Background The Trail Making Test (TMT) is a two-part written tool for detecting executive dysfunction. Part A consists of joining a “trail” of ascending numbers, which serves as a control for a second more challenging Part B where the “trail” alternates between ascending numbers and alphabetical letters. The time taken for completion of each is recorded. Executive dysfunction is common in patients with MND but detection using neuropsychological tests is often confounded by motor involvement (dominant upper limb weakness for the TMT). We sought to design a hands-free TMT using eye-tracking equipment, and to compare it with the standard written version.

Methods A pilot study of 10 healthy volunteers was undertaken. A head-mounted Eyelink® eye-tracking device was used in conjunction with a visual display of the trails. There was an interval of 1 week between testing each version of the TMT. The B:A ratio of time in seconds for each task was used as the reliability outcome measure to standardise across the two different paradigms.

Results A correlation coefficient of 0.6 was found between written and visual TMTs.

Conclusions It is possible to perform the TMT using a hands-free, eye-tracking method which shows reasonable reliability in comparison with the written version. A larger control group is now being studied, with increased visual feedback during the testing process in an effort to improve reliability before application to MND and other dysexecutive patient groups.