Modified Barium Modified Barium SwallowsSwallows

DysphagiaDysphagia

Symptom of abnormal swallowing as it relates Symptom of abnormal swallowing as it relates to aspiration of food and/or liquids, pooling , to aspiration of food and/or liquids, pooling , with or without residuals.with or without residuals.

Typical Diagnoses exhibiting Typical Diagnoses exhibiting dysphagiadysphagia

CPCP Spina Bifida ( Arnold Chiari malformation)Spina Bifida ( Arnold Chiari malformation) Clefts/Pierre Robin Sequence Clefts/Pierre Robin Sequence Maxillofacial anomaliesMaxillofacial anomalies CVACVA TBITBI SCISCI MDMD Neuromuscular Dysfunction Neuromuscular Dysfunction Respiratory Dysfunction – BPD, laryngomalaciaRespiratory Dysfunction – BPD, laryngomalacia

Cranial Nerve Involvement in Cranial Nerve Involvement in SwallowingSwallowing

V. TrigeminalV. Trigeminal VII. FacialVII. Facial IX. GlossopharyngealIX. Glossopharyngeal X. VagusX. Vagus XI. AccessoryXI. Accessory XII. HypoglossalXII. Hypoglossal

2 Assessments for Dysphagia2 Assessments for Dysphagia

MBSMBS

Clinical Swallowing AssessmentClinical Swallowing Assessment

Modified Barium Swallow Modified Barium Swallow ProcedureProcedure

Patient’s medical historyPatient’s medical history Feeding history including Feeding history including

textures / consistencies with textures / consistencies with noted problemsnoted problems

Lateral view in seated Lateral view in seated positionposition

Anterior view if suspect Anterior view if suspect asymmetryasymmetry

Offer variety of textures - Offer variety of textures - typically start with “most typically start with “most unlikely to aspirate” / “most unlikely to aspirate” / “most successful” consistency then successful” consistency then progress. progress.

Ex.: thickened liquidEx.: thickened liquid semisolidsemisolid thin liquidthin liquid solidsolid Assess swallow with each Assess swallow with each

different consistencydifferent consistency Educate family re: the Educate family re: the

resultsresults Communicate with MD to Communicate with MD to

make feeding planmake feeding plan Make appropriate referrals.Make appropriate referrals.

Phases of SwallowPhases of Swallow

Oral: tongue movement, premature spillageOral: tongue movement, premature spillage Pharyngeal: timeliness of reflex, pooling, Pharyngeal: timeliness of reflex, pooling,

aspiration, residue after swallowaspiration, residue after swallow Esophageal: motilty, obstructionEsophageal: motilty, obstruction

Typical problems noted on MBSTypical problems noted on MBS

Premature spillagePremature spillage Delayed swallow reflexDelayed swallow reflex Laryngeal penetrationLaryngeal penetration Primary aspirationPrimary aspiration PoolingPooling IncoordinationIncoordination Weakness/toneWeakness/tone

Characteristics of swallow Characteristics of swallow dysfunction often related to specific dysfunction often related to specific

problems problems Respiratory problemsRespiratory problems

--incoordination--incoordination--primary aspiration--primary aspiration

Weakness / toneWeakness / tone--pooling--pooling--primary aspiration--primary aspiration--delayed swallow reflex--delayed swallow reflex--residue--residue

Understanding the Understanding the Recommendations / ExamplesRecommendations / Examples

Thin liquidsThin liquids--small boluses given via spoon--small boluses given via spoon--no straws--no straws--controlled cup drinking – 1 swallow vs several --controlled cup drinking – 1 swallow vs several

continuouscontinuous Thickened liquidsThickened liquids--As above--As above--rice cereal, thick-it, simply thick--rice cereal, thick-it, simply thick--nectar or honey consistencies--nectar or honey consistencies

Cont. Recommendations and Cont. Recommendations and ExamplesExamples

Semisolid (puree)Semisolid (puree)--consider texture – is it sticky, runny, lumpy--consider texture – is it sticky, runny, lumpy--weakness- may recommend runny vs thick --weakness- may recommend runny vs thick SolidSolid--mechanical soft – can chew and mash--mechanical soft – can chew and mash--crunchy- more proprioceptive input--crunchy- more proprioceptive input--meats – require grinding / rotary chew – more --meats – require grinding / rotary chew – more

advanced oral skill advanced oral skill

Cont. Recommendations and Cont. Recommendations and ExamplesExamples

Extra swallows – esp. if weak and unable to Extra swallows – esp. if weak and unable to clear the pharynx – residueclear the pharynx – residue

Head in midline with chin tuck – Head in midline with chin tuck – Liquid between bites to “wash down” bolus – Liquid between bites to “wash down” bolus –

again if weak with residue, pooling, etc.again if weak with residue, pooling, etc. In some cases of significant weakness, liquid In some cases of significant weakness, liquid

is safer than thicker substances – would have is safer than thicker substances – would have to consider timeliness of swallowto consider timeliness of swallow

When to Refer for MBSWhen to Refer for MBS

Consistent chokingConsistent choking Apparent incoordination Apparent incoordination Head and neck ext necessary to move bolusHead and neck ext necessary to move bolus Frequent respiratory illnessFrequent respiratory illness Poor weight gain and limited intakePoor weight gain and limited intake