Clinical Assessment Comparison: Trail Making
The following table outlines the comparison of the standard Trail Making Test versus RESET's gamified Asteroid Adventure.
| The Trail Making Test (TMT) is an assessment of executive function (EF). The cognitive abilities it evaluates include visual scanning, visuo-motor tracking, divided attention, working memory, set-shifting and cognitive flexibility (Arbuthnott K & Frank J 2000; Lesak MD et al, 2012). It is ubiquitously used in the research and clinical care of adults and children with a variety of diagnoses including brain injury, ADHD, concussion, dementia, Parkinson’s, heart failure, cancer, diabetes and mental illness (schizophrenia, bipolar disorder, depression) (Lesak MD et al, 2012; Xiaofend G et al, 2011; Ranchet M, et al, 2012; Syrjala K et al, 2011; Guskiewicz KM et al, 2001). Many versions of the TMT exist some as a stand-alone test others as part of neuropsychological test batteries such as the Halsted-Reitan Neuropsychological Test Battery, Delis-Kaplan Executive Function System, and Alzheimer’s Disease Centers Uniform Data Set (National Institute of Aging). |
RESET's Asteroid Adventure evaluation is an updated version of Trails A and B that tests the client's speed of processing, sequence alternation, cognitive flexibility, visual searching, motor performance and executive functioning.
|
| The TMT consists of two parts, A and B. In part A, clients are asked to connected numbered circles scattered across a page and in part B they are asked to connect circles with alternating numbers and letters scattered across a page |
As the game begins, the explorer's ship navigates close to a unfamiliar planet and encounters a cluster of asteroids rich in resources. These asteroids must be mined as quickly and precisely as possible. As the game begins, the client taps asteroids in sequential order as quickly and correctly as possible. Tapping an asteroid in the correct order allows the client to proceed to the next asteroid. If the wrong asteroid is tapped, a red reticle appears over the incorrect asteroid and the client is not allowed to progress until the correct sequential asteroid is selected. |
| Clients are instructed to connect the numbers or letters "as fast as you can." If errors are made, the examiner points them out such that the client completes the test without errors. The score is based only on time . |
A learn by doing tutorial is presented to assure that the client can perform the activity within the test. |
| Up to 4 minutes, depending on client performance. |
Up to 4 minutes, depending upon client performance. |
|
Scored with a stopwatch and paper by the administrator. Administrator must interrupt the client each time an error is made. The administrator’s technique introduces random measurement error.
Results for both TMT A and B are reported as the number of seconds required to complete the task; therefore, higher scores reveal greater impairment.
|
Computer scored. Errors and time tracked. Systematic measurement, error limited to 1/1000 of a second. |
| The TMT is sensitive to the effects of brain injury, progressive cognitive decline in dementia, and difficulty with IADL’s in the elderly (Lesak MD et al, 2012; Fernandez AL & Marcopuos BA, 2008). TMT-B has been found to be correlated with or predictive of driving ability in older adults with cognitive-visual impairments and individuals with dementia, Alzheimer’s, Parkinson’s, brain injury, and stroke (Asimakopulos J et al, 2012; Niewowhner PM et al, 2012; Ranchet M, et al, 2012). Impairments in executive function, as measured by Trails-B and other executive function measures, have been associated with falls in community dwelling older adults . |
Similar |
| Norms vary across cultures and sample characteristics (Lesak MD et al, 2012; Fernandez AL & Marcopuos BA, 2008). Reliability coefficients differ, but are generally above 0.65 for Trails B . |
To Be Determined |
REFERENCES
Arbuthnott K & Frank J. Trail making test part B as a measure of executive control validation using a set switching paradigm. J Clin & Experimental Neuropsych. 2000;22(4):518-528.
Asimakopulos J, Boychuch Z, Sondergaard D, et al. Assessing executive function in relation to fitness to drive a review of tools and their ability to predict safe driving. Austrailian Occupational Therapy Journal 2012; 59: 402-427l .
Fernandez AL, Marcopuos BA. A comparison of normative data for the trail making test from several countries equivalence of norms and considerations for interpretation. Scand J Pschol. 2008;49(3):239-46.
Guskiewicz KM, Ross S, Marshall. Postural stability and neuropsychological deficits after concussion in collegiate athletes. J of Athletic Training. 2001;36(3):263-273.
Lesak MD, Howieson DB, Bigler ED, Teranel D (2012). Neuropsychological Assessment 5th Edition. New York: Oxford University Press.
Niewowhner PM, Henderson RR, Dalchow J, et al. Predicting road test performance in adults with cognitive visual impairment referred to a Veterans Affairs Medical Center driving clinic. J Am Geriatr Soc. 2012; 60(11):2070-2074.
Ranchet M, Broussolle E, Poisson A et al. Relationships between cognitive functions and behavior in Parkinson’s disease. Eur Neurol. 2012;68:98-107.
Syrjala K, Atherholt SB, Kurland BF, et al. Prospective neurocognitive function over 5 years after allogenic hematopoietic cell transplantation for cancer survivors compared with matched controls at 5 years. J of Clin Oncol. 2011;29(17):2397-2404.
Xiaofend G, Zhanchou Z, Weiwei Z, et al. Cognitive functioning in schizophrenia with or without diabetes. J Cent South Univ. 2011;36(8):724-727.