Skip to main content

Advertisement

SpringerLink
Log in

MBS Measurement Tool for Swallow Impairment—MBSImp: Establishing a Standard

  • Original Article
  • Published:
Dysphagia Aims and scope Submit manuscript

An Erratum to this article was published on 10 February 2010

Abstract

The aim of this study was to test reliability, content, construct, and external validity of a new modified barium swallowing study (MBSS) tool (MBSImp) that is used to quantify swallowing impairment. Multiple regression, confirmatory factor, and correlation analyses were used to analyze 300 in- and outpatients with heterogeneous medical and surgical diagnoses who were sequentially referred for MBS exams at a university medical center and private tertiary care community hospital. Main outcome measures were the MBSImp and index scores of aspiration, health status, and quality of life. Inter- and intrarater concordance were 80% or greater for blinded scoring of MBSSs. Regression analysis revealed contributions of eight of nine swallow types to impressions of overall swallowing impairment (p ≤ 0.05). Factor analysis revealed 13 significant components (loadings ≥ 0.5) that formed two impairment groupings (oral and pharyngeal). Significant correlations were found between Oral and Pharyngeal Impairment scores and Penetration-Aspiration Scale scores, and indexes of intake status, nutrition, health status, and quality of life. The MBSImp demonstrated clinical practicality, favorable inter- and intrarater reliability following standardized training, content, and external validity. This study reflects potential for establishment of a new standard for quantification and comparison of oropharyngeal swallowing impairment across patient diagnoses as measured on MBSS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. McConnel FM, Guffin TNJ, Cerenko D, Ko AS. The effects of bolus flow on vertical pharyngeal pressure measurement in the pharyngoesophageal segment: clinical significance. Otolaryngol Head Neck Surg. 1992;106(2):169–74.

    CAS  PubMed  Google Scholar 

  2. Cook IJ, Dodds WJ, Dantas RO, Kern MK, Massey BT, Shaker R, et al. Timing of videofluoroscopic, manometric events, and bolus transit during the oral and pharyngeal phases of swallowing. Dysphagia. 1989;4(1):8–15. doi:10.1007/BF02407397.

    Article  CAS  PubMed  Google Scholar 

  3. Martin-Harris B, Brodsky MB, Michel Y, Ford CL, Walters B, Heffner J. Breathing and swallowing dynamics across the adult lifespan. Arch Otolaryngol Head Neck Surg. 2005;131(9):762–70. doi:10.1001/archotol.131.9.762.

    Article  PubMed  Google Scholar 

  4. Martin-Harris B, Brodsky MB, Price CC, Michel Y, Walters B. Temporal coordination of pharyngeal and laryngeal dynamics with breathing during swallowing: single liquid swallows. J Appl Physiol. 2003;94(5):1735–43.

    PubMed  Google Scholar 

  5. Perlman AL, Palmer PM, McCulloch TM, Van Daele DJ. Electromyographic activity from human laryngeal, pharyngeal, and submental muscles during swallowing. J Appl Physiol. 1999;86(5):1663–9.

    CAS  PubMed  Google Scholar 

  6. Tracy JF, Logemann JA, Kahrilas PJ, Jacob P, Kobara M, Krugler C. Preliminary observations on the effects of age on oropharyngeal deglutition. Dysphagia. 1989;4(2):90–4. doi:10.1007/BF02407151.

    Article  CAS  PubMed  Google Scholar 

  7. Van Daele DJ, McCulloch TM, Palmer PM, Langmore SE. Timing of glottic closure during swallowing: a combined electromyographic and endoscopic analysis. Ann Otol Rhinol Laryngol. 2005;114(6):478–87.

    PubMed  Google Scholar 

  8. Mathew OP, Abu-Osba YK, Thach BT. Genioglossus muscle responses to upper airway pressure changes: afferent pathways. J Appl Physiol. 1982;52(2):445–50.

    CAS  PubMed  Google Scholar 

  9. McConnel FM, Cerenko D, Mendelsohn MS. Manofluorographic analysis of swallowing. Otolaryngol Clin North Am. 1988;21(4):625–35.

    CAS  PubMed  Google Scholar 

  10. Castell JA, Castell DO, Schultz AR, Georgeson S. Effect of head position on the dynamics of the upper esophageal sphincter and pharynx. Dysphagia. 1993;8(1):1–6. doi:10.1007/BF01351470.

    Article  CAS  PubMed  Google Scholar 

  11. Castell JA, Dalton CB, Castell DO. Pharyngeal and upper esophageal sphincter manometry in humans. Am J Physiol. 1990;258(2 Pt 1):G173–8.

    CAS  PubMed  Google Scholar 

  12. Kahrilas PJ, Logemann JA, Lin S, Ergun GA. Pharyngeal clearance during swallowing: a combined manometric and videofluoroscopic study. Gastroenterology. 1992;103(1):128–36.

    CAS  PubMed  Google Scholar 

  13. Perlman AL, Schultz JG, Van Daele DJ. Effects of age, gender, bolus volume, and bolus viscosity on oropharyngeal pressure during swallowing. J Appl Physiol. 1993;75(1):33–7.

    CAS  PubMed  Google Scholar 

  14. Robbins J, Hamilton JW, Lof GL, Kempster GB. Oropharyngeal swallowing in normal adults of different ages. Gastroenterology. 1992;103(3):823–9.

    CAS  PubMed  Google Scholar 

  15. Shaker R, Ren J, Podvrsan B, Dodds WJ, Hogan WJ, Kern M, et al. Effect of aging and bolus variables on pharyngeal and upper esophageal sphincter motor function. Am J Physiol. 1993;264(3 Pt 1):G427–32.

    CAS  PubMed  Google Scholar 

  16. Steele CM, Huckabee ML. The influence of orolingual pressure on the timing of pharyngeal pressure events. Dysphagia. 2007;22(1):30–6. doi:10.1007/s00455-006-9037-4.

    Article  PubMed  Google Scholar 

  17. Nasrallah S, Hendrix E. The effect of topical pharyngeal anesthesia on esophageal motility. Am J Gastroenterol. 1987;82(6):523–5.

    CAS  PubMed  Google Scholar 

  18. Green JR, Wang YT. Tongue-surface movement patterns during speech and swallowing. J Acoust Soc Am. 2003;113(5):2820–33. doi:10.1121/1.1562646.

    Article  PubMed  Google Scholar 

  19. Logemann JA, Pauloski BR, Rademaker AW, Colangelo LA, Kahrilas PJ, Smith CH. Temporal and biomechanical characteristics of oropharyngeal swallow in younger and older men. J Speech Lang Hear Res. 2000;43(5):1264–74.

    CAS  PubMed  Google Scholar 

  20. Logemann JA, Pauloski BR, Rademaker AW, Kahrilas PJ. Oropharyngeal swallow in younger and older women: videofluoroscopic analysis. J Speech Lang Hear Res. 2002;45(3):434–45. doi:10.1044/1092-4388(2002/034).

    Article  PubMed  Google Scholar 

  21. Burkhead LM, Sapienza CM, Rosenbek JC. Strength-training exercise in dysphagia rehabilitation: principles, procedures, and directions for future research. Dysphagia. 2007;22(3):251–65. doi:10.1007/s00455-006-9074-z.

    Article  PubMed  Google Scholar 

  22. Lazarus C, Logemann JA, Pauloski BR, Rademaker AW, Helenowski IB, Vonesh EF, et al. Effects of radiotherapy with or without chemotherapy on tongue strength and swallowing in patients with oral cancer. Head Neck. 2007;29(7):632–7. doi:10.1002/hed.20577.

    Article  PubMed  Google Scholar 

  23. Leonard RJ, Belafsky PC, Rees CJ. Relationship between fluoroscopic and manometric measures of pharyngeal constriction: the pharyngeal constriction ratio. Ann Otol Rhinol Laryngol. 2006;115(12):897–901.

    PubMed  Google Scholar 

  24. Cerenko D, McConnel FM, Jackson RT. Quantitative assessment of pharyngeal bolus driving foces. Otolaryngol Head Neck Surg. 1989;100(1):57–63.

    CAS  PubMed  Google Scholar 

  25. Daniels SK, Schroeder MF, DeGeorge PC, Corey DM, Rosenbek JC. Effects of verbal cue on bolus flow during swallowing. Am J Speech Lang Pathol. 2007;16(2):140–7. doi:10.1044/1058-0360(2007/018).

    Article  PubMed  Google Scholar 

  26. Johnsson F, Shaw D, Gabb M, Dent J, Cook IJ. Influence of gravity and body position on normal oropharyngeal swallowing. Am J Physiol. 1995;269(5 Pt 1):G653–8.

    CAS  PubMed  Google Scholar 

  27. Olsson R, Nilsson H, Ekberg O. Simultaneous videoradiography and computerized pharyngeal manometry—videomanometry. Acta Radiol. 1994;35(1):30–4.

    CAS  PubMed  Google Scholar 

  28. Pauloski BR, Blom ED, Logemann JA, Hamaker RC. Functional outcome after surgery for prevention of pharyngospasms in tracheoesophageal speakers. Part II: Swallow characteristics. Laryngoscope. 1995;105(10):1104–10. doi:10.1288/00005537-199510000-00017.

    Article  CAS  PubMed  Google Scholar 

  29. Kahrilas PJ, Lin S, Rademaker AW, Logemann JA. Impaired deglutitive airway protection: a videofluoroscopic analysis of severity and mechanism. Gastroenterology. 1997;113(5):1457–64. doi:10.1053/gast.1997.v113.pm9352847.

    Article  CAS  PubMed  Google Scholar 

  30. Logemann JA, Kahrilas PJ, Cheng J, Pauloski BR, Gibbons PJ, Rademaker AW, et al. Closure mechanisms of laryngeal vestibule during swallow. Am J Physiol. 1992;262(2 Pt 1):G338–44.

    CAS  PubMed  Google Scholar 

  31. Leow LP, Huckabee ML, Sharma S, Tooley TP. The influence of taste on swallowing apnea, oral preparation time, and duration and amplitude of submental muscle contraction. Chem Senses. 2007;32(2):119–28. doi:10.1093/chemse/bjl037.

    Article  CAS  PubMed  Google Scholar 

  32. Pelletier CA, Dhanaraj GE. The effect of taste and palatability on lingual swallowing pressure. Dysphagia. 2006;21(2):121–8. doi:10.1007/s00455-006-9020-0.

    Article  PubMed  Google Scholar 

  33. Aviv JE, Martin JH, Keen MS, Debell M, Blitzer A. Air pulse quantification of supraglottic and pharyngeal sensation: a new technique. Ann Otol Rhinol Laryngol. 1993;102(10):777–80.

    CAS  PubMed  Google Scholar 

  34. Logemann JA, Pauloski BR, Colangelo L, Lazarus C, Fujiu M, Kahrilas PJ. Effects of a sour bolus on oropharyngeal swallowing measures in patients with neurogenic dysphagia. J Speech Hear Res. 1995;38(3):556–63.

    CAS  PubMed  Google Scholar 

  35. Dodds WJ, Logemann JA, Stewart ET. Radiologic assessment of abnormal oral and pharyngeal phases of swallowing. AJR Am J Roentgenol. 1990;154(5):965–74.

    CAS  PubMed  Google Scholar 

  36. Ekberg O, Sigurjonsson SV. Movement of the epiglottis during deglutition. A cineradiographic study. Gastrointest Radiol. 1982;7(2):101–7. doi:10.1007/BF01887619.

    Article  CAS  PubMed  Google Scholar 

  37. Martin-Harris B, Logemann JA, McMahon S, Schleicher M, Sandidge J. Clinical utility of the modified barium swallow. Dysphagia. 2000;15(3):136–41.

    CAS  PubMed  Google Scholar 

  38. Ramsey GH, Watson JS, Gramiak R, Weinberg SA. Cinefluorographic analysis of the mechanism of swallowing. Radiology. 1955;64(4):498–518.

    CAS  PubMed  Google Scholar 

  39. Logemann JA. Behavioral management for oropharyngeal dysphagia. Folia Phoniatr Logop. 1999;51(4–5):199–212. doi:10.1159/000021497.

    Article  CAS  PubMed  Google Scholar 

  40. American Speech-Language-Hearing Association (ASHA). Omnibus survey: caseloads for speech-language pathologists. Rockville, MD: ASHA; 2000.

    Google Scholar 

  41. Kidder TM, Langmore SE, Martin BJ. Indications and techniques of endoscopy in evaluation of cervical dysphagia: comparison with radiographic techniques. Dysphagia. 1994;9(4):256–61. doi:10.1007/BF00301919.

    Article  CAS  PubMed  Google Scholar 

  42. Ciolek DE, Hwang W. AdvanceMed—Project Report. Baltimore: Centers for Medicare and Medicaid Services, November 15, 2004.

  43. Langmore SE, Terpenning MS, Schork A, Chen Y, Murray JT, Lopatin D, et al. Predictors of aspiration pneumonia: how important is dysphagia? Dysphagia. 1998;13(2):69–81. doi:10.1007/PL00009559.

    Article  CAS  PubMed  Google Scholar 

  44. Martin BJ, Logemann JA, Shaker R, Dodds WJ. Coordination between respiration and swallowing: respiratory phase relationships and temporal integration. J Appl Physiol. 1994;76(2):714–23.

    CAS  PubMed  Google Scholar 

  45. Martin BJW. The influence of deglutition on respiration. PhD dissertation. Evanston, IL: Northwestern University; 1991.

    Google Scholar 

  46. Loeb LP, McGreer A, McArthur M, Walter S, Simor AE. Risk factors for pneumonia and other lower respiratory tract infections in elderly residents of long-term care facilities. Arch Intern Med. 1999;159:2058–64. doi:10.1001/archinte.159.17.2058.

    Article  CAS  PubMed  Google Scholar 

  47. Marik PE, Kaplan D. Aspiration pneumonia and dysphagia in the elderly. Chest. 2003;124:328–36.

    Article  PubMed  Google Scholar 

  48. Sackman H. Delphi critique. Lexington, MA: Lexington Books; 1975.

    Google Scholar 

  49. Radiographic interpretation of swallowing disorders [computer program]. Rockville, MD: American Speech-Language-Hearing Association, 2004.

  50. Register F. Radiology devices. Rockville, MD: U.S. Department of Health and Human Services, Food and Drug Administration; 2002.

    Google Scholar 

  51. Balter S, editor. Intravascular brachytherapy/fluorosopically guided interventions. College Park, MD: American Association of Physicists in Medicine; 2002.

  52. Rosenstein M, Suleiman O, Burkhart R, Stern S. The handbook for selected tissue doses for the upper gastrointestinalfluoroscopic examination. Rockville, MD: U.S. Department of Health and Human Services, Food and Drug Administration; 1992.

    Google Scholar 

  53. Dodds WJ, Stewart ET, Logemann JA. Physiology and radiology of the normal oral and pharyngeal phases of swallowing. AJR Am J Roentgenol. 1990;154(5):953–63.

    CAS  PubMed  Google Scholar 

  54. Logemann JA. Manual for the videofluorographic study of swallowing. 2nd ed. Austin, TX: ProEd; 1993.

    Google Scholar 

  55. Logemann JA. Evaluation and treatment of swallowing disorders. Austin, TX: ProEd; 1998.

    Google Scholar 

  56. Robbins J, Coyle J, Rosenbek J, Roecker E, Wood J. Differentiation of normal and abnormal airway protection during swallowing using the penetration-aspiration scale. Dysphagia. 1999;14(4):228–32. doi:10.1007/PL00009610.

    Article  CAS  PubMed  Google Scholar 

  57. Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11(2):93–8. doi:10.1007/BF00417897.

    Article  CAS  PubMed  Google Scholar 

  58. National Heart, Lung and Blood Institute. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults (Publication No. 98-4083). Bethesda, MD: National Institutes of Health; 1998.

  59. Ottery F. Patient-generated subjective global assessment. In: McCallum P, Polisena C, editors. The clinical guide to oncology nutrition. Chicago: American Dietetic Association; 2000. p. 11–23.

    Google Scholar 

  60. Martin BJ, Corlew MM, Wood H, Olson D, Golopol LA, Wingo M, et al. The association of swallowing dysfunction and aspiration pneumonia. Dysphagia. 1994;9(1):1–6. doi:10.1016/j.otohns.2005.03.059.

    Article  CAS  PubMed  Google Scholar 

  61. Martin-Harris B, McMahon S, Haynes R. Aspiration and dysphagia: pathophysiology and outcome. Phonoscope. 1998;2:125–32.

    Google Scholar 

  62. Stewart AL, Ware JEJ. Measuring functioning and well-being: The Medical Outcomes Study approach. Durham, NC: Duke University Press; 1992.

    Google Scholar 

  63. McHorney CA, Bricker DE, Kramer AE, Rosenbek JC, Robbins J, Chignell KA, et al. The SWAL-QOL outcomes tool for oropharyngeal dysphagia in adults: I. Conceptual foundation and item development. Dysphagia. 2000;15(3):115–21.

    CAS  PubMed  Google Scholar 

  64. McHorney CA, Martin-Harris B, Robbins J, Rosenbek J. Clinical validity of the SWAL-QOL and SWAL-CARE outcome tools with respect to bolus flow measures. Dysphagia. 2006;21(3):141–8. doi:10.1007/s00455-005-0026-9.

    Article  PubMed  Google Scholar 

  65. Martin-Harris B, Michel Y, Castell DO. Physiologic model of oropharyngeal swallowing revisited. Otolaryngol Head Neck Surg. 2005;133(2):234–40. doi:10.1016/j.otohns.2005.03.059.

    Article  PubMed  Google Scholar 

  66. Dodds WJ, Taylor AJ, Stewart ET, Kern MK, Logemann JA, Cook IJ. Tipper and dipper types of oral swallows. AJR Am J Roentgenol. 1989;153(6):1197–9.

    CAS  PubMed  Google Scholar 

  67. Ergun GA, Kahrilas PJ, Lin S, Logemann JA, Harig JM. Shape, volume, and content of the deglutitive pharyngeal chamber imaged by ultrafast computerized tomography. Gastroenterology. 1993;105(5):1396–403 [see comment].

    CAS  PubMed  Google Scholar 

  68. Kahrilas PJ, Lin S, Logemann JA, Ergun GA, Facchini F. Deglutitive tongue action: volume accommodation and bolus propulsion. Gastroenterology. 1993;104(1):152–62.

    CAS  PubMed  Google Scholar 

  69. Pauloski BR, Logemann JA. Impact of tongue base and posterior pharyngeal wall biomechanics on pharyngeal clearance in irradiated postsurgical oral and oropharyngeal cancer patients. Head Neck. 2000;22(2):120–31. doi :10.1002/(SICI)1097-0347(200003)22:2<120::AID-HED3>3.0.CO;2-U.

    Article  CAS  PubMed  Google Scholar 

  70. Brenner MH, Curbow B, Legro MW. The proximal-distal continuum of multiple health outcome measures: the case of cataract surgery. Med Care. 1995;33:AS236–44.

    CAS  PubMed  Google Scholar 

  71. Translating Research Into Practice (TRIP)-II. Fact sheet. Rockville, MD: Agency for Healthcare Research and Quality, AHRQ Publication No. 01-P017; 2001. http://www.ahrq.gov/research/trip2fac.htm. Accessed 1 Nov 2007.

Download references

Acknowledgments

The authors thank all of the patients who graciously offered their time. This study was funded by the National Institute on Deafness and Other Communication Disorders at the National Institutes of Health (NIDCD K23 DC005764) and by the Mark and Evelyn Trammell Trust, Atlanta, Georgia. The authors extend their gratitude to the members of the multidisciplinary panel that convened to validate the measures for their time and collaborative efforts. They are (in alphabetical order) Donald Castell, MD; Bronwyn Jones, MD; Susan Langmore, PhD, Cathy Lazarus, PhD, Fred McConnel, MD, Jeffrey Palmer, MD, Adrienne Perlman,PhD, JoAnne Robbins, PhD, John Rosenbek, PhD, Reza Shaker, MD, and Barbara Sonies, PhD. The authors thank the speech-language pathologists who were trained for scoring and assisted with data collection and scored over 300 patients for their countless hours, dedication, and perseverance through this project. They are (in alphabetical order) Audra Condon, Grea Durkee, K. Val Evans, Margie Hunnel, Caroline Mitchell, Kristin Thayer, and Tanya Thomason.

Author information

Author notes

  1. Martin B. Brodsky

    Present address: Johns Hopkins Hospital, Baltimore, MD, USA

Authors and Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC, 29425-5500, USA

    Bonnie Martin-Harris & Martin B. Brodsky

  2. Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston, SC, USA

    Bonnie Martin-Harris, Martin B. Brodsky, Rebekah Maxwell & Julie Blair

  3. Department of Communication Sciences & Disorders, Medical University of South Carolina, Charleston, SC, USA

    Bonnie Martin-Harris, Martin B. Brodsky, Rebekah Maxwell & Julie Blair

  4. Evelyn Trammell Voice & Swallowing Center, Saint Joseph’s Hospital of Atlanta, Atlanta, GA, USA

    Bonnie Martin-Harris, Melanie Schleicher & John Sandidge

  5. Department of Speech Pathology, Medical University of South Carolina, Charleston, SC, USA

    Martin B. Brodsky, Rebekah Maxwell & Julie Blair

  6. College of Nursing, Medical University of South Carolina, Charleston, SC, USA

    Yvonne Michel

  7. College of Medicine, Medical University of South Carolina, Charleston, SC, USA

    Donald O. Castell

Authors
  1. Bonnie Martin-Harris
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Martin B. Brodsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yvonne Michel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Donald O. Castell
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Melanie Schleicher
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. John Sandidge
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rebekah Maxwell
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Julie Blair
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bonnie Martin-Harris.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s00455-010-9275-3

Rights and permissions

Reprints and permissions

About this article

Cite this article

Martin-Harris, B., Brodsky, M.B., Michel, Y. et al. MBS Measurement Tool for Swallow Impairment—MBSImp: Establishing a Standard. Dysphagia 23, 392–405 (2008). https://doi.org/10.1007/s00455-008-9185-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00455-008-9185-9

Keywords

Search

Navigation