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Dysphagia in the Myopathies (pp. 49-68) $100.00
Authors:  (Danielle Ramos Domenis, Raphaela Barroso Guedes Granzotti, Paula de Carvalho Macedo Issa Okubo, Claudia Ferreira da Rosa Sobreira, Roberto Oliveira Dantas, Departamento of Ophtalmology, Otolaryngology and Head and Neck Surgery, University Hospital of Ribeirão Preto, USP, Ribeirão Preto, SP, Brazil, and others)
Myopathies are hereditary or acquired diseases of skeletal muscle
that result from dysfunction of any constituent of this tissue, leading to
the onset of isolated symptoms or combinations of signs and symptoms.
There are several types of myopathies, among them inflammatory ones,
muscular dystrophies, congenital myopathies, mitochondrial myopathies,
and metabolic myopathies. Swallowing is a neurophysiological process
whose main function is the efficient transport of food from the mouth to
the stomach and which may be divided into four phases: preparatory,
oral, pharyngeal, and esophageal. Dysphagia is defined as a set of
alterations in any one of these phases, which may cause changes in eating
pleasure, malnutrition, dehydration, and even the risk of death. Dysphagia
is one of the changes that may be present in myopathies and may vary
according to the type of myopathy and the duration of the disease, among
other factors. It may appear as an initial symptom or during the course of
the disease. Together with cerebrovascular accidents and cranial traumas,
neuromuscular diseases are one of the main causes of dysphagia, mainly
as a consequence of changes in skeletal muscle directly related to the
swallowing process. Speech therapy intervention is essential for
dysphagic patients in order to identify factors that increase the risk of
tracheal aspiration and to determine ways of avoiding it, thus
guaranteeing safe swallowing. This therapy starts with a process of
clinical and instrumental evaluation of swallowing. Clinical evaluation is
of fundamental importance and guides the indication of objective exams,
when necessary, as well as the therapeutic process. Among the objective
or complementary methods, videofluoroscopy of swallowing,
nasofibrolaryngoscopy and manometry are those most frequently used.
After clinical and complementary evaluation it is possible to make an
appropriate speech therapy diagnosis and to establish a later conduct
regarding the safest feeding route, as well as the indication of
rehabilitation or management. Few studies of myopathies have described
speech therapy rehabilitation in dysphagia, as well as its efficacy. As is
the case for other neurological diseases, it should be kept in mind that the
main objective of rehabilitation in the presence of dysphagia often is not
the return to, or the maintenance of, feeding by the oral route, but rather
the provision of safe nutrition and hydration conditions. 

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Dysphagia in the Myopathies (pp. 49-68)