Treatment of Underlying Forms

Introduction to the Technique

Treatment for Underlying Forms (TUF) is a linguistic approach to aphasia therapy designed to improve sentence production and comprehension by targeting complex sentence structures. Developed by Cynthia Thompson and colleagues, TUF is based on the idea that training in complex sentence forms will generalize to simpler sentence structures due to shared syntactic properties.

TUF is designed for people with impaired grammar and sentence structure. Most successful people will have basic comprehension abilities, but this therapy might be too advanced for someone with severe comprehension impairments.

TUF is effective in helping people with aphasia produce more complex sentences. It has also led to longer sentences and improved correct use of verbs.

Patient population

This treatment is specifically designed for individuals with agrammatic aphasia, 

• Commonly seen in Broca’s aphasia.
• Individuals have difficulty understanding and producing complex sentences.
• People who can engage in structured linguistic exercises.
• Individuals with moderate to severe nonfluent aphasia.

Contraindication

• Severe comprehension deficits – If someone struggles to understand simple sentences, TUF may be too complex.
• Global aphasia – TUF requires some ability to process sentence structure.
• Significant cognitive impairments – Conditions like advanced dementia may make structured linguistic therapy ineffective.
• Severe apraxia of speech – If motor planning issues make sentence production nearly impossible, other therapies may be better suited.

Material with an Illustrated Example

Description of Technique

1. Step 01 - Thematic role training

• Show a picture of the subject + verb + object with a meaningful sentence.
• Guided question to identify roles.

            THE BOY             PAINTS              THE WALL

            AGENT                  ACTION              THEME

• Read or repeat

2. Step 02 - Sentence building

• Turn the original sentences into a question.

• WHAT DID THE BOY PAINT?

                                                      THE WALL

          THE BOY PAINTS WHAT?

                                                     THE WALL

3.  Step 03 - Thematic role training.

• Identify roles with the same guided question

         WHAT DID        THE BOY      PAINT?            THE WALL

                                     AGENT          ACTION          THEME

4. Step 04 - practice

• Re-arranged back into the original active sentence.
• Repeat

 Video Demonstration

           

 

Sample outcome recording sheet

 

Home-Based Activity

 1. Sentence Building with Cards

• On index cards, write sentence components (e.g., subject, verb, object, prepositional phrases).
• Mix them up and ask the individual to arrange them into a grammatically correct sentence.
• Gradually increase complexity (e.g., adding relative clauses: "The woman who is reading loves coffee").

2. Passive sentence hunt

Encourage the client to find passive sentences in newspapers or books.

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