Audiological Medicine, 2010; 8: 163–170

ORIGINAL ARTICLE

Communication and its disorders: Definition and taxonomy

from a phoniatric perspective

ANTONIO SCHINDLER1, GIOVANNI RUOPPOLO2 & UMBERTO BARILLARI3

1Department of Clinical Sciences ‘L. Sacco’, University of Milan, Milan, 2Department of Otorhinolaryngology, Audiology,
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Phoniatrics ‘G. Ferreri’, University of Rome ‘La Sapienza’, Rome, and 3Department of Audiology and Phoniatrics,
Second University of Naples , Naples, Italy

Abstract
Objective: The aim of the paper is to describe communication sciences and disorders from a phoniatric perspective,
i.e. from the point of view of medical doctors involved in the rehabilitation management of a communication disorder.
Communication: Communication is a complex behaviour, combining physical and mental events, with the aim of exchang-
ing messages between two or more individuals. Communication is the execution of a task by an individual in his daily life.
Different body structures and functions, as well as environmental factors, strongly impact on communication and related
activities. Communication disorders: A communication disorder is an impairment in sending and/or receiving a message; it
For personal use only.

could be the consequence of a disease, a treatment or an environmental situation. There are several professions, both
medical and non-medical, involved in the management of patients with a communication disorder. The phoniatrician is
the only medical doctor whose focus is the diagnosis and rehabilitation of communication disorders. Taxonomy of commu-
nication disorders: There are several diseases, conditions and situations that can lead to a limitation and/or restriction in
communication. A list of diseases would be misleading in describing possible communication disorders; it might be more
useful to offer a framework of the impaired functions that may lead to a communication disorder. A communication dis-
order taxonomy based on the direct and indirect impairment of voice, speech, language and hearing functions is presented.
Conclusion: The presented taxonomy may contribute to the assessment and management of patients with communication
disorders and represents a framework for clinical research in the different disciplines involved in the large field of
communication science and disorders.

Key words: communication, communication disorders, phoniatrics, taxonomy, voice, speech, language, hearing, ICF

Introduction to a referee communicating the call of an off-side

during a soccer game. While it is extremely difficult,
Communication is a complex behaviour, combining
and beyond the aim of this paper, to define com-
physical and mental events, with the aim of exchang-
munication, there are several facets that need to
ing messages between two or more individuals
considered (2):
(1). Communication plays a significant role in the
lives of both animals and human beings; only humans
could also take advantage of the language function • Communication is an exchange of messages;
for the exchange of messages. When communication not only is a message sent by one person
takes place as a result of the language function, it to another, but an answer or at least some
is called verbal communication. However, human kind of feedback is also sent in reply to the
communication is a much broader concept than the received message. Thus, communication can be
simple exchange of verbal messages between a speaker seen as a circular rather than linear pattern
and a listener. It includes different situations – from of behaviour between individuals. Several
a 10-month-old child interacting with his mother, communication channels can be used during

Correspondence: A. Schindler, U.O. Otorinolaringoiatria, Ospedale ‘L. Sacco’, Via GB Grassi 74, 20154 Milan, Italy. Fax: ⫹39 02 50319855. E-mail: antonio.
schindler@unimi.it

(Accepted 5 October 2010)

ISSN 1651-386X print/ISSN 1651-3835 online © 2010 Informa Healthcare
DOI: 10.3109/1651386X.2010.530023
 164 A. Schindler et al.
communication; a communication channel is
the physical space connecting the organs send-
ing and receiving a message. For example, there
is a communication channel between the mouth
that is uttering the word and the ear that is
hearing that word; another communication
channel lies between the hand producing a ges-
ture and the eyes seeing that gesture. Each
channel has its own proper and finite capacity
as the amount of information passing through
a channel for a given time unit is not infinite.
Different communication modalities may be
used: communication modalities may be divided
into two broad categories – verbal, which is
communication based on a language system
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(oral, signed, oral-derived, as in Morse code),
and non-verbal.
• Communication messages are conveyed by
signs: signs include all actions, events and
objects that have a communication value. There
are three main types of signs: indexes, icons and
symbols depending on the relationship between
the sign and what it represents. In indexes, this
relationship is one of cause and effect and/or
physical proximity, as in the case of an auto-
For personal use only.
nomic response indicative of emotional states;
in icons there is a physical resemblance between
the sign and what it signifies, as in the case of
pictures; in symbols, finally, the relationship
between the sign and what it represents is
arbitrary and conventional and reflects the his-
torical, geographical and cultural background
in which they were created and are used, as in
the case of the signs of language (3).
• Messages may have different degrees of sophis-
tication, ranging from extremely simple to
extremely complex:
• Communication is carried out in consequence
of a desire or need;
• Communication is carried out in a given envi-
ronment, that impacts on the channel capacity,
the signs used, the complexity and the modality
of the message as well as on the need and desire
to communicate.
If all of these facets of human communication are
considered, it is not surprising that different disci-
plines, ranging from anatomy to physiology, neurosci-
ence, psychology, linguistics, education, acoustics,
sociology and many other fields are involved in the
development of communication science. The aim of
the paper is to describe communications sciences and
disorders in a phoniatric perspective, which is from
the point of view of medical doctors involved in
the rehabilitation management of a communication
disorder. Following an initial description of structures,
function, activities and participation, as well as envi-
ronmental factors related to communication, we pres-
ent a taxonomy of communication disorders.
Communication and related functions
As already stated, a definition of communication
including all of the different perspectives related to
it is beyond the aim of this paper; however, a defini-
tion to be used in a health perspective will be useful
for a better understanding of communication disor-
ders and the related taxonomy. Given the large
number of different professions involved in the man-
agement of patients with communication disorders,
the terminology used is inconsistent (4). Several
authors have tried to implement solutions to the
terminology problem (5,6), but the suggestions for
improvement have never been adopted. In order to
overcome this terminology problem (7), we use the
terms and definition of the International Classifica-
tion of Functioning, Disability and Health (ICF) in
this paper (8).
ICF is not intended to classify diseases, but the
consequences of health related problems of patients
with chronic diseases and disabilities, and today it
is considered the most relevant classification for
functioning, disability and health. The ICF was
published by the World Health Organization in
2001, and different disciplines, including health
insurance, social security, labour, education, peo-
ple with disabilities and several medical specialists
were involved in its development. Moreover, one
of the ICF aims is to establish a common language
for describing health and health related states in
order to improve communication between differ-
ent disciplines.
ICF is divided into two parts: 1) Part one consists
of three sections: body functions (the physiological
functions of body systems), body structures (ana-
tomical parts of the body) and activity and participa-
tion (the execution of a task or action by an
individual and involvement in a life situation, respec-
tively); 2) Part two comprises two other sections –
the environmental factors (physical, social and
attitudinal environment in which people live and
conduct their lives), and personal factors (the par-
ticular background of an individual’s life and living).
The section personal factors is currently included in
the ICF framework but does not include a list of
items because it comprises features of the individual
that are not part of health condition or health states
but influence how disability is experienced by the
individual (e.g. gender, age, coping styles, social
background, education, profession, past and current
experience). Each of the four classified sections (body
functions, body structures, activity and participation,
 Communication disorders definition and taxonomy 165
Table I. Communication, its sections and definitions according to the ICF.

Communication section Communication sub-section Definition

Communicating - receiving Spoken messages Comprehending literal and implied meanings of

Receiving – non-verbal messages (body
gestures, general symbols, drawings
and photographs)
Receiving – formal sign language messages
Written messages
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messages in spoken language, such as understanding
that a statement assert a fact or is an idiomatic
expression
Comprehending the literal and implied meaning of
messages conveyed by gestures, symbols and drawings,
such as realizing that a child is tired when she rubs the
eyes or that a warning bell means that there is fire
Receiving and comprehending messages in formal sign
language with literal and implied meaning
Comprehending the literal and implied meanings of
messages that are conveyed through written language
(including Braille), such as following political events in
the daily newspaper

Communicating - producing Speaking Producing words, phrases and longer passages in spoken
messages with literal and implied meaning, such as
expressing a fact or telling a story in oral language
Producing – non verbal messages (using Using gestures, symbols and drawings to convey
body language, symbols, drawing and messages, such as shaking one’s head to indicate
photographs) disagreement or drawing picture or diagram to convey
a fact or complex idea
Producing messages in formal sign Conveying with formal sign language, literal and implied
language meaning
Writing messages Producing the literal and implied meaning of messages
that are conveyed through written language, such as
writing a letter to a friend
For personal use only.

Conversation and use of
communication devices
and techniques
Conversation (starting, sustaining,
ending a conversation)
Discussion (with one person, with many
people)
Using communication devices and
techniques (using telecommunication
devices, writing machines)
Starting, sustaining and ending an interchange of
thoughts and ideas, carried out by means of spoken,
written, sign or other forms of language, in formal or
casual settings
Starting, sustaining and ending an examination of
matter, with arguments for or against, or debate
carried out by means of spoken, written, sign or other
forms of language, with one or more people one
knows or who are strangers
Using devices, techniques and other means for the
purpose of communicating, such as calling a friend on
the telephone

environmental factors) is divided into chapters, Communication should not be considered an

under which are common categories or specific items.
Within each chapter there are individual two-, three-
or four-level categories; categories are arranged
hierarchically so that users can pick the level of gran-
ularity that suits their purpose.
In ICF, communication is considered both an
activity and a participation. Following the ICF sys-
tem, communication includes three main sections:
receiving messages (spoken, written, signed, non-
verbal), producing messages (spoken, written, signed,
non-verbal) and conversation. Communication sec-
tions and their definitions are reported in Table I.
According to the ICF system it is quite clear that
communication is an activity of daily living, and that
communication may use the mental functions of
language (oral, written, signed) as well as other
functions for non-verbal communication. Most
importantly, language is not considered an activity or
a participation, but a mental function.
independent activity/participation, since it might
impact on other activities/participations. Even if few
data exist on the relationship between communica-
tion and other activities and participations, it might
be speculated that the following activities/participa-
tion are influenced by communication: interpersonal
interactions and relationships, education, work and
employment, economic life as well as community,
social and civic life (Table II).
While communication is an activity and a
participation, several structures are essential for
human communication. The central nervous system,
as well as the sensory organs, plays a central role
together with structures involved in respiration,
voice and speech. Furthermore, the structures
related to movement need to be considered since
they are often essential for non-verbal communica-
tion, signed verbal communication, and written
verbal communication.
 166 A. Schindler et al.
Table II. Structures, functions, activities and participation, and environmental factors related to communication.
Functioning domains Chapter of the functioning domains
Structures Structures of the nervous system
- structures of brain
- structures of spinal cord
Structures of the eye and ear
Structures involved in voice and speech
- structure of nose, mouth, pharynx
- structure of larynx
Structures of the respiratory system
Structures related to movement
Functions Mental functions
- consciousness
- orientation
- intellectual functions
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- global psychosocial functions
- attention
- memory
- perceptual functions
- thought functions
For personal use only.
- higher level cognitive functions
- mental functions of language
- mental functions of sequencing
complex movements
- experience of self and time
Sensory functions
- seeing functions
- hearing functions
- vestibular functions
- proprioceptive functions
- touch functions
Voice and speech functions
- voice functions
- articulation functions
- fluency and rhythm of speech
functions
- alternative vocalization functions
Functions of the respiratory system
Activities and Interpersonal interactions and
Participation relationship
- basic, complex and general
interpersonal interactions
- relating with strangers
- formal, informal, family and intimate
relationships
Definitions
- general mental functions of the state of awareness and alertness
- general mental functions of knowing and ascertaining one’s relation
to self, to others, to time and to one’s surroundings
- general mental functions required to understand and constructively
integrate the various mental functions, including all cognitive
functions and their development
- general mental functions, as they develop over the life span, required
to understand and constructively integrate the mental functions that
lead to the formation of the interpersonal skills needed to establish
reciprocal social interactions,
- specific mental functions of focusing on an external stimulus or
internal experience for the required period of time
- specific mental functions of registering and storing information and
retrieving it as needed
- specific mental functions of recognizing and interpreting sensory stimuli
- specific mental functions related to the ideational component of
the mind
- specific mental functions especially dependent on the frontal lobes of
the brain, including complex goal-directed behaviours such as
decision-making, abstract thinking, planning and carrying out plans,
mental flexibility, and deciding which behaviours are appropriate
under what circumstances;
- specific mental functions of recognizing and using signs, symbols and
other components of a language
- specific mental functions of sequencing and coordinating complex,
purposeful movements
- specific mental functions related to the awareness of one’s identity, one’s
body, one’s position in the reality of one’s environment and of time
- sensory functions relating to sensing the presence of light and sensing
the form, size, shape and colour of the visual stimuli
- sensory functions relating to sensing the presence of sounds and
discriminating the location, pitch, loudness and quality of sounds
- sensory functions of the inner ear related to position, balance and
movement
- sensory functions relating to sensing the relative position of body parts
- sensory functions relating to sensing surfaces and their texture or quality
- functions of the production of various sounds by the passage of air
through the larynx
- functions of the production of speech sounds
- functions of the production of flow and tempo of speech
- functions of the production of other manners of vocalization
- function of inhaling air into the lungs, the exchange of gases between
air and blood, and exhaling air
Actions and tasks required for basic and complex interactions with
people (strangers, friends, relatives, family members, and lovers) in a
contextually and socially appropriate manner
(Continued)
 Communication disorders definition and taxonomy 167
Table II. (Continued).

Functioning domains Chapter of the functioning domains Definitions

Education
- informal education - learning at home or in some other non-institutional setting
- preschool, school education - learning at an initial level of organized instruction, designed primarily
- vocational training, higher education to introduce a child to the school-type environment
Major life areas
- education Tasks and actions required to engage in education, work and
- work and employment employment and to conduct economic transactions
- economic life
Community, social and civic life Actions and task required to engage in organized social life outside the
family, in community, social and civic life areas
Environmental Products and technology
factors - products and technology for - equipment, products and technologies used by people in activities of
communication sending and receiving information
Natural environment
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- sound - a phenomenon that is or may be heard in any volume, timbre or

- light
Support and relationships
- immediate and extended family
- friends
- peers, colleagues
- people in position of authority
- people in subordinate positions
For personal use only.
tone, and that may provide useful or distracting information about
the world
- electromagnetic radiation by which things are made visible by either
sunlight or artificial lighting and which may provide useful or
distracting information about the world
People or animals that provide practical physical or emotional support,
nurturing, protection, assistance and relationship to other person in
their home, place of work, school or in other aspects of their daily
activities

Attitudes The observable consequences of customs, practices, ideologies, values,

norms, factual and religious beliefs. These attitudes influence
individual behaviour and social life
Services Services providing benefits, structured programs and operations in
various sectors of society designed to meet the need of individuals
Policies Rules and regulations established by governments at the local, regional,
national and international level

Different body functions are also necessary
and contribute to communication (Table II).
Voice, speech, language and hearing have always
been considered the functions contributing the most
to communication. However, many functions are
required to use voice, speech, language and hearing
functions in communication activity and participa-
tion. Furthermore, given the communication facets
described previously, there are many more functions
involved in communication (Table II). For instance,
if you are communicating a complex subject to a
friend, first you need to be awake and conscious, then
you need higher level cognitive functions to organize
your ideas properly, and finally you will use your
speech and language functions to express your ideas.
At the same time you will need your seeing functions
in order to analyse your friend’s feedback coming
from his facial expressions.
With regard to many other activities and partici-
pations, communication could be influenced by sev-
eral environmental factors (Table II). Environmental
elements that may be considered important factors in
human communication, as they each have their own
impact, could include the following: products and
technology for communication, products and tech-
nology for education, light, sound, air quality, support
and relationships, attitudes, services, systems and
policies. For instance, an anarthric adolescent with
cerebral palsy could have a severe limitation in com-
munication; however, the implementation of a simple
product for communication, as a communication
board, could improve his communication limitation.
Communication disorders
A communication disorder is an impairment in send-
ing and/or receiving a message. This could result as
a consequence of a disease, as in the case of a deaf
patient who cannot hear an oral message, the conse-
quence of a treatment as in the case of a patient
who cannot speak after a total glossectomy, but it
could also be the consequence of an environmental
situation as in the case of wolf children, when chil-
dren grow up with minimal human contact. There
are several professions, both medical and non-
medical, involved in the management of patients with
 168 A. Schindler et al.
a communication disorder. On the one hand, there
are many non-medical professions that take care of
people with a communication disorder: speech and
language pathologists, occupational therapists, psy-
chologists, psychomotor specialists, teachers for the
deaf, special education experts, pedagogists, engi-
neers and many others; each of these professions has
its own perspective and goals, but the speech and
language pathologist is the only non-medical profes-
sion entirely devoted to the assessment and manage-
ment of communication disorders. On the other
hand, there are different medical specialities treating
diseases that impair key structures or functions for
communication: otolaryngologists, neurologists, psy-
chiatrists, physical medicine specialists, child neu-
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rologists, plastic surgeons, neurosurgeons, etc. The
phoniatrician is the only medical doctor whose focus
is on the diagnosis and rehabilitation of communica-
tion disorders. For example, if a patient has a com-
munication disorder due to an aphasia following an
ischaemic stroke, it is the neurologist’s role to estab-
lish the diagnosis of an ischaemic stroke, treat it and
prevent further complications, while it is the phonia-
trician’s role to understand the impact of the brain
lesion on the patient’s verbal and non-verbal com-
For personal use only.
munication and thus establish a rehabilitation pro-
gramme to be implemented. At the same time, while
a nurse gives medications and takes over many
aspects of this patient, the speech and language
pathologist, applying his own assessment and reha-
bilitation protocols, rehabilitates the communication
disorder in collaboration with the phoniatrician.
Taxonomy of communication disorders
There are several diseases, conditions and situations
leading to communication limitation and restriction.
A list of diseases, as can be found in the International
Classification of Diseases (ICD) (9), even if well
structured and organized, would be misleading and
incomplete in describing communication disorders.
A better framework for the field would be to analyse
the functions that, once impaired, lead to a commu-
nication disorder. Even if several functions contrib-
ute to communication activity and participation,
and need to be considered in a rehabilitative perspec-
tive, only the impairment of voice, speech, language
and hearing functions are used for communication
disorder taxonomy. Other functions that significantly
contribute to communication, as intellectual func-
tions, are considered in this taxonomy as long as they
impact on voice, speech, language and hearing. Thus,
in the taxonomy here reported (Table III), aetiology
does not play a role; on the contrary, the system is
based on the functional systems that contribute to
communication. This kind of taxonomy is very useful
for rehabilitation planning. In the wide field of
rehabilitation, procedural interventions might be
divided into restorative and compensatory interven-
tions. Restorative interventions are directed toward
remediating or improving the impaired function;
compensatory interventions, on the other hand, are
directed toward promoting optimal functioning using
residual abilities. The taxonomy reported here high-
lights the functional systems that are impaired and
might be improved through restorative interventions,
without considering the preserved functional sys-
tems. For example, a stroke patient with a language
disorder due to damage of the language areas (apha-
sia), may improve his language function through
restorative interventions; at the same time he also has
a very high chance of improving his non-verbal com-
munication as a result of compensatory interven-
tions, using other preserved functional systems, such
as the intellectual and psychosocial functions. On the
other hand, a stroke patient with diffuse brain dam-
age has an impairment of several intellectual func-
tions and may only use restorative interventions for
both language and communication improvement.
The taxonomy presented here is applicable to the
entire age spectrum, from a developmental age to geri-
atric age: communication disorders may involve chil-
dren, adults, the elderly and the extremely elderly.
Voice disorders
Voice disorders are a large spectrum of conditions
characterized by deviation in pitch, intensity or
quality of the voice, and may involve the entire
age spectrum. They might be due to a body struc-
ture impairment (laryngeal alterations) and are thus
called ‘organic voice disorders’; another group of
voice disorders is related to a neuromuscular control
of the voice modification and they are called ‘move-
ment disorders’. A large group of voice disorders,
however, is neither organic nor movement disorders,
and may be psychogenic or related to altered laryn-
geal kinesiology (‘functional voice disorders’).
Speech disorders
The term ‘speech disorder’ covers an extremely large
group of conditions, since different structural and
functional systems contribute to speech. Motor speech
disorders result from neurological impairment affect-
ing motor planning and programming (apraxia of
speech) or execution of speech (dysarthria). They may
involve children, adults or geriatric patients. Fluency
disorders are deviations in the flow and rhythm of
speech and develop in childhood, even if manifesta-
tions may last the whole lifetime; in rare cases fluency
 Communication disorders definition and taxonomy 169
Table III. Taxonomy of communication disorders.

Impaired function Communication disorder Definition

Voice Voice disorders (dysphonia) Deviation in pitch, intensity or quality of the voice due to laryngeal
- organic voice disorder (organic), kinesiology (functional) or neuromuscular control of the
- functional voice disorder voice (movement disorder) modification
- movement disorder
Speech Motor speech disorders Speech disorders resulting from neurologic impairment affecting
- dysarthria complex movements sequencing (apraxia of speech) or execution of
- apraxia of speech speech (dysarthria)
Fluency disorders Deviation in the flow and rhythm of speech with involuntary
- stuttering repetitions, prolongations of sounds, syllables, words, or phrases and/
- cluttering or involuntary silent pauses or blocks (stuttering) or with rapid
utterances and many elisions, transpositions and omissions (cluttering)
Organic speech disorders Speech disorders resulting from speech structures impairment due to
malformations (e.g. cleft palate), medical treatment (e.g. glossectomy),
or trauma
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Articulation (phonetic) disorders
Auditory based speech disorders
Language Primary language disorders
- aphasia
- specific language impairment
- phonological disorder
- developmental dyslexia
Secondary language disorders or language Language disorders resulting from an impairment in a function
disorders due to:
For personal use only.
Speech disorders based on difficulty in learning to physically produce
the intended phoneme
Speech disorders due to reduced or absent auditory feedback (hearing
function)
Language disorders not due to hearing, mental, neurologic, psychosocial
disorder or cultural restriction. The language disorder may be due to
a damage of brain language areas (aphasia) or to a dysfunction in
phonological (phonological disorder) and lexical and grammatical
oral (specific language impairment) or written (developmental
dyslexia) language acquisition
different from language (hearing, intellectual function, higher level

- deafness cognitive functions, psychosocial function, attention) or in a

- mental retardation structure not related to language (diffuse brain damage) or a social/
- pervasive developmental disorders cultural restriction
- attention deficit hyperactivity disorders
- acquired diffuse brain damage
- social/cultural/language issues
Hearing Deafness Severe hearing disorder resulting from a cochlear impairment
Central auditory processing disorders Disorders that affect the way the brain processes auditory information

disorders are not developmental but acquired, follow-
ing brain damage. In the case of stuttering they are
characterized by involuntary repetitions, prolonga-
tions of sounds, syllables, words, or phrases and/or
involuntary silent pauses or blocks. Cluttering, instead,
manifests with rapid utterances and many elisions,
transpositions and omissions and is often considered
a disorder of the thought processes preceding speech.
Organic speech disorders result from speech structure
impairment due to malformations (e.g. cleft palate),
medical treatment (e.g. glossectomy), or trauma; they
may involve the entire age spectrum. Articulation dis-
orders, also called phonetic disorders, are develop-
mental speech disorders based on a difficulty in
learning to physically produce the intended phoneme.
Finally, auditory based speech disorders are due to
reduced or absent auditory feedback, and may affect
whoever develops significant bilateral hearing loss.
Language disorders
Language disorders are the main and more complex
group of communication disorders; both spoken
and written language can be impaired. Language
disorders may affect the entire age spectrum and are
divided into two main groups: primary language dis-
orders and secondary language disorders. While sec-
ondary language disorders are due to an impairment
of a function different from language, in primary lan-
guage disorders only the language function is
impaired. Primary language disorders can be acquired
or developmental. Acquired primary language disor-
ders are due to damage to brain language areas.
Developmental primary language disorders may
involve only the phonological component of spoken
language (phonological disorder), as well as all of the
different language subsystem (phonology, lexicon,
grammar and pragmatics) and are called specific lan-
guage impairment; furthermore, in an increasing
number of cases only the written language function
is impaired (developmental dyslexia).
Secondary language disorders include a large vari-
ety of diseases and conditions. They include: language
disorders due to a severe/profound hearing problem
in children under three years of age; language disor-
ders secondary to the impairment of a specific mental
 170 A. Schindler et al.
function, the psychosocial mental function, as in
the autistic spectrum; language disorders due to a
severe intellectual impairment, as in the case of men-
tal retardation and dementia, or to a higher level cog-
nitive impairment, as in the case of diffuse brain
damage. Finally, an increasing number of patients
experience a form of language disorder following a
reduced exposure to a given language, which may
be the consequence of the increasing number of
immigrants or to a reduced social experience.
Hearing disorders
Hearing disorders may affect children, adults and
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elderly individuals; they may be due to a reduced ear
function (deafness) or may be the consequence of
central auditory pathway impairment (central audi-
tory processing disorders).
Conclusions
As societies worldwide have evolved, the number of
workers who need communication abilities to carry
For personal use only.
out their jobs is constantly increasing; thus, com-
munication disorders severely impact not only on the
clinical activity of several professions, but also on the
economic costs of modern countries (10). Commu-
nication disorders include a large variety of clinical
conditions and phoniatricians are the medical doc-
tors specifically devoted to their management in a
rehabilitative perspective. Phoniatrics is a medical
speciality officially created in 1905, when the first
phoniatric clinic was established in Germany (11).
Over the last century, phoniatrics has spread to many
European and non-European countries and it is now
included in the medical education of many countries
(12–18). While many medical specialities may con-
tribute significantly to the management of patients
with communication disorders, only phoniatrics has
a complete vision of communication disorders, their
assessment, management and rehabilitation plan-
ning. Since the presented taxonomy is based on ICF
definitions, it may overcome terminology problems
related to the large number of professions involved.
Also, the taxonomy presented here represents a
framework for clinical practice and research in the
different disciplines involved in communication sci-
ence and disorders.
Declaration of interest: The authors report no
conflicts of interest. The authors alone are respon-
sible for the content and writing of the paper.
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