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Video Swallow Study
MBS
A video swallow study is also called a Modified Barium Swallow study (MBS) and is a test used by speech-language patholosgists to assess and treat dysphagia. It is basically an x-ray taken multiple times to form a ‘video’ of the swallow process. It is performed by speech-language pathologists (SLPs) in conjunction with a radiologist or a doctor trained to perform the procedure. The SLP directs the study, gives the patient the food or liquid consistencies, determines the reasons the patient may be having a swallowing difficulty, and provides treatment and behavioral/compensatory strategies. The radiologist operates the flouroscopy equipment, identifies structural deficits and collaborates with the speech pathologist to identify aspiration.
Procedure:
An MBS must be ordered by a doctor. Usually, the SLP will first perform a bedside swallow evaluation prior to the MBS. Then, a recommendation for an MBS may be made based on the results of the swallow evaluation. If the bedside swallow evaluation was not performed prior to to the test, a thorough history and oral-peripheral exam should be done.
Patients do not have to fast prior to having a video swallow study.
The MBS is typically done in a radiology suite, although sometimes the xray can be brought into the patient’s room. The patient is then positioned comfortably. Ideally the patient should be sitting upright, at 90 degrees either in their bed, or MBS chair. If the patient is ambulatory, he or she may be asked to stand, or sit on a chair. In some facilities, C-arm equipment is used for the study. The C-arm device has the advantage of being able to accommodate physically larger and mobility-challenged patients, as often times patients are able to remain in their wheelchairs (however, their shoulders and head/neck must rise above the wheelchair frame).
Once the patient is seated upright, the radiologist will check the patient’s positioning. The radiologist will place the flouroscopy in an adequate position in order to view the oral and pharyngeal phases of swallowing. The oral phase includes the tongue, lips, jaw, and the soft palate. Important structures utilized during the pharyngeal phase include the larynx, epiglottis, valleculae, pyriforms, pharyngeal wall constriction, vocal folds and the upper esophageal stricture.
Oral and Pharyngeal structures
Protocols vary for different facilities. Please see video swallow protocol for an example. Speech pathologists typically suggest the order of food and liquid consistencies to trial. The SLP tries to get a representative sample of p.o. textures and samples to draw a reliable conclusion about which consistencies are safe for the patient to swallow. The patient is typically given 2 swallows each of small to large amounts (1, 3, 5, 10 ml) of thin liquids, nectar, or honey thick liquid consistency barium, puree food, and two swallows of ¼ of a Lorna Doone® cookie coated with barium pudding (3 ml). This examination enables the clinicians to determine the normalcy of the oropharyngeal swallow as it adjusts to accommodate various bolus volumes and viscosities. The patient is asked to keep the bolus in his or her mouth until instructed to swallow.If the esophagus is of interest, then a barium swallow should be completed, not a modified barium swallow.
The video is viewed in ‘real-time’ by the doctor and speech-language pathologist. The video is usually recorded for later viewing. The amount of time must be limited to reduce radiation exposure.
What to Look for During the Video Swallow Study:
SLP’s should compare the normal swallow to the patient’s swallowing.
Oral Phase
Anterior spillage- Patients may have difficulty containing the liquids in the oral cavity due to poor lip seal.
Buccal pocketing- Weakness or reduced sensation of the buccal muscles may cause patients to pocket food in the buccal cavities. Patients may require cues to sweep their tongue laterally to clear the food.
Tongue pumping- Tongue pumping can be due to uncoordinated lingual movements. This is frequently seen in patients with Parkinson’s Disease.
Reduced bolus control- Individuals may have difficulty positioning the bolus on the tongue due to weak, uncoordinated or jerky tongue movements.
Nasal pharyngeal regurgitation- Liquids may come up into the nasopharynx due to reduced closure of the velopharynx either secondary to soft palate dysfunction or defective function of the superior pharyngeal constrictor.
Pharyngeal Stage
Although the modified barium swallow study is widely considered the “gold standard” examination for oral and pharyngeal dysphagia, a newer, complimentary instrumental endoscopic examination called FEES (Fiberoptic Endoscopic Evaluation of Swallowing) has been gaining acceptance and may soon be performed competitively with the MBSS (Langmore, 2006).Fiberoptic endoscopic examination of swallowing is used particularly for examination of the anatomy of the pharynx and larynx before and after swallowing. During the swallow, the pharynx and larynx close and cannot be seen.
MORE INFORMATION COMING SOON!
Related posts:
- Video Swallow Study Protocol
- Neurology of the Swallow
- Sample Fiberoptic Endoscopic Evaluation of Swallowing (FEES) Protocol
- Does Thickening Liquids Work to Prevent Aspiration in Patients with Dementia?
- Dyphagia and Head and Neck Cancer
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