[Dysphagia] MBS issues

[wabeach at hsc.vcu.edu (Woodford Beach)]

I fully agree with Kelly's comments. In my MBS reports I put in a statement
indicating that the MBS does only sample swallows: it may capture a peak or
trough of performance and patients certainly vary in performance sometimes
doing better or worse than in their living situation. If a clinician asks me
for some specific information (which is incredibly rare in the 17 years I've
been doing these things) I will try to oblige them, or explain why I cannot
provide the requested info. If I'm not told what information is desired, I
will do the best I can in the evaluation.

Woodford A. Beach, Ph.D., CCC/SP
Senior Speech Pathologist
VCU Medical Center
Richmond, VA
----- Original Message ----- 
From: "Robert Newman" <ronewman@columbus.rr.com>
To: <dysphagia@b9.com>
Sent: Wednesday, September 01, 2004 8:55 PM
Subject: [Dysphagia] MBS issues


Just a comment or two about this subject.  I have been on both sides of this
fence.  Get to know your acute care mbs therapist(s).  Call them before
and/or after the exam. Give them more than an hour before the test--say a
day or two--to give time for a call back.  I am primarily on the acute care
side these days. We try some strategies, but quite frankly, a lot of nursing
home or even home health patients cannot consistently follow verbal
directions. I cannot say that pt x is able to safely eat with chin tiuck/
head tilt / etc. if he can only do that one out of various tries. We set
ourselves up for failure and liability. We actually do look at all info.
sent to us--how else can one test without dx and background info. If I don't
have it, I call and ask for it.  If a patient has various s/s of dysphagia
by hx, however, does not exhibit these during the MBS exam at  the hospital,
there is nothing else to be reported. I cannot make a person show me s/s if
he is not experiencing them at that point in time. I will note reported hx,
make appropriate referrals ( if applicable), otherwise, no therapuetic
recommendations if not seen while I am examining the pt. Remember, the MBS
is a test with many limitations, many of which has been discussed on the
listserve.

Communication is the key. Talk with your manager and see if he will allow
you to do some marketing on company time. Go to the one or two hospitals
with which you would prefer to work, set up a mtg with the slps, and lay out
your expectations. Bring examples of what cases/reports have been good. If
you are able to put forth this effort, it will pay off in the long run. You
and your  pts/families will reep the benefits.

good luck,

Kelly L. Newman, CCC-SLP
Columbus, Ohio



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