Mangilli Laura Davison, Andrade Claudia Regina Furquim de
Programa de Pós-Graduação em Ciencias da Reabilitação, Faculdade de Medicina, Universidade de São Paulo, Brazil.
Pro Fono. 2007 Apr-Jun;19(2):215-22. doi: 10.1590/s0104-56872007000200010.
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.
To present the speech therapy procedures adopted with a patient with botulism and who was presenting dysphagia.
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.
Improvement in mobility, tonicity and sensibility of the OMSs; improvement in the elevation of the larynx; re-establishment 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.
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.
肉毒中毒是一种严重的具有急性特征的神经麻痹症，无发热症状，由肉毒杆菌产生的毒素作用引起。这种毒素与运动神经元轴突膜的受体结合，阻止乙酰胆碱在神经肌肉接头处释放，导致颅神经和骨骼肌松弛性麻痹。
介绍对一名患有肉毒中毒且存在吞咽困难的患者所采用的言语治疗程序。
一名患有肉毒中毒的成年男性，因吞咽唾液困难而接受言语-语言评估。评估期间观察到以下情况：口面肌功能系统（OMSs）器官的运动性、张力和感觉改变；喉部运动减少；口腔内唾液淤积；吞咽反射缺失；吞咽功能缺失。进行了九次言语治疗，采用以下程序：刺激OMSs——运动性、张力和感觉；刺激口腔和咽部反射；针对不同食物稠度进行吞咽测试和训练，并借助旨在保护和清理气道的手法。
OMSs的运动性、张力和感觉得到改善；喉部抬高改善；无需其他专业人员协助或临床手法即可重新建立吞咽功能；嗓音质量接近正常参数（轻度高鼻音和呼吸-语音-发音不协调）。患者出院，不再接受言语治疗；建议进行临床辅助以调整和改善OMSs。
言语治疗在重建OMSs和吞咽功能方面显示出有效性，使患者能够恢复其口面肌功能系统的适当功能。
