THE process of symbolization is the most distinctively human of man's bodily functions. The clinically recognized impairments of the symbolization process are primarily those of spoken language. Disorders of spoken language involve impaired phonation, speech sound articulation, fluency and rate, or symbolic representation, singly or in combination, associated or not with significant organic or physiological complications or emotional disturbance.
The clinically significant organic or physiological conditions most often associated with speech problems are those related to hearing loss, cleft palate, laryngectomy, cerebral palsy or other types of neuromuscular impairment, brain damage including cerebrovascular accident with attendant aphasia and dysarthria, and retarded or limited development affecting language and speech. Associated emotional reactions are rather more likely to be effects than causes of the speech disorder, and are, in any event, interactive with it.
The magnitude of the problem is suggested in part by current estimates of incidence. I recently had occasion
Johnson W. PROBLEMS OF IMPAIRED SPEECH AND LANGUAGE: GUEST EDITORIAL. JAMA. 1959;170(17):2102–2103. doi:10.1001/jama.1959.03010170064014
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