MBS Flashcards
Modified Barium Swallow Study
CSD 629 Dysphagia
Also known as…
Videofluoroscopic Swallow Study Videofluoroscopic Evaluation Modified Barium Swallow Study Cookie Swallow Study Pharyngeal function test
Purpose:
Assess oral and pharyngeal physiologic function
Screen esophageal function
upper 1/3 9DIFFERENT FORM FEES
Evaluate the effectiveness & efficiency of the swallow
Determine the presence, timing, amount, and cause of aspiration or penetration
Determine the presence of delay in swallow initiation or presence of pharyngeal residue (strength of swallow)
Based on MBSS…
Establish appropriate diet and liquid levels
Identify any compensatory strategies needed
Plan treatment based on the identified symptoms and disorders
Equipment Fluoroscopy suite (video xray)
Standard Radiofluorographic Table (rectangle perpendicular to ground)
Usually require special seating devices
Must move the pt to change the view from lateral to A/P
C-Arm
Portable fluoroscopy unit
Usually doesn’t require special seating
Rotation of the “c” changes the view lateral to A/P without moving the pt
Viewing monitor
Recorder connected to fluoroscopy
Barium
Various food consistencies Spoons, cups, straws Radiation (Under 5 minutes) Radiation vest/shield, glove? Dosimeter badge: how much radiation overtime you are exposed to
Seating Options
Standard chair
Wheel chair
Pink chair
Stretcher
Personnel
Radiologist Radiologist Tech Patient Family SLP
consultancies
Liquid/Paste Barium EZ Paste Thin Thick/nectar Thick/honey Paste
WHY BARIUM???
it is water soluble, if swallowed into lungs it will dissolve and be absorbed
Pt. Consideration
Medical Condition: stable enough to eat and drink Alertness: following commands BSE results Endurance: can they eat and drink enough Precautions: spine injury Transportation: can leave floor
Lateral View
Typically:
Anterior to lips Posterior to PPW Superior to hard palate Inferior: CP segment Anterior-Posterior View
Move any metal objects (earings, zippers, etc.)
Adjust shoulders Elbows off arm rest, hands in lap Protocol (NO) patient? Can the patient implement the technique independently? Maneuvers: intervention Supraglottic swallow: Swallow—->cough—-Swallow if there was asprirarion Super-supraglottic swallow: swallow—> cough—-Swallow—->cough—-Swallow Effortful swallow: swallow as hard as you can Stopping the Study Not necessarily when aspiration occurs When to Recommend AMON NG Tube: Short term Acute onset of dysphagia Good potential for spontaneous or facilitated recovery Medical status is good and improving When to Recommend AMON G Tube: Long term Progressive end stage disease Lack of cooperation with treatment due to decreased alertness, altered consciousness Large CVA with severe dysphagia
Liquids (easiest to hardest)
¼ tsp ½ tsp 1 tsp Sip from cup Large drink, multiple sips
Pastes/Solids
From small to patient
controlled bite ½ tsp 1 tsp Small bite Large bite Pt controlled bites
Protocol other
1-4 presentations per consistency Start 1 level down For NPO pts, begin with ¼ tsp of liq. Done in conjunction with MD – Radiologist Typically also with Radiology Tech SLPs tells when to turn fluoro “on/off” SLP determines progression of boluses
Can typically see:
Oral Prep Swallow initiation Penetration Aspiration Before, during and after the swallow Pharyngeal Contraction Movement of bolus through the UES and upper esophagus
Oral Stage
Bolus cohesiveness
Posterior oral spillage / Premature Spillage
Anterior oral spillage
Pocketing
Nasal regurgitation
Posterior tongue approximation with PPW
Mastication with solids
Swallow Initiation
Where is the bolus when the swallow is initiated?
Posterior oral cavity?
Vallecula?
Pyriform sinuses?
Is there a true delay in swallow initiation or is it premature oral spillage?
Is it timely (in seconds) regardless of bolus location?
Pharyngeal Stage
Assess the hyolaryngeal excursion Assess the pharyngeal peristaltic wave Is there penetration? Does it remain after the swallow? Flash penetration? Epiglottic stripping? Why does it occur? Can the person clear it? Is there aspiration? Is it silent or audible? When does it occur? Why does it occur? Can the person clear it? Is there residue? Where is it located? Why does it occur? Does it clear with spontaneous subsequent swallows? Does it result in aspiration?
Esophageal Stages
Does the UES open adequately and for sufficient duration to allow the bolus to pass from the pharynx to the esophagus?
If not, is it the result of decreased hyolaryngeal excursion, UES issues, pharyngeal strength issues?
Does the upper esophageal motility interfere with the pharyngeal phase of swallowing?
i.e. residue noted, back flow noted
Compensatory Techniques
Try these to aid in or improve swallow fxn: Cued cough or throat clear Chin tuck Head Turn Head Tilt Bolus size changes / Controlled rate or amount Liquid wash down Cued multiple swallows
Postures
Chin tuck
Head turn
Head tilt
Head back
Compensatory Techniques
When trying compensatory techniques, know why you are trying it physiologically
Does the compensatory technique improve swallowing efficiency?
Will the compensatory technique overly fatigue the
