Three Good Dysphagia References

Eisenhuber, E., Schima, W., Schober, E., Pokieser, P., Stadler, A., Scharitzer, M., et al. (2002). Videofluoroscopic assessment of patients with dysphagia: pharyngeal retention is a predictive factor for aspiration. American Journal of Roentgenology, 178(2), 393-398.

Perlman, A. L., Booth, B. M., & Grayhack, J. P. (1994). Videofluoroscopic predictors of aspiration in patients with oropharyngeal dysphagia. Dysphagia, 9 (2), 90-95.

Rosenbek, J. C., Robbins, J. A., Roecker, E. B., Coyle, J. L., & Wood, J. L. (1996). A penetration-aspiration scale. Dysphagia, 11(2), 93-98.

"Certificates... Do We Really Need 'Em?"

You do not need to pay for a certification course to become competent to perform FEES, MBS’s or other techniques. As I stated in my earlier post, you do need “Training, yes (does it need to be training by a specific entity, I would argue “not necessarily”). Sound and evidence based decision making capabilities, yes. The ability to produce an objective and defensible rationale for the proposed treatment, yes.”

Holding a piece of paper only means that the certificate holder attended a meeting. It does not convey competence or evidence based decision making. You state that you are not trained to perform FEES or MBS’s, but that training is possible without paying for a “certificate”.

True SLP’s pay to receive a certificate for certain kinds of training such as FEES (as you have cited). However many facilities “certify” clinician competence of SLP’s to perform FEES after they have performed 25 (or a specific number of) exams under supervision or other clinicians with more than that level of experience/competence. They do not have to pay for a piece of paper. Similarly, physicians that perform many surgical procedures do not necessarily receive a certificate stating they have attended a meeting to train them to perform the procedure. They learn from each other, in much the same way that we train and educate our students and supervisees.

Isn’t a clinician who is “certified” in lsvt qualified to train others to perform lsvt? If not, what would qualify him or her to train others? I attended a Jeri Logemann conference in 1987 and received a piece of paper, but was completely unqualified to perform the MBS procedure until I had received mentoring, experience and extensive training after the conference.

Cheers,

James L. Coyle, Ph.D., CCC-SLP, BRS-S
Assistant Professor, Communication Science and Disorders
University of Pittsburgh

MBS Protocol

One of the issues in performing a modified barium swallow study with a radiologist is time-constraints.

The radiologist is generally attempting to perform the study as quickly and efficiently as possible. This, of course, should be our goal as well.

Arranging your presentation items is key to improving efficiency.

Sometimes, the radiologist will begin to "take over" your study if you are not fully in control. Try not to allow this to make you nervous.

As you (as a student) perform more and more MBSes, you will gain confidence and all will fall into place.

Barium Standardization for MBS

Catriona M. Steele
Ph.D., M.H.Sc., S-LP(C), CCC-SLP, Reg. CASLPO writes:

Hi everyone!
I wanted to contribute to the discussion on barium standardization.

First let me start by saying that I believe the preferred option here is to use the Varibar products. These products have undergone rigorous testing.

However, if you are in a facility where Varibar is not yet available (which is true for all of us in Canada), then the next best approach is to standardize your barium recipes. I believe that we should be attempting to match the DENSITY of the Varibar products (acknowledging, of course that those products have the advantage of including various suspension agents and emulsifiers that are not part of the procedure I am going to describe below).

To make barium products of a specific DENSITY, you need a good digital scale as well as containers that specify volume (in ML). Density is always reported as a WEIGHT to VOLUME ratio. That means that for a specific VOLUME of liquid, you need to add a particular WEIGHT (in grams) of barium.

The particular amount of barium that you will add depends on the original barium product (is it a powder or already in liquid form?) and what density it is already determined to have. Liquid Polibar, for example, has a 100% weight to volume ratio in the bottle. Liquid Polibar Plus is slightly more dense (105% weight to volume). EZ-HD is intended to yield a 250% weight to volume suspension when you add the specified amount of water marked on the bottle.

So, in the absence of Varibar here in Canada, this is how I suggest that people attempt to standardize their home-made barium recipes (let me reiterate that I believe purchasing Varibar is the preferred option).

a) How to make ~1 cup (250 ml) of 40% w/v liquid barium suspension with Liquid Polibar(100% w/v base):

- Place an empty container on a digital balance and set the weight to 0 g.
- Pour in 100 g of Liquid Polibar.
- Add water until the volume reaches 250 ml.
- Shake well and leave to stand in a refrigerator.

b) How to make ~1 cup (250 ml) of 40% w/v liquid barium suspension with Liquid Polibar Plus (105% w/v base):

- Place an empty container on a digital balance and set the weight to 0 g.
- Pour in 95 g of Liquid Polibar Plus.
- Add water until the volume reaches 250 ml.
- Shake well and leave to stand in a refrigerator.

c) How to make 40% w/v barium products (any consistency) with E-Z-HD powder:

- Calculate the volume of liquid that you want to prepare (e.g. 250 ml)
- Determine the value of 40% of this volume (e.g., 250 X 0.4 = 100). Divide this value by 2.5 (e.g., 100/2.5 = 40).
- Using a digital balance, weigh out this value in grams of EZ-HD powder on a scale.
- Add this amount of powder to your liquid (e.g. 40 g of EZ-HD plus 250 ml of liquid).
- Shake or stir well with a whisk and store in a refrigerator.

Catriona M. Steele
Ph.D., M.H.Sc., S-LP(C), CCC-SLP, Reg. CASLPO

* Research Scientist, Toronto Rehabilitation Institute
* Corporate Practice Leader for Speech-Language Pathology and Audiology, Toronto Rehabilitation Institute
* CIHR New Investigator in Aging
* Assistant Professor, Department of Speech-Language Pathology, University of Toronto
* Coordinator-Elect, Special Interest Division 13 (Swallowing and Swallowing Disorders), American Speech-Language Hearing Association

Mailing Address:
550 University Avenue, #12030,
Toronto, ON, M5G 2A2
Telephone: 416-597-3422 X 7603
Fax: 416-597-7131
E-mail: steele.catriona@torontorehab.on.ca