Disclaimer: this resource is intended for speech and language therapists and students of this profession. If you require therapy for aphasia please contact a speech and language therapist.
Treatment of Underlying Forms (TUF)
Summary: Treatment of Underlying Forms (TUF) is a linguistic approach that seeks to improve sentence comprehension and production amongst patients with agrammatic aphasia (e.g. Broca’s aphasia). More complex and non-typical sentence structures, e.g. passive sentences and sentences with embedded clauses, are targeted on the basis that improvements in these will generalise effectively to untrained, related sentence structures that are less complex.
Example: The treatment outlined below is an example of how Treatment of Underlying Forms (TUF) could be used to train a client to produce object cleft sentences (i.e. sentences with a main clause and a dependent clause). In this instance the target sentence is ‘It was the boy who the girl hit’.
Assessing the client’s ability to comprehend and produce object cleft sentences: The client is presented with a semantically reversible pair of pictures (e.g. a girl hitting a boy and a boy hitting a girl). The client’s ability to comprehend and to produce object cleft sentence structures are probed as follows:
1) Comprehension: the therapist provides a spoken target object cleft sentence (in this case either “It was the boy who the girl hit” or “It was the girl who the boy hit”) and asks the client to match this to the corresponding picture.
2) Production: the therapist primes the client to produce an object cleft sentence “In this picture it was the girl who the boy hit. But in this picture [pointing to the target picture]...”. The client responds or is supported to respond “...it was the boy who the girl hit”.
Treatment
Thematic Role Training:
1) The therapist selects one of the sentences used above to focus on in treatment, e.g. “Let’s focus on this sentence ... It was the boy who the girl hit”.
2) Below the picture of the girl hitting the boy the therapist now places 4 cards which, when laid side-by-side, read as follows: “THE GIRL” “HIT” “THE BOY”. The client now repeats or reads this active form of the sentence aloud. The therapist also introduces 2 additional cards: “IT WAS” and “WHO” and lays these next to the picture.
3) The therapist then familiarises the client with the verb and verb arguments in this sentence as follows:
“This is hitting - it is the action of the sentence”
“This is the girl - she is the person who did the hitting”
“This is the boy - he is the person who was hit”
4) The therapist then asks the client to identify the agent, person hitting and person being hit.
5) The client again repeats or reads this active form of the sentence aloud.
Sentence Building:
1) The therapist now explains that they are “going to make a new sentence” based on the picture using the cards. The “WHO” card is placed next to the object noun-phrase “THE BOY” because he “the boy is the person who was hit”. The client now repeats/reads aloud the sentence as it stands: “THE GIRL” “HIT” “THE BOY” “WHO”.
2) The therapist then moves the the object noun-phrase and the “WHO” cards to the beginning of the sentence. The sentence now reads “THE BOY” “WHO” “THE GIRL” “HIT”. The therapist explains this as follows: “To make this new sentence, you move these words to the start of the sentence. These words move together because the boy is the one who was hit.”
3) The therapist explains that to make the sentence grammatically correct the phrase “It was” must be added to the beginning of the sentence (demonstrated using the “IT WAS” card).
4) The client then reads and repeats the grammatically correct sentence “IT WAS” “THE BOY” “WHO” “THE GIRL” “HIT”.
Thematic Role Training:
1) The therapist explains that the agent, person hitting and person being hit are the same in this new sentence as in the original sentence.
2) The therapist then asks the client to identify the agent, person hitting and person being hit.
3) The client again repeats or reads this active form of the sentence aloud.
Practice:
1) The therapist repositions the sentence element cards into their original positions (i.e. “THE GIRL” “HIT” “THE BOY”) and asks the client to move the cards so as to recreate the object cleft sentence. The therapist offers support as necessary.
Reassessing the client’s ability to comprehend and produce object cleft sentences:
1) The therapist again uses spoken sentence to picture matching and sentence production priming tasks to assess the client’s ability to comprehend and produce object cleft sentences (see above).
Adapted from Thompson (2001).
Assessing the client’s ability to comprehend and produce object cleft sentences: The client is presented with a semantically reversible pair of pictures (e.g. a girl hitting a boy and a boy hitting a girl). The client’s ability to comprehend and to produce object cleft sentence structures are probed as follows:
1) Comprehension: the therapist provides a spoken target object cleft sentence (in this case either “It was the boy who the girl hit” or “It was the girl who the boy hit”) and asks the client to match this to the corresponding picture.
2) Production: the therapist primes the client to produce an object cleft sentence “In this picture it was the girl who the boy hit. But in this picture [pointing to the target picture]...”. The client responds or is supported to respond “...it was the boy who the girl hit”.
Treatment
Thematic Role Training:
1) The therapist selects one of the sentences used above to focus on in treatment, e.g. “Let’s focus on this sentence ... It was the boy who the girl hit”.
2) Below the picture of the girl hitting the boy the therapist now places 4 cards which, when laid side-by-side, read as follows: “THE GIRL” “HIT” “THE BOY”. The client now repeats or reads this active form of the sentence aloud. The therapist also introduces 2 additional cards: “IT WAS” and “WHO” and lays these next to the picture.
3) The therapist then familiarises the client with the verb and verb arguments in this sentence as follows:
“This is hitting - it is the action of the sentence”
“This is the girl - she is the person who did the hitting”
“This is the boy - he is the person who was hit”
4) The therapist then asks the client to identify the agent, person hitting and person being hit.
5) The client again repeats or reads this active form of the sentence aloud.
Sentence Building:
1) The therapist now explains that they are “going to make a new sentence” based on the picture using the cards. The “WHO” card is placed next to the object noun-phrase “THE BOY” because he “the boy is the person who was hit”. The client now repeats/reads aloud the sentence as it stands: “THE GIRL” “HIT” “THE BOY” “WHO”.
2) The therapist then moves the the object noun-phrase and the “WHO” cards to the beginning of the sentence. The sentence now reads “THE BOY” “WHO” “THE GIRL” “HIT”. The therapist explains this as follows: “To make this new sentence, you move these words to the start of the sentence. These words move together because the boy is the one who was hit.”
3) The therapist explains that to make the sentence grammatically correct the phrase “It was” must be added to the beginning of the sentence (demonstrated using the “IT WAS” card).
4) The client then reads and repeats the grammatically correct sentence “IT WAS” “THE BOY” “WHO” “THE GIRL” “HIT”.
Thematic Role Training:
1) The therapist explains that the agent, person hitting and person being hit are the same in this new sentence as in the original sentence.
2) The therapist then asks the client to identify the agent, person hitting and person being hit.
3) The client again repeats or reads this active form of the sentence aloud.
Practice:
1) The therapist repositions the sentence element cards into their original positions (i.e. “THE GIRL” “HIT” “THE BOY”) and asks the client to move the cards so as to recreate the object cleft sentence. The therapist offers support as necessary.
Reassessing the client’s ability to comprehend and produce object cleft sentences:
1) The therapist again uses spoken sentence to picture matching and sentence production priming tasks to assess the client’s ability to comprehend and produce object cleft sentences (see above).
Adapted from Thompson (2001).
Evidence Base: Thompson et al. (1997) carried out a study investigating the effects of targeting Wh and noun-phrase movement in therapy for 2 participants with agrammatic aphasia. They found that therapy targeting object-clefts (a Wh movement structure) led to improvements in production of object wh-questions. Interestingly, therapy targeting Wh movement resulted in little generalisation to structures involving noun-phrase movement. The same effect was noted when therapy targeted a structure involving noun-phrase movement, i.e. improvements targeting subject raising (an example of an noun-phrase movement structure) generalised to a production of passives (another noun-phrase movement structure) but not to Wh movement structures.
Several studies have shown that greater generalisation is seen when therapy targets complex, atypical sentence structures. For example, in a study with 3 participants who had agrammatic aphasia Thompson et al. (1998) found that therapy targeting object clefts, an atypical (that is, noncanonical) Wh movement structure, resulted in generalisation to untrained object-extracted wh-questions (a more canonical wh movement structure). However, therapy targeting wh-questions did not result in generalisation to untrained object clefts.
TUF also appears to improve participants’ online comprehension of sentences. In a study into TUF treatment for Wh movement structures, participants who received TUF were able to reject anomalous sentences involving Wh movement whereas participants who did not receive this treatment were not (Dickey & Thompson, 2004).
As noted by Murray & Karcher (2008), there are few studies into the potential of TUF to generalise to other modalities and less structured tasks (e.g. discourse). Murray et al. (2007) treated one participant with agrammatic aphasia using a modified version of TUF, which targeted written ability as well as providing training on how to use target structures in discourse, and noted improvements in some aspects of discourse ability.
A computer-based TUF treatment, Sentactics®, has been developed. Thompson et al.’s (2010) study of twelve participants with agrammatic aphasia (six received Sentactics® therapy, six received no treatment) found that the Sentactics® software led to significant improvement in comprehension and production of trained and linguistically similar, untrained sentences, as compared to the control group. When the gains made by the Sentactics® treatment group were compared to those made by a participants in earlier studies who received clinician-led TUF, no significant difference was found.
Several studies have shown that greater generalisation is seen when therapy targets complex, atypical sentence structures. For example, in a study with 3 participants who had agrammatic aphasia Thompson et al. (1998) found that therapy targeting object clefts, an atypical (that is, noncanonical) Wh movement structure, resulted in generalisation to untrained object-extracted wh-questions (a more canonical wh movement structure). However, therapy targeting wh-questions did not result in generalisation to untrained object clefts.
TUF also appears to improve participants’ online comprehension of sentences. In a study into TUF treatment for Wh movement structures, participants who received TUF were able to reject anomalous sentences involving Wh movement whereas participants who did not receive this treatment were not (Dickey & Thompson, 2004).
As noted by Murray & Karcher (2008), there are few studies into the potential of TUF to generalise to other modalities and less structured tasks (e.g. discourse). Murray et al. (2007) treated one participant with agrammatic aphasia using a modified version of TUF, which targeted written ability as well as providing training on how to use target structures in discourse, and noted improvements in some aspects of discourse ability.
A computer-based TUF treatment, Sentactics®, has been developed. Thompson et al.’s (2010) study of twelve participants with agrammatic aphasia (six received Sentactics® therapy, six received no treatment) found that the Sentactics® software led to significant improvement in comprehension and production of trained and linguistically similar, untrained sentences, as compared to the control group. When the gains made by the Sentactics® treatment group were compared to those made by a participants in earlier studies who received clinician-led TUF, no significant difference was found.
References
Dickey, M.W. & Thompson, C.K., 2004. The resolution and recovery of filler-gap dependencies in aphasia: Evidence from on-line anomaly detection. Brain and Language, 88(1), 108–127
Murray, L.M. & Karcher, L., 2008. Can TUF Writing Make Speaking Easier?. In: Clinical Aphasiology Conference (Teton Village, WY). [online] Available at: <http://aphasiology.pitt.edu/archive/00001949/01/viewpaper.pdf> [Accessed 26/01/2016]
Murray, L.M., Timberlake, A., & Eberle, R., 2007. Treatment of underlying forms in a discourse context. Aphasiology, 21(2), 139-163
Thompson, C.K., 2001. Treatment of syntactic and morphologic deficits in agrammatic aphasia: Treatment of underlying forms. In: Chapey, R. ed. Language intervention strategies in aphasia and related neurogenic communication disorders. 4th ed. Philadelphia: Lippincott Williams & Wilkins, 235-255
Thompson, C.K., Ballard, K.J., & Shapiro, L.P., 1998. The role of syntactic complexity and training wh-movement structures in agrammatic aphasia: Optimal order for promoting generalisation. Journal of the International Neuropsychological Society, 4(6), 661-674
Thompson, C.K., Choy, J.J., Holland, A., & Cole, R., 2010. Sentactics®: Computer-automated treatment of underlying forms. Aphasiology, 24(10), 1242-1266
Thompson, C.K., Shapiro, L.P., Ballard, K.J., Jacobs, B.J., Schneider, S.L., & Tait, M.E., 1997. Training and generalized production of wh- and NP- movement structures in agrammatic aphasia. Journal of Speech and Hearing Research, 40(2), 228–244
Dickey, M.W. & Thompson, C.K., 2004. The resolution and recovery of filler-gap dependencies in aphasia: Evidence from on-line anomaly detection. Brain and Language, 88(1), 108–127
Murray, L.M. & Karcher, L., 2008. Can TUF Writing Make Speaking Easier?. In: Clinical Aphasiology Conference (Teton Village, WY). [online] Available at: <http://aphasiology.pitt.edu/archive/00001949/01/viewpaper.pdf> [Accessed 26/01/2016]
Murray, L.M., Timberlake, A., & Eberle, R., 2007. Treatment of underlying forms in a discourse context. Aphasiology, 21(2), 139-163
Thompson, C.K., 2001. Treatment of syntactic and morphologic deficits in agrammatic aphasia: Treatment of underlying forms. In: Chapey, R. ed. Language intervention strategies in aphasia and related neurogenic communication disorders. 4th ed. Philadelphia: Lippincott Williams & Wilkins, 235-255
Thompson, C.K., Ballard, K.J., & Shapiro, L.P., 1998. The role of syntactic complexity and training wh-movement structures in agrammatic aphasia: Optimal order for promoting generalisation. Journal of the International Neuropsychological Society, 4(6), 661-674
Thompson, C.K., Choy, J.J., Holland, A., & Cole, R., 2010. Sentactics®: Computer-automated treatment of underlying forms. Aphasiology, 24(10), 1242-1266
Thompson, C.K., Shapiro, L.P., Ballard, K.J., Jacobs, B.J., Schneider, S.L., & Tait, M.E., 1997. Training and generalized production of wh- and NP- movement structures in agrammatic aphasia. Journal of Speech and Hearing Research, 40(2), 228–244
|
|
