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Box and Blocks Test of Manual Dexterity
Box and Blocks Test of Manual Dexterity
| Availability |
Please visit this website for more information about the instrument: Box and Blocks Test of Manual Dexterity
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| Classification |
NeuroRehab Supplemental - Highly Recommended
Recommendations for Use: Indicated for studies requiring a measure of upper limb motor function in participants who have some degree of grasping function.
Exploratory: Cerebral Palsy (CP)
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| Short Description of Instrument |
Construct measured: It is a timed, norm-referenced measure of unilateral dexterity.
Generic vs. disease specific: Generic.
Means of administration: Examiner administered.
Intended respondent: Child or Adult.
Background: The Box and Blocks is a generic clinical tool developed to measure unilateral manual dexterity. Norms are available for ages 3-65+. Child norms were derived from 471 typical children ages 6-19 years (Mathiowetz et al., 1985). Newer child norms (Jongbloed-Pereboom et al., 2013) were derived from 215 Dutch children ages 3-10 years. The test measures capacity, i.e., what a child does in a standardized environment.
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| Comments/Special Instructions |
The test consists of an oblong box with a partition across the middle and 150, 2-inch square wooden blocks. The participant is seated with the box on the table in front of him/her. The participant is asked to grasp and move the blocks from one compartment to another as quickly as possible for one minute. The dominant hand is tested first, then the procedure is repeated with the non-dominant hand. The examiner sits opposite the participant. The participant is allowed a 15 second practice trial prior to testing each
hand.
NeuroRehab Specific: The blocks should be released when the hand is paused above the other compartment, not tossed from the starting compartment.
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| Scoring and Psychometric Properties |
Scoring: The examiner counts the number of blocks moved from one compartment to another in one minute. Each hand is scored separately. If the participant picks up two or more blocks at a time, they are not counted.
Administration time: 5 minutes.
Administration and scoring procedures are outlined in Mathiowetz et al, 1985. A full description is available from: Box and Blocks Test Instructions, provided courtesy of Virgil Mathiowetz, PhD, OTR/L.
Psychometric Properties: ICC for interrater reliability was .99. ICC for test-retest reliability was .85. Concurrent validity: significant correlations to the manual dexterity subtests of the Movement Assessment Battery for Children-2: correlations were moderate to strong for children aged 3-6 years and weak to moderate for children aged 7-10 years (215 Dutch children ages 3-10 years).
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| Scoring |
The examiner counts the number of blocks moved from one compartment to another in one minute.Each hand is scored separately. If the patient picks up two or more blocks, they are not counted.
Administration and scoring procedures are outlined in Mathiowetz et al, 1985. A full description is available from: Box and Blocks Test Instructions, provided courtesy of Virgil Mathiowetz, PhD, OTR/L.
Administration time: 5 minutes.
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| Rationale/Justification |
Strengths/Weaknesses: Can be administered quickly and easily in a clinical setting. Children must be able to follow directions. Validity and reliability not established in CP population; however, the test has been used in multiple studies to evaluate the hand skills of children with unilateral CP after intervention. Most recent child norms and psychometric properties are derived from a study of Dutch children.
NeuroRehab Specific: Appropriate for studies with the goal of measuring or improving gross dexterity. It is time based, sensitive, and easy to administer. Has been used in multiple neurological disorders.
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| References |
Key References:
Mathiowetz V, Ferderman S, Wiemer D. Box and Block Test of Manual Dexterity: Norms for 6-19 Year Olds. Can J Occup Ther. 1985;52(5):241-246.
Mathiowetz V, Volland G, Kashman N, Weber K. Adult norms for the Box and Block Test of manual dexterity. Am J Occup Ther. 1985;39(6):386-391.
Platz T, Pinkowski C, van Wijck F, Kim IH, di Bella P, Johnson G. Reliability and validity of arm function assessment with standardized guidelines for the Fugl-Meyer Test, Action Research Arm Test and Box and Block Test: a multicentre study. Clin Rehabil. 2005 Jun;19(4):404-11.
Jongbloed-Pereboom M, Nijhuis-van der Sanden MW, Steenbergen B. Norm scores of the box and block test for children ages 3-10 years. Am J Occup Ther. 2013;67(3):312-318.
Additional References:
Tomhave WA, Van Heest AE, Bagley A, James MA. Affected and contralateral hand strength and dexterity measures in children with hemiplegic cerebral palsy. J Hand Surg. 2015;40(5):900-907.
Document last updated January 2022
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