Aphasia Referral Resource
for Healthcare Professionals
Supporting GPs, Speech and Language Therapists, Neurologists, and Brain Injury Specialists
The Golden Rule
Aphasia affects language, NOT intelligence. Patients often retain their pre-morbid competence and mental capacity despite significant communication barriers
1. Quick Bedside Screening (The 60-Second Check)
If a patient presents with a suspected neurological event or cognitive decline, use the S.P.A.N. criteria to identify the need for an SLT referral:
- Strategic Naming: Can they name a common object (e.g. a pen or watch)?
- Phrasing: Is their speech laboured and “telegraphic”, or conversely, fluent but nonsensical?
- Auditory Commands: Can they follow a two-stage command? (e.g. “Point to the window, then touch your chin.”)
- No Ifs, Ands, or Buts: Can they repeat this phrase accurately?
2. When to Refer
Refer for specialist Speech and Language Therapy (SLT) if a patient presents with new or persistent communication difficulties following neurological injury, including:
- Word-finding difficulty (Anomia) or reduced verbal output.
- Impaired comprehension of spoken or written language.
- New-onset reading (Alexia) or writing (Agraphia) changes.
- Communication breakdown affecting daily activities or safety.
- Progressive Decline: Subtle, worsening language loss in the absence of a stroke (consider Primary Progressive Aphasia).
Urgent Referral: Recommended in the acute phase of stroke or TBI once the patient is medically stable to capitalise on early neuroplasticity.
3. Differential Diagnosis Table
Use the table below to help categorise the clinical presentation for the referral:
| Aphasia Type | Key Presentation | Common Cause/Site |
| Non-Fluent (Broca’s) | “Telegraphic” speech; frustrated by inability to output words. | Frontal Lobe (Stroke/TBI) |
| Fluent (Wernicke’s) | Rapid speech; uses made-up words; poor awareness of errors. | Temporal Lobe (Stroke/Tumour) |
| Global | Severe deficits in both production and comprehension. | Extensive Left Hemisphere |
| PPA | Gradual, isolated language decline over months/years. | Neurodegenerative (e.g. FTD) |
4. Referral Pathway & Information Required
To ensure timely triage, please include the following in your referral:
Clinical Essentials
- Diagnosis: Nature and date of the neurological event (include neuroimaging results).
- Current Profile: Results of the S.P.A.N. screen or observed communication style.
- Comorbidities: Cognitive (memory), motor (hemiparesis), or swallowing (dysphagia) concerns.
The Pathway
- Primary Care: Exclude acute medical causes (delirium, UTI). Refer to community SLT for long-term rehab and carer support.
- Secondary/Tertiary Care: Direct referral from Stroke Units, Neurology, or Neurosurgery. Initiate interdisciplinary planning for discharge.
5. Immediate Support Strategies (While Awaiting Assessment)
Do not wait for the SLT appointment to improve communication accessibility:
- Minimise Environmental Noise: Turn off TVs and radios during consultations.
- Use Multimodal Input: Support your speech with gestures, drawings, or written key words.
- Verify Understanding: Use “Yes/No” questions rather than open-ended questions.
- Provide Time: Allow at least 10 seconds for the patient to process and respond.
6. Expected Outcomes of SLT Intervention
Specialist assessment (aligned with RCSLT guidelines and the World Health Organization ICF framework) aims to:
- Improve Functional Communication: Enhancing independence in daily life.
- Communication Partner Training: Teaching families and carers how to “bridge” the communication gap.
- AAC Implementation: Providing high-tech or low-tech augmentative and alternative communication aids.
- Psychosocial Support: Reducing the isolation and low mood commonly associated with aphasia.