Studying cognitive-motor interactions using a tablet-based application of the Color Trails Test.

The Color Trails Test (CTT) is a pen and paper (P&P) test designed to measure cognitive function. The test consists of two parts that evaluate primarily sustained visual attention (Trails A) and divided attention (Trails B). Based on clinical interest in converting neuropsychological testing from P&P to computerized testing, we developed a digital version of the CTT ('Tablet-CTT'). Twenty-four young, healthy participants performed Trails A and B of both the original P&P and the Tablet-CTT. Hand kinematics were calculated using the continuous location of an electronic pen on the tablet touch screen. To compare motor control aspects, we differentiated for each test session the 'movement planning' and 'movement execution' times (accumulated across all single target-to-target trajectories). Concurrent validity was demonstrated by the high correlation between completion times of the P&P and Tablet-CTT, in both Trails A (r = 0.6; p < 0.005) and Trails B (r = 0.8; p < 0.001). Trails B yielded significantly longer completion times in both formats (p < 0.001). Examining hand kinematics in Tablet-CTT revealed that the difference in durations was mostly due to prolonged planning time, but also due to significantly lower execution velocity in Trails B (p < 0.001). Lastly, we found increased hand velocity during the planning phase in Trails B compared to Trails A (p < 0.001). This study demonstrates how transforming the CTT to a digital platform could be useful for studying cognitive-motor interactions in healthy individuals. Moreover, it could potentially serve as a diagnosis tool by introducing a more comprehensive testing method that incorporates online recordings of hand movements.

The trail less traveled: Analytical approach for creating shortened versions for virtual reality-based color trails test.

The Color Trails Test ("CTT") is among the most popular neuropsychological assessment tests of executive function, targeting sustained visual attention (Trails A), and divided attention (Trails B). During the pen-and-paper (P&P) test, the participant traces 25 consecutive numbered targets marked on a page, and the completion time is recorded. In many cases, multiple assessments are performed on the same individual, either under varying experimental conditions or at several timepoints. However, repeated testing often results in learning and fatigue effects, which confound test outcomes. To mitigate these effects, we set the grounds for developing shorter versions of the CTT (<25 targets), using virtual reality (VR) based CTT (VR-CTT). Our aim was to discover the minimal set of targets that is sufficient for maintaining concurrent validity with the CTT including differentiation between age groups, and the difference between Trails A and B. To this aim, healthy participants in three age groups (total N = 165; young, middle-aged, or older adults) performed both the P&P CTT, and one type of VR-CTT (immersive head-mounted-device VR, large-scale 3D VR, or tablet). A subset of 13 targets was highly correlated with overall task completion times in all age groups and platforms (r > 0.8). We tested construct validity and found that the shortened-CTT preserved differences between Trails A and B (p < 0.001), showed concurrent validity relative to the P&P scores (r > 0.5; p < 0.05), and differentiated between age groups (p < 0.05). These findings open the possibility for shortened "CTT-versions", to be used in repeated-measures experiments or longitudinal studies, with potential implications for shortening neurocognitive assessment protocols.