The Box and Block Test assesses unilateral gross manual dexterity.
Commercially produced versions of the test can be purchased for approximately $200.00 (as of 2011)
See description for links on more information about cost and purchasing.
Initially reviewed by Jason Raad, MS of the Rehabilitation Measures Team and Dorian Rose, PT, PhD of the StrokEdge Taskforce of the Neurology Section of the APTA in 9/2011; Updated with references for Stroke and Fibromyalgia populations by Denise Toombs, SPT and Marina Yusupova, SPT in 2011. Updated with references for Stroke and Fibromyalgia populations by Denise Toombs, SPT and Marina Yusupova, SPT in 2011; Reviewed and updated by Michele Sulwer, PT, DPT, NCS and Genevieve Pinto-Zipp, PT, EdD, of the StrokEDGE II Neurology Section, APTA, in 4/2016.
Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (VEDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.
Abbreviations:
LS / UR
Reasonable to use, but limited study in target group / Unable to Recommend
Recommendations for use based on acuity level of the patient:
Acute
Subacute
(CVA 2 to 6 months)
(SCI 3 to 6 months)
Chronic
(> 6 months)
StrokEDGE
Recommendations based on level of care in which the assessment is taken:
Acute Care
Inpatient Rehabilitation
Skilled Nursing Facility
Outpatient
Rehabilitation
Home Health
MS EDGE
StrokEDGE
Recommendations based on EDSS Classification:
EDSS 0.0 – 3.5
EDSS 4.0 – 5.5
EDSS 6.0 – 7.5
EDSS 8.0 – 9.5
MS EDGE
Recommendations for entry-level physical therapy education and use in research:
Students should learn to administer this tool? (Y/N)
Students should be exposed to tool? (Y/N)
Appropriate for use in intervention research studies? (Y/N)
Is additional research warranted for this tool (Y/N)
MS EDGE
StrokEDGE
Changing block surfaces to rubber, improved BBT scores 8% for controls and stroke survivors (both paretic and non-paretic hands), by reducing movement time for “finger closing” and “contact-to-lift”. This study suggests the need to modify daily objects with rubber and indicate need for therapy to focus on goal directed reaching and object grasping/releasing. (Slota et al, 2013)
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Acute and Chronic Stroke: (calculated from statistics in Chen et al, 2009; n = 62 volunteer participants who had sustained a stroke; mean age = 61 (9.9) years; median time post-stroke = 8 months)
(**Note: To calculate the Smallest Real Difference (SRD; aka Minimal Detectable Change MDC) the authors averaged the standard deviations from time points 1 & 2 rather than using the baseline standard deviation; thus, to calculate the SEM, an average standard deviation was used).
Acute and Chronic Stroke: (Chen et al, 2009)
Acute and Chronic Stroke: (Chen et al, 2009)
Stroke: (Lin et al, 2010; n = 59 patients with stroke; sex = 47 males, 12 females; mean age = 55.5(11.66) years)
Concurrent Validity Pre- and Post- Treatment
Measure
Pretreatment (r)
Posttreatment (r)
-0.80 (Excellent)
-0.71 (Excellent)
0.63 (Excellent)
0.64 (Excellent)
0.44 (Adequate)
0.35 (Adequate)
-0.37 (Adequate)
0.49 (Adequate)
0.52 (Adequate)
0.52 (Adequate)
0.59 (Adequate)
0.52 (Adequate)
ARAT = Action Research Arm Test, BBT = Box and Block Test, CI = confidence interval, FMA = Fugl-Meyer Assessment, MAL-AOU = Motor Activity Log-Amount of Use, MAL-QOM = Motor Activity Log-Quality of Movement, NHPT = Nine-Hole Peg Test, SIS = Stroke Impact Scale
Spastic Hemiplegia: (Siebers et al, 2010; n = 17 patients with spastic hemiplegia; median age = 54(22-67) years; 2 week training program; 6 month follow-up)
Upper Extremity Paresis: (Platz et al, 2005; n = 56 people with upper limb paresis as a result of stroke, Multiple Sclerosis (MS), and traumatic brain injury (TBI); median age = 54(13-92) years; n = 37 for stroke; median age = 62(22-92) years; n = 14 for MS; median age = 43(28-60) years; n = 5 for TBI; median age = 34(13-50) years)
Spastic Hemiplegia: (Siebers et al, 2010)
Upper Extremity Paresis: (Platz et al, 2005)
Spastic Hemiplegia: (Siebers et al, 2010)
Upper Extremity Paresis: (Platz et al, 2005)
Central Paresis: (Platz et al, 2008; n = 33 neurological patients with central paresis due to stroke, ischemic/anoxic brain damage, traumatic brain injury, or spinal cord injury; n=3 patients with SCI(C3,C4,T8), 6 patients with TBI, and 23 patients with stroke; sex = 20 males, 13 females; mean duration of disease = 19.4 months; mean age = 49.7(17.3) years)
Normal adults: (Mathiowetz et al, 1985; n = 310 normal adult males, 318 normal adult females; aged 20 and up)
Average Number of Cubes Transferred in One Minute
Male
Female
Age
Hand
Mean
SD
Mean
SD
Normal children: (Mathiowetz et al, 1985; n = 471 normal children, 231 males, 240 females; age range = 6-19 years)
Average Number of Cubes Transferred in One Minute
Male
Female
Age
Hand
Mean
SD
Mean
SD
Normal Adults: (Mathiowetz et al, 1985)
Upper Limb Impairment: (Desrosiers et al, 1994; n = 35 able bodied subjects; mean age = 71.7(60-89) years; n = 34 subjects with impairment; mean age = 74.5(65-87) years)
Upper Limb Impairment: (Desrosiers et al, 1994)
Fibromyalgia: (Canny et al, 2009; n = 30 participants with fibromyalgia; mean age = 46.9(range 20-68) years; n = 30 healthy participants; mean age= 41.2(29-52) years)
Canny, M. L., Thompson, J. M., et al. (2009). "Reliability of the box and block test of manual dexterity for use with patients with fibromyalgia." Am J Occup Ther 63(4): 506-510. Find it on PubMed
Chen, H. M., Chen, C. C., et al. (2009). "Test-retest reproducibility and smallest real difference of 5 hand function tests in patients with stroke." Neurorehabil Neural Repair 23(5): 435-440. Find it on PubMed
Desrosiers, J., Bravo, G., et al. (1994). "Validation of the Box and Block Test as a measure of dexterity of elderly people: reliability, validity, and norms studies." Arch Phys Med Rehabil 75: 751-755. Find it on PubMed
Lin, K. C., Chuang, L. L., et al. (2010). "Responsiveness and validity of three dexterous function measures in stroke rehabilitation." J Rehabil Res Dev 47(6): 563-571. Find it on PubMed
Mathiowetz, V., Ferderman, S., et al. (1985). "Box and Block Test of Manual Dexterity: Norms for 6-19 Year Olds." Canadian Journal of Occupational Therapy. Revue Canadienne d'ergothérapie 52(5): 241-246.
Mathiowetz, V., Volland, G., et al. (1985). "Adult norms for the Box and Block Test of manual dexterity." Am J Occup Ther 39(3160243): 386-391. Find it on PubMed
Platz, T., Pinkowski, C., et al. (2005). "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 19(4): 404-411. Find it on PubMed
Platz, T., Vuadens, P., et al. (2008). "REPAS, a summary rating scale for resistance to passive movement: item selection, reliability and validity." Disabil Rehabil 30(1): 44-53. Find it on PubMed
Siebers, A., Oberg, U., et al. (2010). "The effect of modified constraint-induced movement therapy on spasticity and motor function of the affected arm in patients with chronic stroke." Physiother Can 62(4): 388-396. Find it on PubMed
Slota, G., Enders, L., et al. (2013). “Improvement of hand function using different surfaces and identification of difficult movement post stroke in the Box and Block Test.” Applied Ergonomics 45: 833-838. Find it on PubMed
rehabilitation measuresWe have reviewed more than 500 instruments for use with a number of diagnoses including stroke, spinal cord injury and traumatic brain injury among several others.