Xray Swallow 01 - MBS Swallow

[freeNode5]

wweeeeiiiiiiiirrrrrrdd :o

[brunac]

Thanks everyone, your comments are food for my soul.

[sweethoneyb7]

I want to pass my exam on monday! >.<

[lopezc15]

Wow that's a lot of backflow. Definately no aspiration, but does anyone else think that there was some slight penetration w/thins. (I'm only a student).

[6ar6el]

there is somthing wrong with the epiglottis !!! am i right

[DoNotSubMeAsshoIe]

That's barium he's swallowing, the same deadly shit nufffrespect says is in chemtrails.

It's okay to swallow the shit, but not for it to be sprayed onto your car or house...i don't think so.

[MST2k]

@DoNotSubMeAsshoIe

The difference is in what form the Barium takes. Barium used for esophagrams, modified barium swallows (as shown here), and other barium x-ray studies is non-toxic and is not absorbed by the digestive system.

[Gr8testMuzic]

We can notice that the epiglottis does a good job. It's like a gate. Yet, many people don't know we all have this. When they see this body part for the first time when sticking the tongue far, they find it weird. The uvula as a similar role but with the Xray we can hardly see it. Nice anatomy lesson.

[penguinsforeverful]

Poor oral containment of the liquid bolus (due to tongue weakness? Can't see the tongue during the liquid swallow...assuming motor-sensory component is affected?) This results in the slow oral to pharyngeal transit time. High potential for aspiration with a thin liquid (Noticed bolus went down with a chin tuck..saw full laryngeal/VF closure). Curious to see if they have the patient do a warm or cold thin liquid??

[serban13iunie]

I am a student in speech language pathology, so im not 100% sure, but it seems to me that during the first swallow, the patient had some reside remaining in either the valleculai or pyriform sinuses. During the swallow when Liquids showed on the screen, there was pooling present. EVLU522, can you explain how there are no signs of aspiration? if there is pooling or residue present, doesnt that lead to aspiration?

[smlspeech]

study a little more -- pooling does not lead to or result in aspiration. it does increase the risk of aspiration to occur!

12 yr working SLP

[NatGrays]

I have dysphagia, I really wish I could be cured.

[MensajesDeCristo96]

God can cure you

[mikeroephonics]

@MensajesDeCristo96 Nah, I'm good. Thanks though.

[rrw0312]

Do you have a speech therapist? not all dysphagia is incurable

[Ruttie2]

Uh... There,there :I

[michael99745]

@NatGrays its ben to years and your still not better? can you reaply back to me im haveing diffacult swallowing

[pussy321pussy]

sssshhhhiiiitttt

[keaton454545]

really unhealthy you know how much radiation that takes????

[LBPreviews]

Electromagnetic radiation (sometimes abbreviated EMR) currently stands at 6583210mA

[amcfan84]

yes not much

[beenimen]

Is this a video of 2 people having sex?

I hope so because I just fapped to it.

Please post more videos of this for my enjoyment. Thank you.

[tsvate]

it's so creepy..i can see his epiglotis! i wish i knew this person then i could walk up to them and say, "i saw ur epiglotis!"

[tsvate]

woah..cool

[stephenharperbest2]

lol looks like darth vader

[theonthepsi]

Is this patient a man or woman?

[Giyermo44]

how can i record this at home???

[evlu522]

Why on earth would you recommend thickened liquids in this patient, who shows no aspiration -- or even penetration -- during the study? (Unless, of course, the patient shows significant symptoms with thin liquid at bedside; but looking at the video, I doubt that's the case).

[Blahineedaname]

Maybe you should take a look again. There was clear stasis on the pyriform sinuses, which would almost always lead to penetration / aspiration if food continuously builds up. Also, he had signs of spillage, and multiple tongue pumps. Check it again.

[evlu522]

Checked it again. The pyriform stasis with puree is due to backflow from the esophagus, and it's not "continuously building up" (nor is it with liquid), so I wouldn't expect any aspiration from it. I don't really see "tongue pumps" to start the swallow, just multiple tongue movements to transfer the bolus -- this inefficient bolus transfer, of which the "spillage" is a part -- is most likely due to the very small bolus size. We need to see a normal sized bolus to really judge swallow function.

[writeincode]

i think it was the bolleculi not the pyroform sinuses.

[writeincode]

sorry it was both

[writeincode]

i only watched the first swallow

[evlu522]

This patient has a functional swallow. The tongue base retraction is NORMAL. A small amount of residue in the valleculae can be normal. The "premature loss of the bolus," "delayed swallow," and "reduced motility" seen with thin liquids are probably all due to the small bolus size that was given. Swallowing is much more efficient with larger boluses. Had the patient been allowed to drink freely from the cup or straw, all those "abnormalities" in the swallow might well have resolved themselves!

[evlu522]

For this patient, I'd be much more concerned with what might be going on in the esophagus rather than the minor "deficits" seen pharyngeally. The slow movement of contrast through the proximal esophagus would warrant at least a fuller screening of esophageal function, and probably a dedicated study. It's possible that any complaints of swallowing difficulty the patient has could be primarily due to esophageal -- rather than pharyngeal -- impairment, since the pharyngeal phase looks functional.

[JCali28]

There doesnt appear to be aspiration. The client doesnt appear to elicit the cough in response to residue. May want to instruct client to cough after swallows of thin liquids. Should remain on diet of nectar- and honey-thick fluids and purees. Can use TTA for delayed pharyngeal swallow response and shaker exercises for reduces pharyngeal motility. Good Luck haha...

[jucarpen]

Please look up the Shaker exercise. It does not target pharyngeal motility; it targets laryngeal elevation.

[jucarpen]

Also notice the residue in the valleculae, which indicates reduced tongue base retraction.

[JCali28]

Good eye.  More to the right than the left.

[JCali28]

You're right. Not directly but it is still often used in such cases to address the surrounding/related musculature. What else would you recommend?

[jucarpen]

When the x-ray switches to the anterior-posterior view, you can see that the residue is on one side of the pharyngeal wall, indicating unilateral pharyngeal wall weakness. It appears as though who ever was conducting the x-ray then has the patient use the head rotation posture (toward the side of weakness), which directs the bolus to the functional side. You can actually see how effective this posture is--no residue is left in the pharynx afterward.

[jucarpen]

As for the reduced tongue base retraction (and consequent residue in the valleculae), I might try the chin down posture. The effortful swallow maneuver might improve tongue base retraction. The Masako manuever (tongue holding maneuver) is an exercise that could be appropriate to improve tongue base retraction, but not during the x-ray study, since it would take time to take effect.

[JCali28]

Seems to have premature loss of the bolus when receiving thin liquids. I notice some incoordination of tongue movements. There is a delayed pharyngeal swallow response and residue left along the pharyngeal walls. This is inidicative of reduced pharyngeal motility.

[cgk000]

Can anyone tell me whats going wrong at each phase - oral, pharyngeal and esophageal?

Thanks

[PaperPlaneFilms]

that is so cool.

[sahbomicah]

thanks for posting this it is useful for showing to people who feed others with impaired swallowing ability in a training session

[her1227]

You can definitely see the difference between swallowing of pureed versus thin liquids.. the patient seems to have much better control over the pureed food whereas the thin liquid drips down before the pharyngeal swallow is triggered. Thanks for posting this!

[panzersherek]

its not food its really thick, gross chalk shit that i could taste when i ate for the rest of the week

[1992peter]

I had one of those several years ago.

It was normal.

But it wasn't the best thing I have ever gone through.

[FreezaSama07]

thats f*cking cool!

[davelangrish]

Video of swallowing food