Trail Making Test (TMT)

Purpose

The Trail Making Test (TMT) is a widely used test to assess executive function in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Successful performance of the TMT requires a variety of mental abilities including letter and number recognition mental flexibilityThe ability to shift between different thoughts and actions so that when a problem arises, one can draw upon past mistakes and successes and use this knowledge to plan solutions (Anderson, 2008)
, visual scanningDuring this intervention the person with USN is encouraged to conduct voluntary eye movements toward the neglected visual field (usually the left side) by performing a task in that hemispace. The treatment often includes a visual target that the patient uses as an anchor to direct voluntary gaze control while scanning.
, and motor function.

In-Depth Review

Purpose of the measure

The Trail Making Test (TMT) is a widely used test to assess executive abilities in patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. Successful performance of the TMT requires a variety of mental abilities including letter and number recognition mental flexibilityThe ability to shift between different thoughts and actions so that when a problem arises, one can draw upon past mistakes and successes and use this knowledge to plan solutions (Anderson, 2008)
, visual scanningDuring this intervention the person with USN is encouraged to conduct voluntary eye movements toward the neglected visual field (usually the left side) by performing a task in that hemispace. The treatment often includes a visual target that the patient uses as an anchor to direct voluntary gaze control while scanning.
, and motor function.

Performance is evaluated using two different visual conceptual and visuomotor tracking conditions: Part A involves connecting numbers 1-25 in ascending order; and Part B involves connecting numbers and letters in an alternating and ascending fashion.

Available versions

The TMT was originally included as a component of the Army Individual Test Battery and is also a part of the Halstead-Reitan Neuropsychological Test Battery (HNTB).

Features of the measure

Description of tasks:

The TMT is comprised of 2 tasks – Part A and B:

• Part A: Consists of 25 circles numbered from 1 to 25 randomly distributed over a page of letter size paper. The participant is required to connect the circles with a pencil as quickly as possible in numerical sequence beginning with the number 1.
• Part B: Consists of 25 circles numbered 1 to 13 and lettered A to L, randomly distributed over a page of paper. The participant is required to connect the circles with a pencil as quickly as possible, but alternating between numbers and letters and taking both series in ascending sequence (i.e. 1, A, 2, B, 3, C…).

What to consider before beginning:

• The TMT requires relatively intact motor abilities (i.e. ability to hold and maneuver a pen or pencil, ability to move the upper extremity. The Oral TMT may be a more appropriate version to use if the examiner considers that the participant’s motor ability may impact his/her performance.
• Cultural and linguistic variables may impact performance and affect scores.

Scoring and Score Interpretation:

Performance is evaluated using two different visual conceptual and visuomotor tracking conditions: Part A involves connecting numbers 1-25 in ascending order; and Part B involves connecting numbers and letters in an alternating and ascending fashion.

Time taken to complete each task and number of errors made during each task are recorded and compared with normative data. Time to complete the task is recorded in seconds, whereby the greater the number of seconds, the greater the impairment.

In some reported methods of administration, the examiner pointed out and explained mistakes during the administration.

A maximum time of 5 minutes is typically allowed for Part B. Participants who are unable to complete Part B within 5 minutes are given a score of 300 or 301 seconds. Performance on Part B has not been found to yield any more information on strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. severity than performance on Part A (Tamez et al., 2011).

Ranges and Cut-Off Scores
	Normal	Brain-damage
TMT Part A	1-39 seconds	40 or more seconds
TMT Part B	1-91	92 or more seconds

Adapted from Reitan (1958) as cited in Matarazzo, Wiens, Matarazzo & Goldstein (1974).

Time:

Approximately 5 to 10 minutes

Training requirements:

No training requirements have been reported.

Equipment:

• A copy of the measure
• Pencil or pen
• Stopwatch

Alternative versions of the Trail Making Test

• Color Trails (D’Elia et al., 1996)
• Comprehensive Trail Making Test (Reynolds, 2002)
• Delis-Kaplan Executive Function Scale (D-KEFS) – includes subtests modeled after the TMT
• Oral TMT – an alternative for patients with motor deficits or visual impairments (Ricker & Axelrod, 1994).
• Repeat testing – alternate forms have been developed for repeat testing purposes (Franzen et al., 1996; Lewis & Rennick, 1979)
• Symbol Trail Making Test – developed as an alternative to the Arabic version of the TMT, for populations with no familiarity with the Arabic numerical system (Barncord & Wanlass, 2001)

Client suitability

Can be used with:

• Patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. and brain damage.

Should not be used with:

• Patients with motor deficiencies. If motor ability may impact performance, consider using the Oral TMT.

In what languages is the measure available?

Arabic, Chinese and Hebrew

Summary

What does the tool measure?	Executive function in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
What types of clients can the tool be used for?	The TMT can be used with, but is not limited to, patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Is this a screeningTesting for disease in people without symptoms. or assessment tool?	Assessment tool
Time to administer	The TMT takes approximately 5 to 10 minutes to administer.
Versions	Color Trails Comprehensive Trail Making Test Delis-Kaplan Executive Function Scale (D-KEFS) Oral TMT Repeat testing – alternate forms have been developed for repeat testing purposes Symbol Trail Making Test
Other Languages	Arabic, Chinese and Hebrew
Measurement Properties
ReliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of “true” variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to “noise” in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .	Test-retest: Two studies examined the test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society). of the TMT among patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. and found adequate to excellent test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society). .
ValidityThe degree to which an assessment measures what it is supposed to measure.	Content: One study examined the content validityRefers to the extent to which a measure represents all aspects of a given social concept. Example: A depression scale may lack content validity if it only assesses the affective dimension of depression but fails to take into account the behavioral dimension. of the TMT and found it to be a complex test that involves aspects of abstraction, visual scanningDuring this intervention the person with USN is encouraged to conduct voluntary eye movements toward the neglected visual field (usually the left side) by performing a task in that hemispace. The treatment often includes a visual target that the patient uses as an anchor to direct voluntary gaze control while scanning. and attention. Criterion: Predictive: Several studies have examined the predictive validityA form of criterion validity that examines a measure’s ability to predict some subsequent event. Example: can the Berg Balance Scale predict falls over the following 6 weeks? The criterion standard in this example would be whether the patient fell over the next 6 weeks. of the TMT and have found Part B to be predictive of fitness to drive following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Construct: Convergent: One study examined the convergent validityA type of validity that is determined by hypothesizing and examining the overlap between two or more tests that presumably measure the same construct. In other words, convergent validity is used to evaluate the degree to which two or more measures that theoretically should be related to each other are, in fact, observed to be related to each other. of the TMT and found poor to adequate correlations with the Category Test, Wisconsin Card Sort Test, Paced Auditory Serial Addition Task and the Visual Search and Attention Test. Known groups: Three studies have examined the known groups validityKnown groups validity is a form of construct validation in which the validity is determined by the degree to which an instrument can demonstate different scores for groups know to vary on the variables being measured. of the TMT and found that the TMT was able to differentiate between patients with and without brain damage however, it was not sensitive to differentiating between front and non-frontal brain damage.
Floor/Ceiling Effects	One study found Part A of the TMT to have significant ceiling effects.
Does the tool detect change in patients?	The responsivenessThe ability of an instrument to detect clinically important change over time. of the TMT has not formally been studied, however the TMT has been used to detect changes in a clinical trial with patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Acceptability	The TMT is simple and easy to administer.
Feasibility	The TMT is relatively inexpensive and highly portable. The TMT is public domain and can be reproduced without permission. It can be administered by individuals with minimal training in cognitive assessment.
How to obtain the tool?	The Trail Making Test (TMT) can be purchased from: http://www.reitanlabs.com

Psychometric Properties

Overview

A literature search was conducted to identify all relevant publications on the psychometric properties of the Trail Making Test (TMT) involving patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain..

Floor/Ceiling Effects

In a study by Mazer, Korner-Bitensky and Sofer (1989) that investigated the ability of perceptual testing to predict on-road driving outcomes in patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain., part A of the TMT was found to have significant ceiling effects. For this reason, Part A was excluded from study results as it was deemed too easy for participants when evaluating the ability of the TMT to predict on-road driving test outcomes. No ceiling effects for part B were found.

Reliability

Internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency.:
No studies were identified examining the internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of the TMT in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Test-retest:
Matarazzo, Wiens, Matarazzo and Goldstein (1974) examined the test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
of the TMT and other components of the Halstead Impairment Index with 29 healthy males and 16 60-year old patients with diffuse cerebrovascular disease. Adequate test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
was found for both Part A and Part B of the TMT in the healthy control group (r=0.46 and 0.44 respectively), as calculated using Pearson correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
coefficients. Excellent and adequate test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
was found for Part A and Part B of the TMT respectively (r=0.78 and 0.67), among participants with diffuse cerebrovascular disease.

Goldstein and Watson (1989) investigated the test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
of the TMT as a part of the Halstead- Reitan Battery in a sample of 150 neuropsychiatric patients, including patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Test-retest correlations were calculated using Pearson CorrelationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
Coefficients for the entire sample and for the sub-group of patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Excellent test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
for both Part A and Part B were found (0.94 and 0.86 respectively) in the sub-group of patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.; and adequate reliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of “true” variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to “noise” in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .
for the entire participant sample (0.69 and 0.66 respectively).

Intra-rater:
No studies were identified examining the intra-rater reliabilityThis is a type of reliability assessment in which the same assessment is completed by the same rater on two or more occasions. These different ratings are then compared, generally by means of correlation. Since the same individual is completing both assessments, the rater’s subsequent ratings are contaminated by knowledge of earlier ratings.
of the TMT in patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Inter-rater:
No studies were identified examining the inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
of the TMT in patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain..

Validity

Content:

O’Donnell, MacGregor, Dabrowski, Oestreicher & Romero (1994) examined the face validityA form of content validity, face validity is assessed by having 'experts' (this could be clinicians, clients, or researchers) review the contents of the test to see if the items seem appropriate. Because this method has inherent subjectivity, it is typically only used during the initial phases of test construction.
of the TMT in a sample of 117 community-dwelling patients, including patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. The results suggest that the TMT is a complex test that involves aspects of abstraction, visual scanningDuring this intervention the person with USN is encouraged to conduct voluntary eye movements toward the neglected visual field (usually the left side) by performing a task in that hemispace. The treatment often includes a visual target that the patient uses as an anchor to direct voluntary gaze control while scanning.
and attention.

Criterion:

Concurrent:
No studies were identified examining the concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also “gold standard.”
of the TMT.

Predictive:
Mazer, Korner-Bitensky and Sofer (1998) examined the ability of the TMT and other measures of perceptual function to predict on-road driving test outcomes in 84 patients with subacute strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. For Part B of the TMT, a cut-off score of < 3 errors demonstrated high positive predictive value (85%) and low negative predictive value (48%) for successful completion of driving evaluation. The Motor Free Visual Perception Test (MFVP) and the TMT Part B, when combined, demonstrated the highest predictive value for on-road driving test outcome. Participants who scored poorly on both the MFVP and TMT Part B had 22 times the likelihood of failing the on-road evaluation.

Devos, Akinwuntan & Nieuwboer (2011) conducted a systematic reviewA systematic review is a summary of available research on a given topic that compares studies based on design and methods. It summarizes the findings of each, and points out flaws or potentially confounding variables that may have been overlooked. A critical analysis of each study is done in an effort to rate the value of its stated conclusions. The research findings are then summarized, and a conclusion is provided.
to identify the best determinants of fitness to drive following strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. The TMT Part B was evaluated in 2 studies (Mazer et al., 1998 and Mazer et al., 2003) and found to be one of the best predictors of passing on-road driving evaluation tests (effect sizeEffect size (ES) is a name given to a family of indices that measure the magnitude of a treatment effect. Unlike significance tests, these indices are independent of sample size. The ES is generally measured in two ways: as the standardized difference between two means, or as the correlation between the independent variable classification and the individual scores on the dependent variable. This correlation is called the "effect size correlation".
= 0.81, p<0.0001). In addition, when using a cutoff score of 90 seconds, the TMT Part B had a sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also "Specificity."
of 80% and a specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
of 62% for detecting unsafe on-road performance. In a subsequent systematic reviewA systematic review is a summary of available research on a given topic that compares studies based on design and methods. It summarizes the findings of each, and points out flaws or potentially confounding variables that may have been overlooked. A critical analysis of each study is done in an effort to rate the value of its stated conclusions. The research findings are then summarized, and a conclusion is provided.
by Marshall et al. (2007), the TMT was, again, found to be one of the most useful predictors of fitness for driving post-stroke.

Construct:

Convergent/Discriminant:
O’Donnell et al. (1994) examined the convergent validityA type of validity that is determined by hypothesizing and examining the overlap between two or more tests that presumably measure the same construct. In other words, convergent validity is used to evaluate the degree to which two or more measures that theoretically should be related to each other are, in fact, observed to be related to each other.
of the TMT and four other neuropsychological tests: Category Test (CAT), Wisconsin Card Sort Test (WCST), Paced Auditory Serial Addition Task (PASAT), and Visual Search and Attention Test (VSAT). The study involved 117 community-dwelling adults, including patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Poor to adequate correlations were found between the TMT and the other measures (CAT r=0.38; WCST r=0.31; PASAT r=0.44; VAST r=0.30), using Pearson product-moment correlations.

Known groups:
Reitan (1955) examined the ability of the TMT to differentiate between patients with and without organic brain damage, including patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. Highly significant differences in mean and sum scores were found between the two groups (p<0.001) on both parts of the TMT, suggesting that the TMT is able to different between patients with and without brain damage.

Corrigan and Hinkeldey (1987) examined the relationship between Part A and Part B of the TMT. Data was collected from the charts of 497 patients receiving treatment at a rehabilitation centre. Patients with traumatic brain injury and strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. comprised a large majority of the sample. A difference (B-A) and a ratio (B/A) score were calculated. The difference score was highly correlated with intelligence and severity of impairment and only moderately correlated with age, education and memory functioning. The B/A ratio appeared to show greatest sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also "Specificity."
to differences in cerebral lateralization of damage.

Tamez et al. (2011) examined the effects of frontal versus non-frontal strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. and severity of strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. on TMT performance in 689 patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. The TMT, Digit Span and National Institute of Health StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Scale (NIHSS) were administered within 72 hours of hospital admission. StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. severity was classified according to the NIHSS, and frontal or non-frontal lesions by CT or MRI scans. Performance on both Part A and Part B of the TMT were significantly correlated with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. severity using the NIHSS. Patients with frontal and non-frontal lesions were found to score equally on Part A and Part B (p>0.05). Results of this study suggest that the TMT is sensitive to brain damage, however, there is little evidence to support the widely held assumption that Trails B is more sensitive to frontal lesions than Part A.

Sensitivity/ Specificity:

No studies were identified examining the specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
of the TMT in patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain..

Responsiveness

Barker-Collo, Feigin, Lawes, Senior and Parag (2000) assessed the course of recovery of attention span in 43 patients with acute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. over a 6-month period. The TMT and other measures of attention were administered at baseline (within 4 weeks following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. onset), 6 weeks, and 6 months after strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Although the responsivenessThe ability of an instrument to detect clinically important change over time.
of the TMT was not formally assessed in this study, the scale was sensitive enough to detect an improvement in attention at 6 weeks and 6 months following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

References

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See the measure

How to obtain the Trail Making Test (TMT)?

The Trail Making Test (TMT) can be purchased from:

Reitan Neuropsychology Laboratory
P.O. Box 66080
Tucson, AZ
85728

http://www.reitanlabs.com