Modified Mondays: Staying Focused
It’s so easy to be distracted. As I am writing this, I’m getting notifications from email, from social media, from my phone (WHY does my 16-year-old son send me a grocery list while I’m at work? WHY is he ALWAYS hungry?!)… and since it’s Friday afternoon, the sun is outside notifying me that summer is almost over and I should really finish this up and get out of here early today.
In MBS studies, the distraction is often aspiration. We are looking for it, the Radiologist is looking for it, the patient’s physician is asking about it, everyone is focused on aspiration. But for the SLP completing the study, it is crucial to not be distracted by aspiration. We run the risk of overemphasizing it’s importance (see our multiple cat memes and blog posts on why we all need to calm down about aspiration) and we also can miss other aspects of the study that can have serious consequences for the patient.
This video is a great example of this. This patient has a lot going on that could distract the SLP. There is silent aspiration, in addition to some hardware in there from a prior cervical spine fusion, he’s unable to produce a good cough, and residues throughout the pharynx. Thankfully, our Cleveland SLP Malinda was focused enough to also spot an abnormality to the base of tongue. If you look carefully, you can see the barium outlining it briefly- a slight bulging at the base, with an irregular outline. Malinda noted it, our Radiologist agreed, and the patient is getting a thorough workup with ENT and GI.
Assessing the structures of the swallowing mechanism is an important part of the MBS study, according to both ASHA and the American College of Radiology. Taking a good look at your “scout” image (the image you take before any barium is presented) is important but continuing to assess throughout the study is also needed-as was the case here.
Focusing on all of the swallowing structures and physiology throughout the MBS can be difficult and is another reason to make sure we are adequately reviewing after the completion of the study. There really is no one piece of the study that should be distracting us from a thorough evaluation - just like I’m not about to let another email from ASHA distract me from leaving a bit early on a Friday.
ACR-SPR Practice Parameter for the Performance of the Modified Barium Swallow
Videofluoroscopic Swallowing Study (VFSS) (asha.org)