Modified Barium Swallow Flashcards
1
Q
Swallowing 101 Facts
A
- 26 muscles and 6 cranial nerves to swallow
- How long- .5 to 1 sec (exclusive of the esophageal phase)
- Swallow 600-1000 times a day, each meal 250+ and 50x while sleeping
- How long does it take to digest, 90 mins (up to 6 hours for high fat)
- How long is the GI tract- 30 feet
- How long does food stay in the GI tract 4-72 hours
- .5 to 1.5 liters of saliva a day
2
Q
What is the MBS or VFSS
A
- Recorded dynamic radiography that utilizes continuous x-rays to objectively assess swallowing function
- instrumental exam
- Provides real-time images of bolus transport and oropharyngeal motility
- Provides a means for off-line assessment of the patients swallowing status.
- Bedside is subjective (you have to infer with eyes and ears, MBS you can see all stages of the swallow)
- Real time image
- You can suggest compensations (postures, maneuvers, or sensory enhancements) check stimulability under x-ray and see if there is a less restrictive way to help the pt. than just modifiying their diet.
3
Q
Why do an instrumental exam instead of a bedside? 1
A
- The bedside is inconclusive.
- If pharyngeal or esophageal dysphagia is suspected.
- The patient’s pulmonary status or nutritional status is compromised and dysphagia might be part of the cause of the problem.
4
Q
Why do an instrumental exam instead of a bedside? 2
A
- You cannot develop an appropriate treatment plan without information obtained on the instrumental examination.
- The patient continues to show signs of aspiration even though the initial bedside eval did not indicate a pharyngeal problem.
- The patient has had a previous instrumental exam and now you think the patient has changed (improved or declined).
5
Q
What information do we obtain from a MBS? 1
A
- Not only to determine whether or not the patient is aspirating, but to figure out why the patient is and if there is a way to prevent it.
- To evaluate swallowing physiology, timing and coordination.
*** Timing and coordination is very important
- To identify the impact of abnormal swallowing physiology, timing and coordination.
- We can see all phases of the swallow
- Individuals with structural/mechanical problems should have MBS (cancer pts.)
6
Q
What information do we obtain from a MBS? 2
A
- Identify the etiology, timing and amount of penetration and/or aspiration
- Reaction to laryngeal penetration/aspiration
- Make note of sensory awareness and reaction to residue, penetration and/or aspiration.
- Identify etiology, percentage and location or residue.
7
Q
What information do we obtain from a MBS? 3
A
- To see the effects of compensations (posture changes such as chin tuck and head rotation), bolus/texture modification, maneuvers such as the supraglottic swallow, sensory enhancements
- To look at therapeutic intervention trials.
- To determine patient stimulability to perform maneuvers and compensations.
— With an MBS we can provide biofeedback to patients with behavioral disorders
8
Q
Rationale for MBS
A
- To simulate a natural feeding environment, as possible
- To provide recommendations regarding optimum delivery of nutrition and hydration
- To collaborate with and educate other team members, referral sources, caregivers and patient re: recommendations for optimum swallowing safety and efficiency.
9
Q
MBS/VFSS
A
- Most frequently used procedure to assess the pharyngeal phase of the swallow.
- Considered by most to be the “Gold Standard”.
- Procedure usually performed by an SLP and a radiologist.
- Allows for visualization of all phases of the swallow, from the oral preparatory phase through the esophageal phase.
- This view is captured on a video media for later review
- Pts. With COPD (you need to be able to hold your breath long enough to swallow) If people are getting really out of breath while they are eating or drinking, you want to do a MBS
- If pt. is medically unstable, it may be better to do FEES or a bedside
- MBS may not be best for the elderly with a poor posture
- Size of the individual may prevent a MBS from being preformed, the MBS room is small, and the larger the room, the larger the x-ray beam which makes the view of the swallow difficult
10
Q
Indications of Swallowing Issues
- 3 types of impairments
A
- Known or suspected medical diagnoses of:
a. Neurological impairment
b. Structural/Mechanical impairment
c. Functional/Behavioral disorders
11
Q
Signs/symptoms of dysphagia 1 (6)
A
- Complaint of difficulty swallowing
- Overt coughing/choking/strangling during eating or drinking
- Increased effort with swallowing
- Multiple respiratory infections
- History of new or recurrent pneumonia
- Respiratory changes with eating/feeding
12
Q
Signs/symptoms of dysphagia 2 (5)
A
- Food refusal/avoidance
- Decreased nutritional status
- Failure to thrive
- Change in oral intake behavior
- Impaired oropharyngeal/laryngeal sensory/motor functions
13
Q
Contraindications of MBS (5)
A
- Patient is medically unstable
- Patient is unable to cooperate or participate in instrumental exam
- Patient is unable to be adequately positioned
- Size of patient prevents adequate imaging or exceeds limit of positioning devices
- Allergy to barium
14
Q
Limitations of MBS
A
- Time restraints due to radiation exposure
(Should only be in the MBS room for 3-5 mins, radiation is always an issue) - Procedure only samples swallow function
- Viscosity issues (thickness with barium may not be accurate)
- Command vs. natural swallow (command, you tell the pt. to hold the food then swallow, but you want to use the natural swallow)
- **not a natural setting
- Barium, unnatural food bolus with potential for refusal or alteration of swallow
15
Q
Patient Positioning of MBS
A
- Patient positioned between table & fluoroscopy tube (need to be able to sit at straight 90 degree angle)
— Fluoroscopy views are either lateral or anterior posterior view
— Typically seated upright to simulate normal ingestion.
- The video image should include the entire oropharyngeal region, with the borders including:
a. the lips anteriorly
b. the palate superiorly
c. the cervical spine posteriorly
d. the subglottic airspace inferiorly
16
Q
Identify Structures at Rest 1
A
- lips
- dentition
- mandible
- tongue
- velum and velopharyngeal port
- valleculae
- epiglottis
- hyoid
17
Q
Identify Structures at Rest 2
A
- pharynx
- posterior pharyngeal wall
- pyriform sinuses
- larynx
- trachea
- upper esophageal sphincter
- cervical esophagus
- cervical spine
18
Q
Procedure for MBS
A
- Typically begins in the lateral view
- Follows a protocol
- Begin with the liquid consistency most tolerated, or thin liquids
- Liquids are given in small amounts (3cc, 5cc, 10cc) and progress to larger amounts if the patient is swallowing safely.
- Liquids are tried from a cup, straw, and spoon
- Original Logemann protocol involved 6 swallows
19
Q
Lateral View for MBS 1
A
- Allows visualization of the oral preparatory and oral phases as the patient manipulates the bolus.
- You can see anterior loss, material falling to the floor of the mouth or anterior or lateral sulci, residue on the hard palate, and premature spill of the bolus over the back of the tongue.
20
Q
Lateral View for MBS 2
A
- Allows assessment of the pharyngeal phase such as delay in initiation of the pharyngeal swallow, penetration into the laryngeal vestibule, aspiration before, during, or after the swallow,and residue in valleculae or pyriforms.
- It also allows for screening of the esophageal phase of the swallow.
21
Q
Anterior-Posterior View (AP)
A
- Allows visualization of symmetry of movement in the pharynx
- Allows for observation of shortening and contraction of the pharynx.
- It provides a view of the movement of the vocal cords toward the midline
- Can see bolus clearance through the esophagus during screening sweep
22
Q
Logemann Barium Protocol
A
- 1/3 teaspoon of thin liquid barium with one time confirmation
- 1/3 teaspoon esophatrast barium paste with one time confirmation
- ¼ cookie coated with esophatrast barium paste with one time confirmation
