Traditional Trail Making Test Modified into Brand-new Assessment Tools: Digital and Walking Trail Making Test

Traditional trail making test are used for executive function to assess. While opposed, the digital Walking Trail Making Test assess the motor ability in addition to cognitive function. Considering that cognitive motor test has gained immense attention recently, the main advantage of this integrated test paradigm is that it provides more information than conventional assessments.

Both the new and modified trail making tests can be used for clinical patients with cognitive and movement disorders. For those patients with upper limb disability, the Walking Trail Making Test is particularly useful. As both of the tests collect information in real time and the subjects needs complete the test quickly, take care to explain the test processes in detail before each trial.

Visual demonstration can be helpful in minimizing misunderstandings, destractions, or other types of delays during the test, all of which can confound the data. To carry out a digital trail making test A procedure, seat each participant in front of a desk in a quiet and comfortable environment and adjust the computer position, background light, and electronic pen. Check the near-visual acuity of the participant to ensure that they can easily read the numbers on the screen, and show the instructions to the participant, indicating that they will need to use the pen to draw a line as rapidly as possible to join consecutive numbers in the circles randomly distributed on the screen.

When the participant is ready, initiate a 150-second maximum pre-test trial demonstrating that if the circles have been correctly joined, the color of the first circle will change. If the circles are not correctly joined, the color will remain unchanged, and the participant will need to restart the task from the last circle. Encourage the participant to draw the line as fluently and accurately as possible while avoiding errors and time wastage.

At the end of the pre-trial have the participant select part A to complete the Digital Trail Making Test A without interruption. When the Digital Trail Making Test A has been completed, carry out a Digital Trail Making Test B in similar manner. First showing the digital trail making test B guidelines to the participant that instruct the participant to draw a line as rapidly as possible to alternatively join the numbers and Chinese characters within the circles randomly distributed on the screen.

To perform the Walking Trail Making Test A, in a quiet and comfortable environment with a full room light, randomly distribute coins with numbers at each of 15 positions in a 16-meter squared area. Connect the intelligent device for energy expenditure and activity to a computer and enter the anthropometric data for the participant. When the data has been entered, bring the participant into the room and use medical tape to attach one biaxial mini accelerometer over the sternum, one to the front side of each thigh, and one under each foot.

Use thin, flexible cables to attach all of the accelerometers to a microprocessor storage unit. And use a clip to attach the unit to the participant's clothes. When the participant is ready, ask them to walk up and down a walkway without any targets at a comfortable pace.

After the warm-up, show the participant the Walking Trail Making Test A instructions, which ask the participant to walk on numbered targets in a sequential order as rapidly but accurately as possible, joining consecutive numbers on the coins randomly distributed on the floor. Take care to ensure the safety of the participants as dual-task walking in a challenging environment may increase the risk of falling. For Walking Trail Making Test B, after disturbing the coins as just demonstrated, show the Walking Trail Making Test B instructions to the participant.

And have the participant walk on the numbered targets in sequential order as rapidly as possible to alternatively join the numbers and Chinese characters on the coins randomly distributed on the floor. In this representative analysis, most of the Digital Trail Making Test A data between healthy elderly, elderly with mild cognitive impairment, and elderly with Parkinson's disease were similar. However, elderly with Parkinson's disease exhibited a larger total pathway deviation of each step, a larger variability of pathway deviation, and a lower velocity of drawing.

In completing Digital Trail Making Test B, aged patients with mild cognitive impairment needed a longer time of completion with more errors, more time inside the circle and the tolerance circle, more pathway deviation, and a lower drawing velocity compared to healthy elderly individuals. Elderly with Parkison's disease also needed a longer time of completion, had more errors, more time inside the circle, less time inside the tolerance circle, more pathway deviation, a larger variability of pathway deviation, and a lower drawing velocity for each step compared to aged healthy individuals. Gate data in the Walking Trail Making Test A revealed differences in the elderly with Parkison's disease group in terms of speed, step length, and stride length.

The gate data in the Walking Trail Making Test B revealed that aged patients with mild cognitive impairment and Parkinson's disease needed a longer time and more steps to complete the test with a shorter step and stride length relative to aged healthy participants. In addition, aged patients with Parkinson's disease showed an even more severe trend compared to mild cognitive impairment subjects with marked differences in step length, stride length, and step length gait variability. The most important thing to remember is to show the instructions to the participants before the test to prevent any misunderstandings or delays that might occur during the test.

Following this procedure, the left-handed Digital Trail Making Test can be performed to assess intermanual differences or movement assessments can be performed to evaluate the pure walking ability of participants. This technique has paved the way for the study of cognitive and motor functions here in an incorporated manner suitable for patients with motor cognitive risk syndrome.