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Cognitive Assessments

This is an excerpt from Developmental and Adapted Physical Activity Assessment 2nd Edition With Web Resource by Michael Horvat,Luke Kelly,Martin Block & Ron Croce.

Cognitive assessments may include a variety of formal and informal assessments of a person’s perceptual and cognitive abilities and skills. Testing may cover a wide range of areas that might measure, for example, an individual’s level of intelligence, perceptual abilities, verbal and nonverbal skills, attention, and processing or memory abilities. Unlike cognitive and perceptual tests administered by qualified clinical psychologists or diagnosticians, cognitive tests administered by adapted physical educators and therapists are geared more toward analyzing an individual’s perceptual and cognitive abilities as they relate to movement. In addition, it is critical to appreciate that most standard cognitive assessment instruments are geared for adults - in particular adults recovering from brain injury or stroke or who have Alzheimer’s disease. Consequently, there are few cognitive assessment instruments that can be applied to individuals with disabilities in the school setting. Of those instruments available, the Trail Making Test (TMT) is one of the most reliable for use by adapted physical educators and therapists in schools, and it has been used extensively since its development as part of the Army Individual Test Battery (1944).


Briefly, the TMT requires subjects to connect a sequence of consecutive targets on a sheet of paper or computer screen, in a similar manner to what a child would do in a connect-the-dots puzzle. There are two parts to the test. In the first part, the targets are 25 numbers randomly distributed in space (1, 2, 3, and so on), and the test takers need to connect them in sequential order. The subjects start at the circle marked Begin and continue linking numbers until they reach the endpoint, a circle marked End. Part B is similar to A; however, instead of linking only numbers, the subjects must alternately switch between a set of numbers (1 to 13) and a set of letters (A to L), again linking them in ascending order (1-A, 2-B, 3-C, 4-D, and so on). At the same time, the subjects connect the array of circles as fast as possible without lifting the pencil.


A commonly reported performance index in the TMT is time to completion. A difference score (B - A) is often reported, meant to remove the speed element from the test evaluation. The first part of the test reflects speed of processing, while the second part reflects executive functioning or fluid cognitive ability. Extensive research indicates that the TMT assesses a variety of cognitive functions including attention, visual scanning, switching speed, mental flexibility, and the ability to initiate and modify an action plan (Bowie & Harvey, 2006; Salthouse, 2011; Strauss, Sherman, & Spreen, 2006; Zakzanis, Mraz, & Graham, 2005).


Recently, Horvat and colleagues (Horvat, Fallaize, Croce, & Roswal, in preparation) focused on modifying the TMT to develop a more cognitive-motor-based assessment better suited for use by adapted physical educators and therapists. In this variation, the TMT compares speed of processing and fluid cognitive ability with a running task (subsequently termed a cognitive dash by the authors). Individuals complete a computerized version of the TMT, which is then compared with the time it takes to complete running on a basketball court from baseline to midcourt (42 ft, or 13 m). In condition A, participants pick up a poly spot placed around the center court circle in the appropriate number sequence (1-2-3, and so on), place the poly spot in a bucket, and return to the starting point. Condition B requires the participants to alternatively pick up a number, then a letter (1-A, 2-B, 3-C, 4-D, and so on), place them both into a bucket, and run back to the starting line. Similar to the TMT, condition A requires connecting a series of numbers, reflecting speed of processing. Condition B, which includes a number and letter in unison, is used to detect executive function and verbal fluency. Here, verbal fluency refers to a cognitive function that facilitates information retrieval from memory, requiring executive control over several cognitive processes such as selective attention, selective inhibition, and response generation.The correlation between the TMT and actual movement times from the cognitive dash gives teachers additional information to assess processing speed and planning a movement sequence.