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      Targeted box and blocks test: Normative data and comparison to standard tests

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          Abstract

          Background

          The Box and Block Test (BBT) is a functional outcome measure that is commonly used across multiple clinical populations due to its benefits of ease and speed of implementation; reliable, objective measurement; and repetition of motion. In this study, we introduce a novel outcome measure called the targeted BBT that allows for the study of initiation, grasping, and transport of objects, and also of object release. These modifications to the existing test may increase the ecological validity of the measure while still retaining the previously stated benefits of the standard BBT.

          Methods

          19 able-bodied subjects performed the targeted BBT and two other standard tests. Using an integrated movement analysis framework based on motion capture and ground force data, quantitative information about how subjects completed these tests were captured. Kinematic parameters at the wrist, elbow, shoulder, thorax, and head, as well as measures of postural control, were calculated and statistically compared across the three tests.

          Results

          In general, the targeted BBT required significantly higher RoM at the elbow, shoulder, thorax and head when compared to standard tests. Peak angles at these joints were also higher during performance of the targeted BBT. Peak angles and RoM values for the targeted BBT were close to those found in studies of movements of able-bodied individuals performing activities of daily living.

          Conclusion

          The targeted BBT allows analysis of repetitive movements, and may more closely model common real-world object manipulation scenarios in which a user is required to control a movement from pick-up to release.

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          Most cited references23

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          Measures of postural steadiness: differences between healthy young and elderly adults.

          T Prieto, J B Myklebust, R G Hoffmann … (1996)
          Measures of postural steadiness are used to characterize the dynamics of the postural control system associated with maintaining balance during quiet standing. The objective of this study was to evaluate the relative sensitivity of center-of-pressure (COP)-based measures to changes in postural steadiness related to age. A variety of time and frequency domain measures of postural steadiness were compared between a group of twenty healthy young adults (21-35 years) and a group of twenty healthy elderly adults (66-70 years) under both eyes-open and eyes-closed conditions. The measures that identified differences between the eyes-open and eyes-closed conditions in the young adult group were different than those that identified differences between the eye conditions in the elderly adult group. Mean velocity of the COP was the only measure that identified age-related changes in both eye conditions, and differences between eye conditions in both groups. The results of this study will be useful to researchers and clinicians using COP-based measures to evaluate postural steadiness.
          Article 0 comments Cited 343 times – based on 0 reviews     Review now
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            Compensatory strategies for reaching in stroke.

            M C Cirstea, M Levin (2000)
            A major prerequisite for successful rehabilitation therapy after stroke is the understanding of the mechanisms underlying motor deficits common to these patients. Studies have shown that in stroke patients multijoint pointing movements are characterized by decreased movement speed and increased movement variability, by increased movement segmentation and by spatial and temporal incoordination between adjacent arm joints with respect to healthy subjects. We studied how the damaged nervous system recovers or compensates for deficits in reaching, and correlated reaching deficits with the level of functional impairment. Nine right-hemiparetic subjects and nine healthy subjects participated. All subjects were right-hand dominant. Data from the affected arm of hemiparetic subjects were compared with those from the arm in healthy subjects. Seated subjects made 40 pointing movements with the right arm in a single session. Movements were made from an initial target, for which the arm was positioned alongside the trunk. Then the subject lifted the arm and pointed to the final target, located in front of the subject in the contralateral workspace. Kinematic data from the arm and trunk were recorded with a three-dimensional analysis system. Arm movements in stroke subjects were longer, more segmented, more variable and had larger movement errors. Elbow-shoulder coordination was disrupted and the range of active joint motion was decreased significantly compared with healthy subjects. Some aspects of motor performance (duration, segmentation, accuracy and coordination) were significantly correlated with the level of motor impairment. Despite the fact that stroke subjects encountered all these deficits, even subjects with the most severe motor impairment were able to transport the end-point to the target. All but one subject involved the trunk to accomplish this motor task. In others words, they recruited new degrees of freedom typically not used by healthy subjects. The use of compensatory strategies may be related to the degree of motor impairment: severely to moderately impaired subjects recruited new degrees of freedom to compensate for motor deficits while mildly impaired subjects tended to employ healthy movement patterns. We discuss the possibility that there is a critical level of recovery at which patients switch from a strategy employing new degrees of freedom to one in which motor recovery is produced by improving the management of degrees of freedom characteristic of healthy performance. Our data also suggest that stroke subjects may be able to exploit effectively the redundancy of the motor system.
            Article 0 comments Cited 180 times – based on 0 reviews     Review now
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              Test-retest reproducibility and smallest real difference of 5 hand function tests in patients with stroke.

              Ling Huang, C. Chen, I-Ping Hsueh … (2009)
              To investigate the test-retest reproducibility and smallest real difference (SRD) of 3 hand strength tests (grip, palmar pinch, and lateral pinch) and 2 dexterity tests (the Box and Block test [BBT] and the Nine Hole Peg test [NHPT]) in patients with stroke. The 5 tests were administered on 62 stroke patients in 2 sessions, 3 to 7 days apart. The intraclass correlation coefficient (ICC) was used to determine the level of reproducibility between measurements on 2 sessions. The SRD was used to determine the extent of measurement error because of chance variation in individual patients. SRD percentage (SRD relative to mean score) was used to compare test-retest reliability across tests. We analyzed the group as a whole, then in 2 subgroups (hand spasticity vs none). The test-retest reproducibility of all 5 tests was high for all the patients, with ICCs ranging from 0.85 to 0.98. The SRDs for the more/less affected hand were: 2.9/4.7 kg for the grip test; 1.2/1.3 kg for the palmar pinch test; 1.4/1.0 kg for the lateral pinch test; 5.5/7.8 blocks/minute for the BBT; and 32.8/6.2 seconds for the NHPT. Unacceptably high SRD percentages (>30%) were found for the affected hand using the NHPT (54%), palmar pinch (35%), and lateral pinch (34%). When comparing these indices for participants with spasticity versus none for all 5 tests, the ICCs were lower and the SRD and SRD percentage were higher for the spasticity group. All 5 tests demonstrated satisfactory test-retest reproducibility for a diverse group of patients with stroke. However, all tests showed higher levels of measurement error when performed with the more affected hand and in patients with hypertonicity of that hand. Thus, baseline and postrehabilitation change scores using these common tests of strength and dexterity must be interpreted with some caution, especially in poorly controlled clinical trials. Repeated measures ought to be incorporated to examine reliability within a trial that includes participants with a hypertonic hand.
              Article 0 comments Cited 144 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Esteban Andres Fridman: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 19 May 2017
                Publication date Collection: 2017
                Volume: 12
                Issue: 5
                Electronic Location Identifier: e0177965
                Affiliations
                [1 ]U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Labs, Division of Biomedical Physics, Silver Spring, Maryland, United States of America
                [2 ]U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Device Evaluation, Division of Neurological and Physical Medicine Devices, Silver Spring, Maryland, United States of America
                Weill Cornell Medical College, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                • Conceptualization: KK EC.

                • Data curation: KK.

                • Formal analysis: KK IM BM.

                • Funding acquisition: EC.

                • Investigation: KK BM.

                • Methodology: KK IM BM EC.

                • Project administration: KK.

                • Resources: KK EC.

                • Software: KK IM.

                • Supervision: EC.

                • Visualization: KK IM EC.

                • Writing – original draft: KK.

                • Writing – review & editing: IM BM EC.

                Author information
                http://orcid.org/0000-0002-4978-6011
                Article
                Publisher ID: PONE-D-17-05021
                DOI: 10.1371/journal.pone.0177965
                PMC ID: 5438168
                PubMed ID: 28542374
                SO-VID: 3f7afa2c-df4f-4431-8666-c3f73efef853
                License:

                This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

                History
                Date received : 7 February 2017
                Date accepted : 5 May 2017
                Page count
                Figures: 8, Tables: 1, Pages: 15
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100000185, Defense Advanced Research Projects Agency;
                Award ID: IAA 224-14-6009
                Funded by: funder-id http://dx.doi.org/10.13039/100000038, U.S. Food and Drug Administration;
                Award ID: CPOSEL13
                This work was funded in part by an interagency agreement with DARPA-BTO (IAA 224-14-6009), and by the FDA Critical Path Initiative (CPOSEL13). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Subject: Research Article
                Subject: Physical Sciences
                Subject: Physics
                Subject: Classical Mechanics
                Subject: Kinematics
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Musculoskeletal System
                Subject: Limbs (Anatomy)
                Subject: Arms
                Subject: Wrist
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Musculoskeletal System
                Subject: Limbs (Anatomy)
                Subject: Arms
                Subject: Wrist
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Musculoskeletal System
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Musculoskeletal System
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Thorax
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Thorax
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Musculoskeletal System
                Subject: Limbs (Anatomy)
                Subject: Arms
                Subject: Hands
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Musculoskeletal System
                Subject: Limbs (Anatomy)
                Subject: Arms
                Subject: Hands
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Musculoskeletal System
                Subject: Limbs (Anatomy)
                Subject: Arms
                Subject: Forearms
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Musculoskeletal System
                Subject: Limbs (Anatomy)
                Subject: Arms
                Subject: Forearms
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Musculoskeletal System
                Subject: Limbs (Anatomy)
                Subject: Arms
                Subject: Elbow
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Musculoskeletal System
                Subject: Limbs (Anatomy)
                Subject: Arms
                Subject: Elbow
                Subject: Engineering and Technology
                Subject: Signal Processing
                Subject: Signal Filtering
                Subject: Butterworth Filters
                Custom metadata
                Data Availability All relevant data are within the paper and its Supporting Information file.

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