What is an MBSS and why does it need to be done? Dysphagia is the medical term describing a condition of swallowing difficulty that occurs from an underlying condition. Fifteen million people in the United States suffer from dysphagia (J. Logemann, 1991), and 40-60% of those are residents of a long-term care facility. A Modified Barium Swallow Study (MBSS) is an objective radiological diagnostic tool that assesses swallow function. The MBSS can diagnose pharyngeal and esophageal stage of dysphagia and presence of aspiration, as well as determine appropriate diet and liquids consistencies, swallowing precautions/strategies, and appropriate treatment techniques to reduce aspiration risk. A Modified Barium Swallow Study allows the swallow to be viewed in real time and all phases of the swallow be evaluated on various consistencies. The Modified Barium Swallow Study is the Gold Standard in evaluating dysphagia. Identification of aspiration and elimination of the risk of aspiration pneumonia is cost-effective in that overall medical costs will be reduced. It is estimated that in 1985 the direct and indirect costs of various disorders related to dysphagia totaled nearly $2.5 billion (Brown & Everhart, 1994).
Why a Mobile Unit? The philosophy behind the mobile MBSS is that overall results of the test are more representative of a patients swallowing function, because the issue of fatigue, disorientation and testing delays, related to transportation to a hospital are eliminated. A mobile MBSS is a modification in the equipment of the traditional MBSS performed in a hospital setting. The MBSS is performed inside the mobile clinic that is parked outside the facility. This is not portable equipment that is transferred into a facility. The patient is brought outside to the clinic in their wheelchair or Neuro-chair and with the assistance of an electric wheelchair lift, similar to those used in public transportation settings; they are allowed easy access to the clinic. The mobile clinic is equipped with numerous safety equipment features including suction apparatus, cellular phone, and a CPR certified staff. A mobile video fluoroscopy clinic used for the MBSS allows for assessment of swallowing disorders in a private, controlled, efficient environment that eliminates disorientation, fatigue, and/or agitation often involved with medical transportation and/or clinical appointments. Furthermore, the overall results of the evaluation are more representative of a patient’s swallow function, since they are in their own wheelchair as used during meals. Such functional evaluations are unable to be completed at a hospital location.
A team of licensed professionals are staffed to evaluate the patient:
- ASHA certified Speech Pathologist with specialty training in dysphagia and MBSS.
- Trained Technician
- Consulting and Supervising Medical Doctor
What happens after the recommendations are made?
The recommendations of an MBSS will be for a regular, modified diet, or possibly NPO.
These recommendations are just that, recommendations that are based on the results of the evaluation. The MBSS results will recommend the safest diet or form of nutrition and hydration for the patient. The recommendations should be reviewed by the facility Speech Pathologist and the physician. A decision should be made by family, patient and the primary caregiver if tube feeding or a modified diet was recommended due to the results of the MBSS.
Advance Directive – A written document that tells what you want or do not want, if you become unable to make your wishes about health care treatments known.
AMA forms – Against Medical Advice forms. These forms vary from facility to facility. These forms are often signed by the family or patients when the recommendations for medical treatment are not followed. When signed, this form indicated that the family has been educated and understands the risk and outcomes that may occur by not following the recommendations for medical care.
Artificial Nutrition and Hydration – When synthetic food (or nutrients) and water are fed to you through a tube inserted through your nose into your stomach or into the intestine directly or into a vein. This recommendation is often made due to malnutrition, dehydration, and/or dysphagia.
Comfort Care – Care that helps to keep you comfortable but does not cure your disease.
Dysphagia – a condition of swallowing difficulty that occurs from an underlying condition. Dysphagia can cause aspiration which can cause pneumonia, it can also cause asphyxiation with lodged food in airway.
Durable Power of Attorney – A document that appoints a specific individual to make health care decisions for you if you become unable to make those decisions your self.
Life-sustaining treatment – Any medical treatment this is used to delay death. A breathing machine (ventilator), CPR.
Living Will – Instructions you have made in advance that tell what medical treatment you do or do not want if you become unable to make your wished known.
NPO – Nothing Per Oral. This recommendation is often made to a severe dysphagia due to risk of aspiration/airway obstruction, and/or pulmonary distress, including pneumonia.
Persistent Vegetative State – When a person is unconscious with no hope of regaining consciousness even with medical treatment. The body may move and eyes may open, but as far as the professionals can tell there is no comprehension or ability to communicate.
Speech Pathologist – A nationally certified clinical health care professional with a Master’s degree in Speech Pathology trained and educated in the evaluation and treatment of various cognitive, voice, and swallowing disorders.
Five Wishes – 888-5-WISHES or www.agingwithdignity.org/5wishes.html
Is a document that helps you express how you want to be treated in the event you become seriously ill and unable to speak for yourself.