Trail Making Test (TMT)

Purpose of the measure

The Trail Making Test (TMT) is a widely used test to assess executive abilities in patients with stroke. Successful performance of the TMT requires a variety of mental abilities including letter and number recognition mental flexibility, visual 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 stroke 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 taining requirements have been reported.

Equipment:

  • A copy of the measure
  • Pencil or pen
  • Stopwatch
Alternative versions of the TMT
  • 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 stroke 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