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Which Consistencies Do I Trial?

A Moment in Time

Most people call the Modified Barium Swallow Study (MBSS) a “snapshot in time” or a “moment in time”.

You can’t possibly trial every single consistency the person may eat while under fluoro.  The radiation exposure would get to be ridiculous and the kitchen in your facility may not like you much if you do many modifieds in a week.

So what in the heck should you trial?

Well, if you follow the MBSImP, then you know that there is a standardized set of consistencies to trial (thin, nectar/mildly thick liquid, pureed and solid).  You can add to this if you need.  If you want to add a mixed consistency or need to try honey/moderately thick, then you can add that.

Basically, you want to answer the question, what is the physiology of the swallow?

Somewhere along the line, the MBSS became a test for determining if the patient is aspirating or not and what consistency we need to place the person on (or their diet sentence.)

Don’t forget, you are answering the questions:

  • What does the swallowing physiology look like?
  • How can I change the swallow to make it functional?

You are finding the information to develop that patient’s plan of care to make them as functional with swallowing as possible.

The best thing you can do is to test the consistencies that answer those questions.

Now remember, in the MBSImP course, you learn the nectar (mildly) thick liquids can change the swallowing physiology with increased movement of the pharyngeal structures.   You may recommend the patient stays on regular liquids, however you may use nectar (mildly) thick liquids to exercise the oropharyngeal musculature as an exercise.

References:

Martin-Harris, B., Logemann, J. A., McMahon, S., Schleicher, M., & Sandidge, J. (2000). Clinical utility of the modified barium swallow. Dysphagia15(3), 136-141.

Logemann, J. A. (1997). Role of the modified barium swallow in management of patients with dysphagia. Otolaryngology–Head and Neck Surgery116(3), 335-338.

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. Dysphagia23(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.

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 Groups2(13), 129-138.

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

Gibson, E., Phyland, D., & Marschner, I. (1995). Rater reliability of the modified barium swallow. Australian Journal of Human Communication Disorders23(2), 54-60.

Palmer, J. B., Kuhlemeier, K. V., Tippett, D. C., & Lynch, C. (1993). A protocol for the videofluorographic swallowing study. Dysphagia8(3), 209-214.

 

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Phagia Puree Mixes

As you may be able to see from previous posts, I am always up for a challenge.  From sampling pureed foods to thickened liquids, I like to find the best available product for my patients.

The ASHA Convention

At the ASHA convention this year, the Dysphagia Divas were back with some new pureed mixes.  I was able to get samples of each type to take home and try.

The Phagia Puree Mixes are supposed to be available at http://www.dysphagia-diet.com or by calling 1-855-397-7424.  I have been unable to find the Phagia products on the website.

The Product

There are 7 products available:  Pureed Bread (12 3 oz packets for $15.25), French Toast (12 3.5 oz packets for $18.50), Bread Pudding (12 3.5 oz packets for $18.50), Egg and Toast (6 5 oz packets for $15.25), Peanut Butter Sandwich (6 4.5 oz packets for $22.50), Caramel Apple Pie (6 3 oz packets for $24.50) and Phagia Pureed Food Enhancer (6 5.5 oz packets for $24.50).

All packets contain a powder that you mix with either hot or boiling water.  You mix the packet with the water, use a whisk to combine the water and powder mixture and then let it sit for a specific number of minutes.

The Results

The products were really actually fairly palatable.  The egg and toast did taste like eggs.  The french toast was good, even given the texture of the pureed.  The caramel apple pie was a good dessert and my very picky 9 year old daughter even gave it a thumbs up!  The peanut butter sandwich had a very good flavor, mostly of peanut butter.  I, personally, wasn’t a big fan of the bread, which had a strange, almost cardboard flavor to it or the bread pudding.

Overall, the food had good taste to it.  I think with food molds, it wouldn’t have been difficult to tell that it was pureed.

The Pictures