Modified Barium Swallows

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Modified Barium Swallows
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Dysphagia

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

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Typical Diagnoses exhibiting dysphagia

• CP
• Spina Bifida ( Arnold Chiari malformation)
• Clefts/Pierre Robin Sequence
• Maxillofacial anomalies
• CVA
• TBI
• SCI
• MD
• Neuromuscular Dysfunction
• Respiratory Dysfunction BPD, laryngomalacia

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Cranial Nerve Involvement in Swallowing

• V. Trigeminal
• VII. Facial
• IX. Glossopharyngeal
• X. Vagus
• XI. Accessory
• XII. Hypoglossal

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2 Assessments for Dysphagia

• MBS
• Clinical Swallowing Assessment

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Modified Barium Swallow Procedure

• Patients medical history
• Feeding history including textures /
  consistencies with noted problems
• Lateral view in seated position
• Anterior view if suspect asymmetry
• Offer variety of textures - typically start with
  most unlikely to aspirate / most successful
  consistency then progress.

• Ex. thickened liquid
• semisolid
• thin liquid
• solid
• Assess swallow with each different consistency
• Educate family re the results
• Communicate with MD to make feeding plan
• Make appropriate referrals.

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Phases of Swallow

• Oral tongue movement, premature spillage
• Pharyngeal timeliness of reflex, pooling,
  aspiration, residue after swallow
• Esophageal motilty, obstruction

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Typical problems noted on MBS

• Premature spillage
• Delayed swallow reflex
• Laryngeal penetration
• Primary aspiration
• Pooling
• Incoordination
• Weakness/tone

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Characteristics of swallow dysfunction often
related to specific problems

• Respiratory problems
• --incoordination
• --primary aspiration
• Weakness / tone
• --pooling
• --primary aspiration
• --delayed swallow reflex
• --residue

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Understanding the Recommendations / Examples

• Thin liquids
• --small boluses given via spoon
• --no straws
• --controlled cup drinking 1 swallow vs several
  continuous
• Thickened liquids
• --As above
• --rice cereal, thick-it, simply thick
• --nectar or honey consistencies

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Cont. Recommendations and Examples

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

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Cont. Recommendations and Examples

• Extra swallows esp. if weak and unable to clear
  the pharynx residue
• Head in midline with chin tuck
• Liquid between bites to wash down bolus again
  if weak with residue, pooling, etc.
• In some cases of significant weakness, liquid is
  safer than thicker substances would have to
  consider timeliness of swallow

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When to Refer for MBS

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