MBS

Question 1

Modified Barium Swallow Study
CSD 629 Dysphagia
Also known as…

Answer 1

Videofluoroscopic Swallow Study
Videofluoroscopic Evaluation
Modified Barium Swallow Study
Cookie Swallow Study
Pharyngeal function test

Question 2

Purpose:

Answer 2

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

Question 3

Equipment
Fluoroscopy suite (video xray)

Answer 3

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

Question 4

C-Arm

Answer 4

Portable fluoroscopy unit
Usually doesn’t require special seating
Rotation of the “c” changes the view lateral to A/P without moving the pt

Question 5

Viewing monitor

Answer 5

Recorder connected to fluoroscopy

Question 6

Barium

Answer 6

Various food consistencies
Spoons, cups, straws
Radiation (Under 5 minutes)
Radiation vest/shield, glove?
Dosimeter badge: how much radiation overtime you are exposed to

Question 7

Seating Options

Answer 7

Standard chair
Wheel chair
Pink chair
Stretcher

Question 8

Personnel

Answer 8

Radiologist
Radiologist Tech
Patient 
Family
SLP

Question 9

consultancies

Answer 9

Liquid/Paste Barium
EZ Paste
Thin
Thick/nectar
Thick/honey
Paste

Question 10

WHY BARIUM???

Answer 10

it is water soluble, if swallowed into lungs it will dissolve and be absorbed

Question 11

Pt. Consideration

Answer 11

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

Question 12

Lateral View

Typically:

Answer 12

Anterior to lips
Posterior to  PPW
Superior to hard palate
Inferior: CP segment
Anterior-Posterior View

Question 13

Move any metal objects (earings, zippers, etc.)

Answer 13

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

Question 14

Liquids (easiest to hardest)

Answer 14

¼ tsp
½ tsp
1 tsp
Sip from cup
Large drink, multiple sips

Question 15

Pastes/Solids

From small to patient

Answer 15

controlled bite
½ tsp
1 tsp
Small bite
Large bite
Pt controlled bites

Question 16

Protocol other

Answer 16

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

Question 17

Can typically see:

Answer 17

Oral Prep
Swallow initiation
Penetration
Aspiration
Before, during and after the swallow
Pharyngeal Contraction
Movement of bolus through the UES and upper esophagus

Question 18

Oral Stage

Answer 18

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?

Question 19


Pharyngeal Stage

Answer 19

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?

Question 20

Esophageal Stages

Answer 20

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

Question 21

Compensatory Techniques

Answer 21

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

Question 22

Postures

Answer 22

Chin tuck
Head turn
Head tilt
Head back

Question 23

Compensatory Techniques

Answer 23

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