- 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.
Clinical Considerations
This test is easy and quick to administer
ICF Domain
Activity ▶ Mobility
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.
Number of Items
N/A
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.
Languages
N/A
Training Required
None
Availability
The worksheet can be found here. Detailed instructions are available from Mathiowetz et al. 1985a “”Adult norms for the Box and Block test of manual dexterity”.
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 = 0.93-0.98
High Inter-rater Reliability: ICC = 0.993-1.000
(Platz et al. 2005: n = 56, 37 stroke, 14 MS, 5 TBI; 31 male)
(Chen et al. 2009: N=62 (45 males); Mean age (SD): 61.0 (9.9); 98% RH dominant; 50% right side hemiplegia; median months since stroke (range): 8 (3.0-21.8))
(Mathiowetz et al 1985: N=628 healthy participants, 310 male; age 20-75+)
Validity
Low to Moderate correlation with SCIM-III:
SCIM-self-care: r = 0.55
SCIM-total: r = 0.33
SCIM-mobility: r = 0.29
SCIM-respiration/sphincter: r = 0.12
(Lili et al. 2023; n = 25; 18 males, 7 females; mean age: 58.4 years; injury level: 17 cervical, 8 thoracic; ASIA: 14 ASIA A-B, 11 ASIA C-D; mean time since injury: 17.5 years)
For stroke patients:
Low to High correlation with:
Fugl-Meyer motor – r = 0.921
Fugl-Meyer sensation – r = 0.285
Fugl-Meyer joint motion/pain – r = 0.433
Action Research Arm Test – r = 0.951
Motricity Index – r = 0.798
Ashworth Scale – r = -0.383
Hemispheric Stroke Scale – r = -0.676
Modified Barthel Index – r = 0.044
(Platz et al. 2005: n = 56, 37 stroke, 14 MS, 5 TBI; 31 male)
Reviewers
Carlos L. Cano Herrera, Tyra Chu
Date Last Updated
December 31, 2024
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
Lili L, Sunnerhagen KS, Rekand T, Alt Murphy M. Independence and upper extremity functioning after spinal cord injury: a cross-sectional study. Sci Rep. 2023;13(1):3148. https://pubmed.ncbi.nlm.nih.gov/36823179/
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/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
