Box and Block Test (BBT)

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Tool Description

  • A measure of manual dexterity that requires repeatedly moving 1-inch blocks from one side of a box to another in 60 seconds.
  • Commonly used in the stroke population to determine manual dexterity.
  • Measures unilateral function, not bilateral function.

Availability:

Worksheet available here: http://www.scireproject.com/sites/default/files/worksheet_box_and_block_test.docx

Detailed instructions are available from Mathiowetz et al. 1985a “”Adult norms for the Box and Block test of manual dexterity”. See the ‘How to use’ section for further details.

ICF Domain:

Activity - Mobility

Number of Items:

n/a

Brief Instructions for Administration & Scoring

Administration:

  • Clinician-administered
  • Mathiowetz et al. 1985 describes the standardized dimensions for test materials, procedures and scoring. Individuals are seated at a table, facing the examiner. A rectangular box divided into 2 compartments by a wooden partition is in front of the individual, and 150 coloured wooden blocks are placed in one compartment. The individual is instructed to move as many blocks as possible, one at a time, from one compartment to the other for the duration of 60 seconds.
  • The individual’s hand must cross over the partition for the block to be counted towards total score.
  • Blocks may be dropped once the hand passes the partition.
  • Approximately 5 minutes are required for set up, explanation of the instructions to the patient and administration of the test.

Equipment:

  • Stopwatch
  • Wooden box with partition (box: 53.7 x 25.4 x 8.5 cm, partition: 25.4 cm x 15.2 cm x 1 cm)
  • 150 wooden blocks (2.5 cm cubed)

Scoring:

  • Scored by counting the number of blocks carried over by the individual from one compartment to the other.
  • If the individual carries multiple blocks over at a time, this only counts as 1 point.
  • If the individual brings the block over the partition and drops it outside of the box, the block still counts.

Interpretability

MCID: not established for SCI
SEM: not established for SCI
MDC: not established for the SCI population but for a spastic hemiplegia population, MDC for a 2 week training program = 4 blocks per minute, MDC for 6-month follow-up = 6 blocks per minute [Siebers 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”, n=17]

  • No meaningful cut-points or normative data have been established for the SCI population
  • The BBT has not been validated and there is no published data on the SCI population for comparison.
  • However, normative data for able-bodied adults and children have been published by Mathiowetz et al. 1985[a,b].

Normal adults (>20 years old): N=628, 310M, 318F [Mathiowetz et al. 1985a]

Average BBT score:

Male

Female

Age

Hand

Mean

SD

Mean

SD

20-24

R

88.2

8.8

88.0

8.3

L

86.4

8.5

83.4

7.9

25-29

R

85.0

7.5

86.0

7.4

L

84.1

7.1

80.9

6.4

30-34

R

81.9

9.0

85.2

7.4

L

81.3

8.1

80.2

5.6

35-39

R

81.9

9.5

84.8

6.1

L

79.8

9.7

83.5

6.1

40-44

R

83.0

8.1

81.1

8.2

L

80.0

8.8

79.7

8.8

45-49

R

76.9

9.2

82.1

7.5

L

75.8

7.8

78.3

7.6

50-54

R

79.0

9.7

77.7

10.7

L

77.0

9.2

74.3

9.9

55-59

R

75.2

11.9

74.7

8.9

L

73.8

10.5

73.6

7.8

60-64

R

71.3

8.8

76.1

6.9

L

70.5

8.1

73.6

6.4

65-69

R

68.5

7.1

72.0

6.2

L

67.4

7.8

71.3

7.7

70-74

R

66.3

9.2

68.6

7.0

L

64.3

9.8

68.3

7.0

75+

R

63.0

7.1

65.0

7.1

L

61.3

8.4

63.6

7.4

 

Normal children (6-19 years old): N=471, 231M, 240F [Mathiowetz et al. 1985b]

Average BBT score:

Male

Female

Age

Hand

Mean

SD

Mean

SD

6-7

R

54.4

6.6

57.9

5.3

L

50.7

6.3

54.2

5.6

8-9

R

63.4

4.3

62.8

5.1

L

60.1

4.9

60.4

5.2

10-11

R

68.4

6.9

70.0

7.6

L

65.9

6.8

67.6

8.6

12-13

R

74.6

8.3

73.6

8.1

L

72.4

8.2

70.5

6.2

14-15

R

76.6

8.7

75.4

8.5

L

74.6

7.9

72.1

7.6

16-17

R

80.3

8.7

77.0

9.0

L

77.6

5.1

74.3

9.1

18-19

R

79.9

8.9

77.9

9.4

L

79.2

8.8

76.0

8.5

Reliability

Not established in SCI. For stroke patients:

 High Test-retest Reliability: ICC = 0.96

High Inter-rater Reliability: ICC = 0.99

(Platz et al. 2005; n = 56, 37 stroke, 14 MS, 5 TBI; 31 male)

Validity

Not established in SCI. For stroke patients:

Low to High correlation with:
Action Research Arm Test = 0.95
Fugl-Meyer Test = 0.92
Hemispheric Stroke Scale = -0.67
Passive Joint motion/Joint pain sub-scale of Fugl-Meyer Test = 0.43
Modified Barthel Index = 0.04

(Platz et al. 2005; n = 56, 37 stroke, 14 MS, 5 TBI; 31 male)

Languages:

n/a

Training Required:

None required.

Clinical Considerations

  • This test is quick and easy to administer

Measurement Property Summary

There are no studies reporting psychometric properties for the BBT for the SCI population at this time.

Reviewers

Dr. Janice Eng, Christie Chan, John Zhu

Date Last Updated:

Nov 1, 2016

Download the measure

Download Worksheet:

Worksheet Document
Procedure:

The patient is allowed a 15-second trial period prior to testing.
Immediately before testing begins, the patient should place his/her hands on the sides of the box.
When testing begins, the patient should grasp one block at a time with the dominant hand, transport the block over the partition, and release it into the opposite compartment.The patient should continue doing this for one minute.
The procedure should then be repeated with the non-dominant hand.

Set-up:
A test box with 150 blocks and a partition in the middle is placed lengthwise along the edge of a standard-height table.
150 blocks should be in the compartment of the test box on the side of the patient’s dominant hand.
The examiner should face the patient so they can view the blocks being transported

Patient Instructions (derived from Mathiowetz et al, 1985):

“I want to see how quickly you can pick up one block at a time with your right (or left) hand [point to the hand]. Carry it to the other side of the box and drop it. Make sure your fingertips cross the partition. Watch me while I show you how.”

Transport three cubes over the partition in the same direction you want the patient to move them. After a demonstration say the following:

“If you pick up two blocks at a time, they will count as one. If you drop one on the floor or table after you have carried it across, it will still be counted, so do not waste time picking it up. If you toss the blocks without your fingertips crossing the partition, they will not be counted. Before you start, you will have a chance to practice for 15 seconds. Do you have any questions?”

“Place your hands on the sides of the box. When it is time to start, I will say ready and then go.”

Trial period: Start the stop watch at the word go. When 15 seconds has passed, say "stop." If mistakes are made during the practice period, correct them before the actual testing begins.

On completion of the practice period, transport the cubes to the original compartment.

“This will be the actual test. The instructions are the same. Work as quickly as you can. Ready.” [Wait 3 seconds]“Go.”“Stop.” [After 1 minute, count the blocks and record as described above]

“Now you are to do the same thing with your left (or right) hand. First you can practice. Put your hands on the sides of the box as before. Pick up one block at a time with your hand, and drop it on the other side of the box.”

“Ready.” [Wait 3 seconds] “Go.”“Stop.” [After 15 seconds]

Return the transported blocks to the compartment as described above.

“This will be the actual test. The instructions are the same. Work as quickly as you can.”

“Ready.” [Wait 3 seconds]“Go.”“Stop.” [After 1 minute, count the blocks and record as described above]

Video

Scoring

Scoring:

The score is the number of blocks carried from one compartment to the other in one minute. Score each hand separately.

Note:
1) If a patient transports two or more blocks at the same time, this should be noted and the number subtracted from the total
2) No penalty should be made if the subjects transported any blocks across the partition and the blocks bounced from the box to the floor or table

Equipment Needed

  • Stopwatch
  • Wooden box with partition (box: 53.7 x 25.4 x 8.5 cm, partition: 25.4 cm x 15.2 cm x 1 cm)
  • 150 wooden blocks (2.5 cm cubed)

Box and Block Test:

Chen HM, Chen CC, Hsueh IP, Huang SL, Hsieh CL. Test-retest reproducibility and smallest real difference of 5 hand function tests in patients with stroke. Neurorehabil Neural Repair. 2009;23(5):435-40. http://www.ncbi.nlm.nih.gov/pubmed/19261767

Mathiowetz V, Gloria V, Kashman N, Weber K. Adult norms for the Box and Block test of Manual Dexterity. The American Journal of Occupational Therapy, 1985; 39 (6): 386-391.
http://www.ncbi.nlm.nih.gov/pubmed/3160243

Mathiowetz V, Federman S, Wiemer D. Box and Block test of manual dexterity: norms for 6-19 year olds. Canadian Journal of Occupational Therapy, 1985; 52: 241-245.
http://cjo.sagepub.com.ezproxy.library.ubc.ca/content/52/5/241.short

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;19(4):404-11.
http://www.ncbi.nlm.nih.gov/pubmed/15929509