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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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What’s In A Name

Seriously, how many names can we have for one test?

We typically do the same thing…..assess swallowing function, so why a million different names?

In the early days, the swallowing assessment using x-ray was called a Cookie Swallow Test.

You can read more about the history of the MBSS:

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The same test is more recently called:

  • Modified Barium Swallow Study (MBSS)
  • Modified Barium Study (MBS)
  • Videofluoroscopic Swallow Study (VFSS)
  • Swallow Study
  • Rehab Swallow Study

No matter what it is called, the procedure should be the same.  A variety of consistencies will be presented with an SLP assessing the swallow.  Compensatory strategies may be trialed (more to come soon), various presentation methods may be trialed, sensory techniques may be trialed.

No matter what the name, the SLP will be assessing the physiology of the swallow so that an accurate treatment plan can be developed.

What other names have you heard that X-Ray swallow study called?