Tests & scales

MBSImP (Modified Barium Swallow Impairment Profile)

Also written as MBSImP, MBSImp, Modified Barium Swallow Impairment Profile, MBSImP score, MBSImP oral total (OT), MBSImP pharyngeal total (PT).

MBSImP is a standard scoring system an SLP uses to rate 17 separate parts of the swallow seen on a modified barium swallow study.

A modified barium swallow study is an X-ray video that records what happens while a person swallows food and drink mixed with barium, a substance that shows up on X-ray. MBSImP is a scoring system used alongside that video. Instead of describing the swallow only in sentences, the speech-language pathologist (SLP) watches the recording and gives a number to each of 17 separate physical parts of swallowing. The idea is that two different clinicians looking at the same video should describe it the same way.

The 17 parts are grouped into three domains, named oral, pharyngeal, and esophageal. Six components make up the oral domain, ten make up the pharyngeal domain, and one covers how the material clears through the esophagus, the tube that carries food to the stomach, while the person is sitting upright. The grouping follows the scoring tool's own domains rather than strict anatomy, so the sixth oral-domain component, initiation of the pharyngeal swallow, is counted with the oral scores. Each part is scored on its own scale that starts at 0, where 0 means no impairment was seen for that part. The highest possible number is 2, 3, or 4 depending on which part is being scored, with larger numbers describing more impairment. The oral-domain scores are then added into one total and the pharyngeal-domain scores into another, so a report may show an oral total and a pharyngeal total.

The system came out of a study led by Bonnie Martin-Harris and colleagues, published in 2008, which tested whether the tool was reliable and whether its scores lined up with other measures. The scoring protocol is a standardized one. In that original study, clinicians were trained until their scores matched an expert scorer's ratings at least 80 percent of the time, and that 80 percent level is described in the later literature as the reliability standard recommended for MBSImP scoring. It is worth knowing what MBSImP is not. The numbers are not a grade, a percentage, or a diagnosis. They are a shorthand for describing how each piece of the swallow moved on that particular day, with those particular foods and liquids.

An SLP uses MBSImP so the same swallow gets described in the same words and numbers by different clinicians, in different clinics, and at different visits. That consistency makes it easier for a team to compare one study with a later one, and to point to which specific part of the swallow they are talking about rather than saying only that swallowing is impaired. Seeing MBSImP named in a report tells you which scoring framework the clinician used. It does not tell you your own scores, what any number in your report means, or what should happen next; only the clinician who ran the study can explain that.