Standardizing The MBS Study

Evidence, rather than opinion, should guide clinical decision-making.

What Is The MBSImP Approach?

The Modified Barium Swallow Impairment Profile provides a standardized protocol to interpret and communicate swallowing impairment in a manner that is specific, consistent, accurate and objective.

What is MBSImP

The Modified Barium Swallow Impairment Profile, or MBSImP, is a standardized approach to instruction, assessment, and reporting of physiologic swallowing impairment based on observations obtained from the MBS study.

Teaches assessment of 17 components of the swallowing mechanism in adults and includes a scoring metric to objectively profile physiologic impairment of swallowing function. For the first time, the MBSImP approach provides the means for clinicians to communicate MBS study results in an evidence-based manner that is consistent, specific, accurate and objective.

Download MBSImP Advocacy Guide

The MBS study, while a clinically useful tool, remains a subjective test. Evidence, rather than opinion, should guide clinical decision-making. Lack of standardization:

  • IMPEDES understanding of true functional results
  • Produces AMBIGUOUS reporting of outcomes
  • HINDERS 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 MBS study results in a practical, consistent, and accurate format that supports evidence-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.

The MBSImP approach standardizes the method of training, administration protocol, assessment tool, vernacular, analysis of impairment and reporting of results.

Clinical Training: Learn to apply the MBSImP scoring metric to capture and profile swallowing impairment through completion of the standardized online training & reliability testing.

MBS Study Protocol: Administer the MBS study using a standardized set of barium volumes and consistencies shown to influence oropharyngeal swallowing function.

Interpretation of Impairment: Profile and quantify physiologic impairment though application of MBSImP’s standardized, operationally defined scoring metric.

Reporting of Results: Develop detailed assessment reports using a standardized vernacular and format allowing treating clinicians to better target evidence-based interventions. view MBSImP report

Assessment of swallow function is completed though examination of 17 physiologic components requisite for the execution of normal swallowing. MBSImP includes an operationally defined scoring metric for each component that is applied to accurately describe and quantify progressing levels of impairment. Together these component-scores build a detailed and specific assessment report to be used by the treating clinician to better target evidence-based interventions. view MBSImP report

The 17 components comprising the MBSImP assessment include:

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)

You may ask, how can a protocol be standardized when I work with patients who are so functionally diverse? Since the MBSImP 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. 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.

"Fantastic variety of MBS films to watch, and learn from. Some really excellent ideas about swallow physiology that I was not familiar with (and I have done more than 8,000 MBS at the time I took the course)."

"While it is hard to teach an "old dog new tricks", I really enjoyed learning how to interpret the MBS using the impairment profile. The MBSImP challenged me to think about the interpretation of the MBS in a different fashion and I really enjoyed this challenge. I am so glad that as a hospital system we are going to make this the "standard" for how we do MBS evaluations."

"Breaking apart the study was a huge learning experience."

"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!"

"After the course last weekend I came in Monday morning and had one of the hardest MBS studies I have ever had. Needless to say the study was a tricky one but I felt so much more confident in my assessment. I used the protocol, implemented strategies, and completed what I believe was a comprehensive and insightful study. Therapy will ensue and the patient can be helped. Thanks to MBSImP what could have been an overwhelming task was manageable. I can't thank you all enough."

"I am an experienced UK clinician, working routinely with videofluoroscopy for a number of years. Working through your course has very tangibly advanced my clinical practice, my thinking and my analytical eye for reading radiographic images. The package you've put together for clinicians is so robust and supportive, I will be highly recommending it for progressing our clinical skill and standardization in this field.”

View the current listing of all "Registered MBSImP Clinicians" worldwide here.

View the current listing of all "Registered MBSImP Clinicians" worldwide here.

This app serves as an excellent visual tool to aid professionals in educating patients and families about swallowing disorders. The custom-designed video animations accurately depict normal swallow physiology and provide clear examples of varying physiologic impairments of the swallow. Video controls allow for zoom, slow motion, pause, and frame-by-frame forward and reverse. Available for iPad and iPhone in the App Store. Learn more.

Research

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 2008 in Dysphagia Journal.

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

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

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

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

Training and CEUs

The standardized clinical training & reliability testing is offered fully online. Participants are taught systematically the 17 physiologic components and impairment scores associated with each that together comprise the MBSImP standardized assessment. Participants have unlimited time to complete the training and the format provides ample opportunity for interactive practice. Offered for 2.1 ASHA CEUs / 21 CEEs / 21 contact hours. video tour of the training

Yes, there is an optional, 6-hour MBSImP introduction course. This course is offered online and more information may be found here. Participants of the online 6-hour MBSImP "Intro" course will receive a $100 tuition credit toward the full MBSImP™ Standardized Training & Reliability Testing. CEUs are offered separately for both the MBSImP "Intro" course and the full MBSImP™ Standardized Training & Reliability Testing. Completion of the Intro Course is optional and is NOT a requirement to become a Registered MBSImP Clinician. The only way to become a Registered MBSImP Clinician is through successful completion of the full MBSImP™ Standardized Training and Reliability Testing (2.1 CEUs).

TUITION:

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

CEUs:

     2.1 CEUs / 21 CEEs

TUITION INCLUDES:

  • Unlimited access to the MBSImP online training
  • Continued 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 web-based reporting templates*
  • Free posting of the 2.1 CEUs to the ASHA CE Registry*

     *for individuals who pass the reliability testing

Most learners require between 20 and 25 hours to work through the MBSImP training and successfully complete the reliability testing. There are no time limits for completing the training and learners may re-test as needed in order to achieve the 80% passing threshold. Access to the training materials remains after test completion for continued review and reference.

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 5 hour CEU training & testing related to the MBSImP approach.  The fee will include the cost of the training and awarding of the CEUs.

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.

Graduate Students: MBSImP training accounts are available at reduced cost for graduate students. To inquire, please email mbsimp@northernspeech.com

Dysphagia Instructors: For a free preview of the MBSImP training program, please email mbsimp@northernspeech.com.

Over 100 universities now use the MBSImP training as part of a graduate level dysphagia course. The MBSImP VFSS segments and swallow animations are an ideal supplement to university dysphagia courses as students learn to identify anatomy on fluoroscopy and begin to interpret swallow impairment. Learners on student accounts will have access to the Learning Zone, the Training Zone, and the Reliability Zone of MBSImP.com. Student learners are not eligible to become "Registered MBSImP Clinicians." No CEUs are offered on student accounts.

MBSImP by the Numbers

12 Number of boluses administered during the MBS study as part of the MBSImP validated protocol.

17 Number of physiologic components of the swallowing mechanism evaluated as part of the MBSImP standardized assessment.

120 Number of universities using the MBSImP standardized training within their dysphagia class curriculum.

2,900 Number of SLPs to date who have completed the MBSImP standardized training and testing. View Clinician Roster here.

38,000 Number of MBSImP swallow studies added to the global swallow data registry, which have contributed much needed data to further the study of dysphagia.

Beyond the Training

The MBSImP approach is much more than merely a CE training program! After completion of the standardized training, participants gain free access to the Patient Data & Reports area of https://www.mbsimp.com. These web-based clinical tools can be used to:

  • Generate standardized assessment reports. These reports will be detailed and reflective of the study and comply with Joint Commission requirements for documentation. tour of full report templates | view sample full report | tour of express report feature
  • Maintain a database of patients with dysphagia, consisting of de-identified data that includes diagnoses, MBSImP results, effectiveness of intervention and patient outcomes.
  • Track patient progress and outcomes and demonstrate evidence for treatment.
  • 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.

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. Download MBSImP Advocacy Guide

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.

This app serves as an excellent visual tool to aid professionals in educating patients and families about swallowing disorders. The custom-designed video animations accurately depict normal swallow physiology and provide clear examples of varying physiologic impairments of the swallow. Video controls allow for zoom, slow motion, pause, and frame-by-frame forward and reverse. Available for iPad and iPhone in the App Store. Learn more.

Questions

Have additional questions? Please email mbsimp@northernspeech.com and we will get back with you shortly. Download MBSImP Advocacy Guide