "Hemiparesis" alone does not tell the reader how much help to give.
- Burying the swallowing plan. Give it its own clear sentence.
- Changing the diet wording. Copy the texture exactly as stated.
- Ignoring mood and family. Both shape rehabilitation goals.
Related: falls risk and mobility, medications in OET letters and abbreviations.
Sources
This guide is medEmu's writing advice, not official OET guidance or clinical advice; all patients, medicines and case notes are invented. The network used for this run could not reach oet.com, so no OET test facts are stated beyond the criterion names. For OET's official Writing information, see oet.com.