What the Heck is the MBSImP?

If you’ve ever looked at a swallow study report and wondered, “What does mild-to-moderate even mean?”—you’re not alone. The Modified Barium Swallow Impairment Profile (MBSImP™) is the answer to that very question: finally, a standardized, evidence-based protocol for MBSS interpretation that actually makes sense.

And guess what? It’s not just for the SLPs performing the study—it’s for all of us who care about treating the actual dysfunction in dysphagia and trying to interpret that report from the MBSS.

Where Did the MBSImP Come From?

The MBSImP was developed after more than a decade of research and collaboration led by Dr. Bonnie Martin-Harris and her team. The goal? To bring consistency, objectivity, and clarity to the interpretation of Modified Barium Swallow Studies (MBSS).

If you’re looking to get trained, Northern Speech Services offers the official MBSImP training, which can be taken online, in person, or a mix of both.

Let’s Talk About the 17 Components

Yep—17. From labial seal to esophageal clearance, each component of the swallow is scored using a scale (ranging from 0 to 3, 4, or 5 depending on the structure), with higher scores indicating more severe impairment.

But don’t let the numbers scare you. The training helps you see these components clearly—literally.

Inside the Training

The MBSImP training uses animated visuals matched to MBSS frames so you can see exactly what impaired movement looks like for each component.

Here’s how it works:

Complete the training module
Practice with scored examples
Take the reliability test (you need 80% agreement with the gold standard, and yes, you can retake it!)
Once you pass, you become a registered user and gain access to a scoring and reporting database

That’s right—you can create comprehensive, de-identified reports that don’t just say “penetration on thin,” but instead show what is functionally impaired and why it matters.

Bonus Training Insights: Respiration & Swallowing

Something that stood out in training (and totally blew my mind at the time): Most people inhale, partially exhale, swallow, and then finish exhaling. That post-swallow exhalation helps clear the airway.

So when we’re cueing patients to cough, let’s rethink it—no “inhale, then cough.” Instead, train an expiratory cough and emphasize audible vocal closure with something like a strong “huh.”

How Do You Even Administer This Thing?

The MBSImP provides a detailed protocol:

What barium consistencies to use
How much to present
When to present them
Specific patient instructions

BUT—and this is big—you don’t have to rigidly follow the protocol if it’s not safe or clinically appropriate. Use your clinical judgment.

If you want your data included in the national database, you’ll need to follow the protocol precisely. But patient care always comes first.

The Power of Scoring

Unlike traditional MBSS write-ups, the MBSImP isn’t about aspiration alone.

✅ It’s not about testing every consistency
✅ It’s not about diet levels
✅ It’s not even about just penetration/aspiration

It’s about impairment-based diagnosis.

With MBSImP scoring, you can:

Quantify impairment
Monitor functional change over time
Guide your actual dysphagia rehabilitation plan

It brings the focus back to the why behind what we’re seeing:

Decreased tongue base retraction
Reduced pharyngeal stripping wave
Poor PES opening (yep—PES, not UES, per Dr. Martin-Harris)

Why This Matters

This protocol came at the perfect time. As SLPs, we’re constantly fighting for recognition as dysphagia experts.

But here’s the thing: We can’t be the experts if our assessments sound like guesswork. “Mild residue,” “maybe some aspiration,” “probably safe with nectar thick” just don’t cut it.

We don’t treat:

Aspiration
Penetration
Premature spillage

We treat:

Impaired biomechanics
Muscle dysfunction
Coordination deficits in a complex system

Dysphagia is a muscle-based impairment. And MBSImP helps us identify the broken gears so we can actually fix the machine.

My Experience

I’ve been using the MBSImP since 2010 and I still get excited about it. Whether or not you’re the one performing the MBSS, this training is worth it. You’ll learn so much about the swallow, and you’ll be able to interpret your colleague’s reports like a pro.

If you want to truly understand swallow function—and dysfunction—this is the protocol to study.

Are you ready for a deeper dive with even more resources available? Join the Dysphagia Skills Accelerator today. You will get so many great tools with new tools being added all the time! Click here to join now!

Have you ever wanted a way to create a more standardized protocol for your Clinical Swallow Evaluation? Do you often forget or leave out parts of the CSE, you know, the parts that are important for your Plan of Care? You probably need the Clinical Dysphagia Assessment Toolkit if you answered yes. You can get your copy here.

References

Martin-Harris, B., et al. (2008). MBS measurement tool for swallow impairment—MBSImP: establishing a standard. Dysphagia, 23(4), 392–405.

Sandidge, J. (2009). The Modified Barium Swallow Impairment Profile (MBSImP). Perspectives on Swallowing and Swallowing Disorders, 18(4), 117–122.

Gullung, J. L., et al. (2012). Oropharyngeal and esophageal swallowing impairments. Annals of Otology, Rhinology & Laryngology, 121(11), 738–745.

Martin-Harris, B., Humphries, K., & Garand, K. L. (2017). MBSImP™–Innovation, Dissemination, and Implementation. Perspectives of the ASHA SIGs, 2(13), 129–138.

Martin-Harris, B. (2017). MBSImP™ Web-Based Learning Module. Northern Speech Services.

Tran, T. T. A., Martin-Harris, B., & Pearson Jr, W. G. (2018). Respiratory-swallow phase training. Computer Methods in Biomechanics and Biomedical Engineering: Imaging & Visualization, 6(5), 532–538.

Dysphagia Ramblings