[Dysphagia] MBS results

[Paula.Leslie at newcastle.ac.uk (Paula leslie)]

Hello Virginia

I know things are different here (UK) but I'm lucky in that although I'm the 
equivalent of your acute VF SLP I would virtually always have the "treating" 
SLP (eg you) in with me.  I can't do a VF without the clinical history side, 
because it is just a snapshot.  For all VFs that are referred to me there is a 
form the treating clinician fills in with all sorts of info, so if the worst 
happens and they can't attend I have a reasonable amount of info to go with.  
So I, as the acute person have a good report from the treating SLP with the 
whys & wherefores and what they want assessing in what manner, which I can go 
beyond if I deem appropriate.  Then I send back a detailed report.  If the 
treating SLP has not been in on the session I would at least phone and 
preferably meet to go over the tape (but part of that is internal training).  
I know this is not always possible due to working patterns (but in the UK we 
should make more of an effort).

You may have done all this already.  Can you phone the VF SLP or get to see 
her/him?  What exactly did they try, how much, off what size spoon or cup etc.
 If all the report said is what you've given here, then that's a very poor 
report indeed and I would be straight back the acute SLP.  No I would not make 
recommendations on that sort of info but I wouldn't produce that sort of 
report either.

You must have thought your patient was ready for something to request the VF.  
It's possible that your client needs a bigger bolus than teaspoon sizes to 
trigger an effective swallow (most people do).  Was the 8 sec delay because 
the patient was holding it in the mouth and once it did move back the swallow 
kicked in nicely?  Or were there barium filled valleculae and piriforms for 8 
secs with the staff all holding their breath?

I think more info is needed from both sides to see why the behaviour is so 
different in the same patient.  Sorry I can't offer any magic solutions.

Good Luck!

Paula

>===== Original Message From "v.cooper" <v.cooper@sbcglobal.net> =====
>I am trying to get feedback from others who do MBSs regularly.
>
>I work in a SNF. I referred an NPO brainstem stroke pt to acute for mbs. She 
came back w/recommendation for pureed w/thin liquid diet, and a statement to 
"leave the GT in for a week to assess tolerance" No therapy recommended. 
Results showed an 8 sec swallow delay and significant pharyngeal pooling but 
"no penetration or aspiration". I did bedside eval and found resident to be 
coughing severely after 5-6 tsp of pureed and 2-3 tsps of thin from spoon. She 
was clearly in distress.
>
>Family is very upset because ST at acute told them that she did "Great" and 
was ready to have the tube d/cd. Then I tell them that she does not appear 
safe. When they saw her coughing themselves, they believed me.
>
>Do others make such recommendations based on what I consider to be not so 
great MBS results? Please advise
>
>Thanks,
>
>Virginia Cooper
>
>
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Paula Leslie
Degree Programme Director
Surgical and Reproductive Sciences
Faculty of Medical Sciences
University of Newcastle
Newcastle upon Tyne
NE2 4HH
UK
T +44 (0) 191 222 6279
F +44 (0) 191 222 8988
http://www.ncl.ac.uk/sars/postgrad/MSc.htm