Botulismo e disfagia

Abstract

Background: botulism is a severe neuroparalytic, of an acute characteristic, afebrile and is caused by the action of a toxin produced by Clostridium botulinum. This toxin links itself to the receptors of the axon membrane of the motor neurons, preventing the release of acetylcholine in the neuromuscular junction, causing flaccid paralysis of the cranial nerves and skeleton musculature. Aim: to present the speech therapy procedures adopted with a patient with botulism and who was presenting dysphagia. Method: a male adult, with botulism, sent for a speech-language evaluation due to the presence of difficulties when swallowing saliva. During the evaluation the following was observed: alteration in mobility, tonicity and sensibility of the organs of the Orofacial Myofunctional System (OMSs); reduction of the laryngeal movements; stasis of saliva in the oral cavity; absence of the swallowing reflex; absence of the swallowing function. Nine speech therapy sessions were carried out with the following procedures: stimulation of the OMSs -mobility, tonicity and sensibility; stimulation of the oral and pharyngeal reflexes; tests and trainings for swallowing with different food consistencies and with the help of maneuvers aiming at the protection and clearing of the airways. Results: improvement in mobility, tonicity and sensibility of the OMSs; improvement in the elevation of the larynx; reestablishment of the swallowing function without the assistance of other professionals or clinical maneuvers; vocal quality close to the normal parameters (light hypernasality and pneumophonoarticulatory incoordination). The patient was discharged from hospital and speech therapy; clinical assistance for adjustment and improvement of the OMSs was suggested. Conclusion: speech therapy demonstrated to be efficient in the re-establishment of OMSs and of the swallowing function, enabling the patient to restore the adequate functionality of his orofacial myofunctional system. Key Words: Botulism; Deglutition; Deglutition Disorders; Rehabilitation. R e s u m oTema: o botulismo é uma doença neuroparalítica grave, de caráter agudo, afebril e causada pela ação de uma toxina produzida pelo Clostridium botulinum. Essa toxina se liga aos receptores da membrana do axônio dos neurônios motores, impedindo a liberação de acetilcolina na junção neuromuscular, o que causa paralisia flácida dos nervos cranianos e da musculatura esquelética, estruturas responsáveis pela adequada funcionalidade da deglutição nos indivíduos. Objetivo: apresentar o trabalho fonoaudiológico realizado junto a um paciente com quadro clínico de botulismo com queixa de disfagia. Método: paciente adulto, gênero masculino, com quadro clínico de botulismo, encaminhado para avaliação fonoaudiológica por apresentar dificuldades em deglutir saliva. Durante avaliação observou-se: alteração na mobilidade, tonicidade e sensibilidade dos órgãos do Sistema Miofuncional Orofacial (OMSs); redução dos movimentos laríngeos; estase de saliva em cavidade oral; ausência do reflexo de deglu...

Rare Case of Dysphagia

“…Frequently turning the patient and daily physical therapy of all the paralyzed muscle groups are necessary to prevent skin wasting, decubitus ulcer formation, and muscle wasting. Speech pathologists must employ daily dysphagia therapy; however, dysphagia can be expected to persist for several months [4]. If muscle wasting is prevented and nutritional requirements are maintained, recovery from botulism will ultimately occur as new neural tissue endplates are regenerated [5].…”

The anatomy and physiology of normal and abnormal swallowing in oropharyngeal dysphagia

“…Several infections can affect either the peripheral or central nervous systems and cause OPD. Examples of these infections include: botulism, syphilis, and diphtheria …”

Editorial

“…The purpose of the case report presented by Mangilli & Andrade (2007) was to present the speech therapy procedures adopted with a patient with botulism and who was presenting dysphagia. Botulism is a severe neuroparalytic disease, of an acute characteristic, afebrile, that causes flaccid paralysis of the cranial nerves and skeleton muscles.…”