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WHAT IS THE MBSImP? why standardize?

The Modified Barium Swallow Study, while a clinically useful tool, remains a subjective test. Evidence, rather than opinion, should guide clinical decision-making.

The Modified Barium Swallow Impairment Profile, or MBSImP, is an evidence-based, standardization of the MBS study in adults. The MBSImP assesses 17 critical components of swallowing and provides an objective profile of the physiologic impairment affecting adult swallowing function.

For the first time, the MBSImP provides the means for clinicians to communicate MBS study results in a standardized, evidence-based manner that is consistent, specific, and accurate.

TESTIMONIALS:

What your colleagues are saying about the MBSImP:

“I did the online course and I found it to be exceptional. . . It’s objective and allows for better communication between trained therapists. Can’t recommend it enough.”

“I really enjoyed the course and am recommending it to all my colleagues. It was positively challenging. I feel so much more confident when evaluating our VFSS results now and it truly does save time in the long run.”

“The characteristics for each component are well defined, the videos provide excellent examples of the components. The attention to detail is outstanding. The learning is enhanced by the availability of the replay of the videos for study.”

“I am so excited to have this standardization protocol in place. I have been frustrated for a long time with the differences in interpretation of MBSs from one clinician to another. I think this will add credibility to our profession. I am excited to start using the reports and contribute to research!”

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A “Registered MBSImP Clinician” is a Speech-Language Pathologist who has successfully completed the MBSImP Online Training and then scored 80% or higher on the MBSImP online reliability testing.

Only Registered MBSImP Clinicians will be granted access to the MBSImP online interface for Patient Data & Reports.

Prerequisite: individuals must have a degree in Speech-Language Pathology in order to enroll in the MBSImP training and to become Registered MBSImP Clinicians.

View a current listing of all "Registered Clinicians" worldwide here.

Lack of standardization:

  • IMPEDES understanding of true functional results
  • Produces AMBIGUOUS reporting of outcomes
  • HINDERS our understanding of restorative surgical and rehabilitation targets

Speech-Language Pathologists have made great gains in the assessment and treatment of swallowing disorders. What has been lacking is a means to communicate MBSS results in a practical, consistent, and accurate format that supports evidenced-based practice. The time has come to standardize how we discuss a patient's impairment, how we target treatment, and how we communicate with physicians, nurses, and our fellow speech-language pathologists. Through using a standardized approach, like the MBSImP provides, information obtained and communicated will be valid, comprehensive, and reliable.

With regard to the MBSS, the MBSImP standardizes the:

  • Method of Training
  • Administration Protocol
  • Assessment Tool
  • Vernacular
  • Analysis and Reporting Methods

For the first time, the MBSImP allows clinicians “to speak the same language” across the entire Dysphagia care continuum: acute, inpatient rehab, skilled nursing, and outpatient.

Oral Impairment Domain:
1. Lip Closure
2. Tongue Control During Bolus Hold
3. Bolus Preparation/Mastication
4. Bolus Transport/Lingual Motion
5. Oral Residue
6. Initiation of the Pharyngeal Swallow

Pharyngeal Impairment Domain:
7. Soft Palate Elevation
8. Laryngeal Elevation
9. Anterior Hyoid Excursion
10. Epiglottic Movement
11. Laryngeal Vestibular Closure
12. Pharyngeal Stripping Wave
13. Pharyngeal Contraction
14. Pharyngoesophageal Segment Opening
15. Tongue Base Retraction
16. Pharyngeal Residue

Esophageal Impairment Domain:
17. Esophageal Clearance (upright position)

Each of the 17 components has 3 to 5 associated scores that describe progressing levels of impairment. The score chosen is determined through observation of the component-specific physiology over the course of the study. Developed and clinically used over a five year period of research, the MBSImP was proven to be clinically efficient, with scoring schema that provide valid profiles of impairment and achieve inter- and intra-rater reliability factors, both greater than 80%, in the hands of like-trained clinicians.

Proficiency in scoring develops after only a short period of routine clinical use. Seasoned MBSImP clinicians average 10 to 15 minutes to adequately score a study. The online interface for Patient Data & Reports was designed for quick, efficient data entry, with point and click input methods for 95% of fields. Once familiar with the screens, entry of the data and generation of the study’s report will take under 10 minutes.

The MBSImP-generated report will be detailed and reflective of the study and complies with Joint Commission requirements for documentation. Each report can be edited and most EMR systems will allow for importing, uploading or scanning this document into the EMR.

No. You may continue to submit reports using your hospital's EMR as always. MBSImP scoring data that you collect may be entered into the MBSImP global dysphagia registry at a time that is convenient for you.

Keep in mind that the MBSImP’s Patient Data & Reports online user tools will generate an assessment report for you. This report will be detailed and reflective of the study and complies with Joint Commission requirements for documentation. Each report can be edited and most EMR systems will allow for importing, uploading or scanning this document into the EMR.

View sample MBSImP report.

Because the assessment is derived through observing specific aspects of physiology for deviation from an expected norm, the MBSImP’s profile of impairment is not dependent on the underlying cause of the physiologic change. The scoring system is also flexible, able to account for boluses not given due to concerns for patient safety and for additional boluses used to determine the effectiveness of a compensatory strategy.

The MBSImP provides an assessment that is derived from observation of specific aspects of physiology, determining the integrity of each to obtain a profile of the components that are affecting functional swallowing. Decisions regarding oral intake recommendations and patient management are left to the clinician's experience and clinical judgment, considering the level of function as influenced by the physical impairment.

Any clinician having any level of intervention with patients who have impaired swallowing function, whether this extends to assessment and treatment or treatment only, will benefit and develop a deeper understanding of the involved physiology, the potential for impairment, and the influence on function that may result. As the MBSImP becomes the preferred method of assessment used by the majority of clinicians, assessment reports will use the MBSImP’s standardized vernacular and scoring schema. "Speaking the same language" will support optimal patient care.

Have additional questions? Please email mbsimp@northernspeech.com

enroll now

THE RESEARCH & BENEFITS - Adopting the MBSImP

Yes. The MBSImP was validated by a rigorous, five-year study. Analysis of research data indicated that the standardized MBSImP provides objective assessment possessing both inter- and intra-rater reliability greater than 80% when used by like-trained clinicians. The research was published in Dysphagia Journal in 2008. access article

Studies of Interest:

2008 Dysphagia:
MBS Measurement Tool for Swallow Impairment—MBSImp: Establishing A Standard. access article

2012 Dysphagia:
Radiation Exposure Time during MBSS: Influence of Swallowing Impairment Severity, Medical Diagnosis, Clinician Experience, and Standardized Protocol Use. access article

2012 The Annals of Otology, Rhinology & Laryngology:
Oropharyngeal and Esophageal Swallowing Impairments: Their Association and the Predictive Value of the Modified Barium Swallow Impairment Profile and Combined Multichannel Intraluminal Impedance-Esophageal Manometry. access article

2013 Dysphagia:
Preliminary Investigation of the Effect of Pulse Rate on Judgments of Swallowing Impairment and Treatment Recommendations access article

2008 Phys Med Rehab Clin N Am:
The Videofluorographic Swallowing Study. access article

Evidence supports that using the MBSImP standardized approach during the MBS study did not cause unnecessary exposure to radiation. This study found that patients were exposed to an average of 2.9 minutes of radiation during MBS studies in which the MBSImP standardized approach was used. Read the study here.

The call for evidence-based practices continues to get louder. The time has come for us to standardize the MBSS. We owe it to our patients to provide for them optimal care – care that is consistent, reliable, and supports evidence-based practices. We owe it to our profession to demonstrate the evidence needed to justify what we do to payors, patients, and to ourselves.

The MBSImP helps to provide:

Objective Assessment. Clinical decision-making should be based on evidence rather than opinion. Analysis of research data indicated that the standardized MBSImP provides objective assessment possessing both inter- and intra-rater reliability greater than 80% when used by like-trained clinicians.

Better Patient Care. Provide the best care for patients – care that is consistent, reliable, and supports evidence-based practices.

Efficient & Precise Communication. The standardized approach of the MBSImP provides a means for you “to speak the same language” as your colleagues within your facility as well as your colleagues in other facilities. Utilize consistent, specific, and accurate communication of patient status to other healthcare professionals through a common vernacular in assessment and reporting.

Professional Competency. Demonstrate your proficiency in the assessment and treatment of swallowing disorders.

Necessity of Skilled Services. Help to provide invaluable data to the MBSImP’s global data registry – data that will demonstrate the evidence needed to justify what we do to payors, physicians, patients, and to ourselves.

Research Data. Contribute to the first and only international data registry dedicated solely to swallowing dysfunction, providing an adjunct to research that has never existed, until now.

Investing in the MBSImP helps to increase:

Staff Competency. Demonstrate MBSS competency in new and existing staff to accrediting agencies through use of a standardized training mechanism of swallowing physiology and impairment.

Efficiency & Accuracy. Achieve standardized assessment, measurement, written documentation, and communication across the entire Dysphagia care continuum: acute, inpatient rehab, skilled nursing, and outpatient.

Evidence-Based Practice. The MBSImP was validated by a rigorous, five-year study. The MBSImP provides objective assessment possessing both inter- and intra-rater reliability greater than 80% when used by like-trained clinicians.

Positive Patient Outcomes. Preparedness of the treating clinician to interpret findings for targeted treatment even if the MBSS was completed at a different facility by a different clinician.

Consumer Recognition. Patients, physicians, and payors will view your facility as having attained advanced MBSS competency.

Necessity of Skilled Services. Promote the accumulation of data to provide the evidence needed to justify what we do to payors, patients, and to ourselves.

Medical University of South Carolina (MUSC) Disclaimer:

The health information stored in this electronic software system meets the requirements of de-identified as stated in 45 Code of Federal Regulations, Part 164.514b(2)(i) of the Health Insurance Portability and Accountability Act (HIPAA).  The requirements of HIPAA do not apply to health information that has been de-identified [164.502(d)(2)]. Please note the disclosure of a code or other means of record identification designed to enable this de-identified information to be re-identified is prohibited.  A disclosure of a code can be defined as the release, transfer, provision of access to, or divulging in any other manner of a re-identification code outside the entity providing treatment or holding the health information. 

Many facilities have been successful in securing funding to train their SLP staff through use of operational funds or through use of CEU education funds. The following PowerPoint presentation offers some points to consider when presenting funding requests to administration. Permission is granted for downloading and use of this PowerPoint document.

What your colleagues are saying about the MBSImP:

“I did the online course and I found it to be exceptional. . . It’s objective and allows for better communication between trained therapists. Can’t recommend it enough.”

“I really enjoyed the course and am recommending it to all my colleagues. It was positively challenging. I feel so much more confident when evaluating our VFSS results now and it truly does save time in the long run.”

“The characteristics for each component are well defined, the videos provide excellent examples of the components. The attention to detail is outstanding. The learning is enhanced by the availability of the replay of the videos for study.”

“I am so excited to have this standardization protocol in place. I have been frustrated for a long time with the differences in interpretation of MBSs from one clinician to another. I think this will add credibility to our profession. I am excited to start using the reports and contribute to research!”

Have additional questions? Please email mbsimp@northernspeech.com


enroll now

TUITION, TESTING & CEUs - becoming registered

TUITION:

     $600 individual**
     $500 each for groups of 3 or more**

CEUs:

     2.1 CEUs

TUITION INCLUDES:

  • Unlimited access to the MBSImP online training
  • Unlimited access to the Learning and Training Zones, even after testing
  • Free additional testing attempts in the Reliability Zone
  • Free expert SLP support for component-score questions
  • Free access to the Patient Data & Reports online clinical tools*
  • Free posting of the 2.1 CEUs to the ASHA CE Registry*

         *for individuals who pass the reliability testing

5-YEAR RENEWAL:

Registered MBSImP Clinician status is awarded for a period of 5 years.  The 5-year renewal process will consist of a $99 renewal fee and completion of a 2 or 3 hour CEU training & testing related to the MBSImP.

DISCOUNT:

**Those who have attended or will attend Dr. Bonnie Martin-Harris' MBSImP CE seminar will receive a tuition credit good toward enrollment in the MBSImP Web-Based Training. CEUs are offered separately for both the seminar and the web training. Attending the CE seminar is NOT a requirement to become a Registered MBSImP Clinician. The only way to become a Registered MBSImP Clinician is through the web-based training and testing.

You will need to complete the MBSImP Web-Based Training. Those who successfully score 80% or higher within the online Reliability Assessment testing will be awarded 2.1 CEUs, earn the designation of "Register MBSImP Clinician," and be granted access to the MBSImP online interface for Patient Data & Reports. Only Speech-Language Pathologists are eligible to become Registered MBSImP Clinicians.

View a current listing of all "Registered Clinicians" worldwide here.

The MBSImP online training, testing, and patient data tools are all web-based. There is no software to download or install. Everything is accessed via user password at www.mbsimp.com. The training and testing are divided into 3 zones:

THE LEARNING ZONE: This first zone will utilize 72 adult videofluoroscopy segments, each combined with state-of-the-art swallow animation, to demonstrate and explain the 17 physiologic components and scores of the MBSImP.

THE TRAINING ZONE: Within the second zone, participants put the scoring scheme to practical use through the scoring of each MBSImP component, initially on single, isolated swallows taken from swallow studies, and then scoring each component on full studies. Participants will need to score all single swallows then score all full studies before access will be granted to zone 3, the reliability zone.

THE RELIABILITY ZONE: This is the "testing zone." Participants will be tested on their newly acquired skill in using the MBSImP to successfully capture and profile swallowing impairment in adults. Ten swallow studies must be scored. The scores can be reviewed and changed as needed prior to submitting the full test. Participants will have the ability to return to zones 1 and 2 as needed as they progress through the Reliability Assessment testing. Once the scores are submitted for all 10 studies, notification is provided of either successful completion (minimum of 80% accuracy) or of the need to repeat the reliability zone testing. The reliability testing can be repeated as needed until a score of 80% or higher is achieved.

PATIENT DATA & REPORTS: This fourth area of MBSImP.com is available to those clinicians who successfully pass the Reliability Zone testing. It contains very functional online user tools that were designed for daily use by clinicians.

Video Tour of the Training Zones

Video Tour of the Patient Data & Reporting tools

It will require between 20 and 25 hours for most learners to work through the MBSImP training and pass the online Reliability Assessment testing with a minimum of 80% accuracy. There are no time limits for completing the training and learners may re-test as needed in order to achieve the 80% passing threshold.

There are no time limits for completing the training. Once a learner successfully passes the testing zone and becomes a "Registered MBSImP Clinician” at that time the “testing zone” is replaced by the Patient Data & Reports online user tools. Unlimited access to the Learning and Training Zones remain after passing the testing, allowing for continued study and practice.

Yes. The status of Registered MBSImP Clinician is awarded for a period of 5 years from date of passing the online reliability testing. The renewal process will consist of a $99 renewal fee and completion of a 2 or 3 hour CEU training & testing related to the MBSImP.  The fee will include the cost of the training and awarding of the CEUs.

No, it is not required. The only way to become a Registered MBSImP Clinician is to complete the MBSImP Web-Based Training. Many will choose to utilize the MBSImP seminar as a preparatory course to become familiar with the MBSImP methodology and scoring system. Attendees of the CE seminar will likely be able to complete the online training in a shorter time.

**In addition, those who have attended or will attend Dr. Bonnie Martin-Harris' MBSImP CE seminar will receive a tuition credit good toward enrollment in the MBSImP Web-Based Training. CEUs are offered separately for both the seminar and the web training.

Yes, student MBSImP accounts are available at reduced cost. To enroll, please email Tom at tom@northernspeech.com.

The MBSImP x-ray segments and swallow animations are an ideal supplement to university dysphagia courses as students learn to identify anatomy on x-ray and begin to assess swallow impairment.  Learners on student accounts will have access to the Learning Zone, the Training Zone, and the Reliability Zone of MBSImP.com. However, student learners will not be granted access to the Patient Data and Reports area of MBSImP.com. Students learners are not eligible to become “Registered MBSImP Clinicians.” No CEUs are offered on student accounts.

Instructor Access:  For a free preview of the MBSImP, email tom@northernspeech.com.

Have additional questions? Please email mbsimp@northernspeech.com

enroll now

BEYOND THE TRAINING - data & reports

For a video preview of the Patient Data & Reports section click here.

Access to this restricted area of MBSImP.com is granted only to those clinicians who have passed the reliability testing and thus achieved the status of Registered MBSImP Clinician. There are no additional fees to access this section.

The Patient Data & Reports area includes online, functional user tools that were designed to be used daily by clinicians to:

  • To maintain a database of their patients with dysphagia, consisting of de-identified data that includes diagnoses, MBSImP results, effectiveness of intervention and patient outcomes.
  • Generate assessment reports. These editable reports will be detailed and reflective of the study and comply with Joint Commission requirements for documentation. View sample MBSImP report.
  • Track patient progress and outcomes, and demonstrate evidence for treatment.
  • Access online forums for communication with other Registered MBSImP Clinicians around the world.
  • Contribute to the first and only international data registry dedicated solely to swallowing dysfunction, providing an adjunct to research that has never existed, until now.

No additional fees apply. This area of MBSImP.com is included with the initial tuition cost.

No. You may continue to submit reports using your hospital's EMR as always. MBSImP scoring data that you collect may be entered into the MBSImP global dysphagia registry at a time that is convenient for you.

Keep in mind that the MBSImP Patient Data & Reports online user tools will generate an assessment report for you. This report will be detailed and reflective of the study and complies with Joint Commission requirements for documentation. Each report can be edited and most EMR systems will allow for importing, uploading or scanning this document into the EMR.

View sample MBSImP report.

Medical University of South Carolina (MUSC) Disclaimer:

The health information stored in this electronic software system meets the requirements of de-identified as stated in 45 Code of Federal Regulations, Part 164.514b(2)(i) of the Health Insurance Portability and Accountability Act (HIPAA).  The requirements of HIPAA do not apply to health information that has been de-identified [164.502(d)(2)]. Please note the disclosure of a code or other means of record identification designed to enable this de-identified information to be re-identified is prohibited.  A disclosure of a code can be defined as the release, transfer, provision of access to, or divulging in any other manner of a re-identification code outside the entity providing treatment or holding the health information. 

Have additional questions? Please email mbsimp@northernspeech.com

enroll now

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