For those of you that don’t know what the heck the MBSImP is, it stands for the Modified Barium Swallow Impairment Profile. What it is, an answer to everyone’s prayers to FINALLY have a standardized method for swallow studies.
Where Can I Find MBSImP
This protocol for MBSS is based on more than 10 years of work and research. Northern Speech Services is the company that provides the MBSImP training which can be taken wholly or partially online.
The 17 Components
The MBSImP consists of 17 components from labial seal to esophageal clearance. Each component is scored from 0 to either 3, 4 or 5, with the higher number indicating a worse impairment.
The nice part of the MBSImP is the training slides. Each MBS frame has a corresponding animation making each component of the swallow easy to see for the training purposes. The animations are used in the live course and the online module. With the online module, you go through a training section, a practice section and then a test. With the test, you have to have 80% reliability on your scoring. Once you reach the 80% (you can take the test as many times as needed), you become a registered user and have access to a database. This database allows you to input your patient information, which is de-identified to create a comprehensive report for each swallow study you complete.
Part of the training is respiration and respiration in relation to swallowing. One thing we learned is that most people will inhale and partially exhale before swallowing. When the swallow is complete they will finish the exhalation. It is important that we as therapists evaluate the respiratory pattern of the patient and take that into account. One point that was emphasized was to teach an expiratory cough to clear and not cue the patient to inhale then cough. Also to force “audible” vocal closure, or take a deep breath with an audible “huh”.
How In the Heck Do You Even Administer This Protocol?
There is a complete outline including instruction to patient, what barium to present, when to present each consistency and how much to present. This is done in a precise manner, however it was emphasized that you DO NOT HAVE TO FOLLOW THE PROTOCOL. There will be times that you have to use your clinical judgement. Now, with the database, Bonnie will have access to all of the inputed data, remember, it is de-identified. To be a part of her collection of data, she needs to protocol to be standardized, but if it is not necessary or safe to standardize it for your patient, then you do it how you need to do it.
Scoring the MBSImP
With the MBSImP, you score each component with the given scale. You are working to capture IMPAIRMENT. This is not focusing on aspiration, penetration or testing every consistency known to man. This is focusing on the function of the swallow and the dysfunction to create an appropriate therapy plan to rehabilitate the swallow.
This gives you a standardized score for the swallow study by entering all MBSS information and findings into a database, which creates your report. This score allows you to demonstrate improvement and to focus on more than just penetration/aspiration, diet consistency, pooling, etc. You focus more on the actual dysfunction. The decreased tongue base retraction (TBR), the decreased pharyngeal stripping wave, they opening of the Pharyngeal Esophageal Segment (PES). Dr. Martin-Harris uses PES rather than Upper Esophageal Sphincter (UES).
Thoughts on the MBSImP
I think that this Profile came at the right time. More than ever, we as SLP’s need to stand our ground and maintain our status as dysphagia experts. We are the ones that study this mechanism. We need to evaluate properly. A modified should not be merely to determine aspiration or to see if the person if “safe” with thin liquids. We need to determine dysfunction, rehabilitate the swallow system and re-evaluate to determine improvement of the function. This will not only create a much nicer and less subjective study (really, what does mild, moderate and severe tell me?)
We don’t treat aspiration, penetration or premature spillage. We treat the dysfunction, the decreased hyoid protraction, the decreased laryngeal elevation.
I think when we realize that dysphagia is muscle-based function of the body that works as a system, we can effectively diagnose and treat the dysphagia, the dysfunction instead of worrying so much about the actual aspiration or sticking our tongues out 10 times. Then and only then can we call ourselves a dysphagia expert.
All-in-all I’m still very excited about this protocol and the direction in which it takes our field. I have been using this protocol since 2010 and I highly recommend it to all SLPs treating dysphagia, whether you actually are responsible for MBSS or not, you can still learn quite a lot about the swallow function and I believe it will be much easier to interpret the results if you have a therapist that uses the protocol.
Martin-Harris, B., Brodsky, M. B., Michel, Y., Castell, D. O., Schleicher, M., Sandidge, J., … & Blair, J. (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): a new standard physiologic approach to swallowing assessment and targeted treatment. Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 18(4), 117-122.
Gullung, J. L., Hill, E. G., Castell, D. O., & Martin-Harris, B. (2012). Oropharyngeal and Esophageal Swallowing Impairments: their association and the predictive value of the modified barium swallow impairment profile and combined multichannel intraluminal impedance—esophageal manometry. Annals of Otology, Rhinology & Laryngology, 121(11), 738-745.
Martin-Harris, B., Humphries, K., & Garand, K. L. (2017). The Modified Barium Swallow Impairment Profile (MBSImP™©)–Innovation, Dissemination and Implementation. Perspectives of the ASHA Special Interest Groups, 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). Improvements resulting from respiratory-swallow phase training visualized in patient-specific computational analysis of swallowing mechanics. Computer Methods in Biomechanics and Biomedical Engineering: Imaging & Visualization, 6(5), 532-538.