Manual Therapy, Posturology & Rehabilitation Journal
Manual Therapy, Posturology & Rehabilitation Journal

Use of the Box and Block Test for the evaluation of manual dexterity in individuals with central nervous system disorders: A systematic review

Oliveira, Claudia Santos; Almeida, Cibele Santos; Freias, Larissa Carolina; Santana, Robéria; Fernandes, Gislene; Fonseca Junior, Paulo Roberto; Moura, Renata Calhes Franco

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Introduction: Therapies designed to improve the functional capacity of the upper limb have become a vast field of research. Current clinical methods for upper extremity evaluations address function, motor control, sensory deficiency, dexterity, muscle tone and range of motion. The quality and performance in relation to activities related to the work of daily living and recreational activities are largely determined by hand functions and manual dexterity. Abnormal dexterity and the loss of motor coordination are among the main adverse conditions stemming from neurological disorders. Objective: The aim of the present study was to perform a systematic review of the literature on the use of the Box and Block Test (BBT) for the evaluation of manual dexterity in patients with central nervous system disorders. Methods: Searches were performed the Medline, PEDro, Lilacs, Scielo and PubMed databases. The articles retrieved during the initial search were analyzed independently by two blinded reviewers based on the following inclusion criteria: (1) controlled clinical trial; (2) population with neurological disorders; (3) evaluation involving the BBT; (4) outcome: evaluation of manual dexterity; (5) year of publication: 2005 and 2016. Preselected articles were evaluated for methodological quality using the Physiotherapy Evidence Database (PEDro) scale (minimum score for inclusion: 5 points). Results: The search resulted in the retrieval of 51 articles, 42 of which did not meet the inclusion criteria. Nine articles addressed the use of the BBT as one of the methods for the evaluation of manual dexterity in patients with central nervous system disorders, were considered methodologically adequate and were included in the present systematic review. Conclusion: The studies analyzed suggest that the BBT is a fast, easy, safe measure of manual dexterity with good applicability for adults and children with neurofunctional diseases.


Box and Blocks, neurofunctional diseases, manual dexterity


1. Carmeli E, Patish H, Coleman R. The Aging Hand. J. Gerontol. Med. Sci. 2003;58a(2):146-152.

2. Poirier F. Dexterity as a valid measure of hand function: 23. A pilot study. Occup. Ther. Health Care 1988;4(3-4):69-83.

3. Gable C, Xenard J, Makiela E, Chau N. Evaluation fonctionnelle de la main. Bilan des 400 points et tests chiffrés. Ann Réad Méd Phys 1997;40:95–101.

4. Kalron A, Greenberg-Abrahami M, Gelav S, Achiron A. Effects of a new sensory reeducation training tool on hand sensibility and manual dexterity in people with multiple sclerosis. NeuroRehabilitation 2013;32:943–948

5. Falconer J, Hughes SL, Naughton BJ, Singer R, Chang RW, Sinacore JM. Self report and performance-based hand function tests as correlates of dependency in the elderly. J Am Geriatr Soc 1991;39:695–699.

6. Higgins J, Salbach NM, Wood-Dauphinee S, Richards CL, Côté R, Mayo NE. The effect of a task-oriented intervention on arm function in people with stroke: a randomized controlled trial. Clin Rehabil 2006;20:296-310

7. Geerdink Y, Aarts P, Geurts A. Motor learning curve and long-term effectiveness of modified constraint-induced movement therapy in children with unilateral cerebral palsy: a randomized controlled trial. Res. Dev. Disabil. 2013;34:923-931.

8. Krumlinde-Sundholm L1, Holmefur M, Kottorp A, Eliasson AC. The assisting hand assessment: current evidence of validity, reliability, and responsiveness to change. Dev Med Child Neurol 2007;49:259–264.

9. Moura RCF, Almeida CS, Dumont AJL, Lazzari RD, Lopes JBP, Duarte NAC, et al. Kinematic upper limb evaluation of children and adolescents with cerebral palsy: a systematic review of the literature. J Phys Ther Sci. 2016 Feb;28(2):695–700.

10. Santos CA, Moura RCF, Lazzari RD, Dumont AJ, Braun LA, Oliveira CS. Upper limb function evaluation scales for individuals whith cerebral palsy: a systematic review. J Phys Ther Sci. 2015 May;27(5):1617-20.

11. Tyson S, Connell L. The psychometric properties and clinical utility of measures of walking and mobility in neurological conditions: a systematic review. Clin Rehabil 2009;23:1018–1033.

12. Desrosiers J, Rochette A, Hébert R, Bravo G. The Minnesota manual dexterity test: reliability, validity and reference values studies with healthy elderly people. Can. J. Occup. Ther., 1997;64(5):270-276.

13. Desrosiers J, Bravo G, Hébert R, Dutil E, Mercier L. Validation of the box and block test as a measure of dexterity of elderly people: reliability, validity, and norms studies. Arch. Phys. Med. Rehabil., 1994;75(7):751-755.

14. Mathiowetz V, Federman S, Wiemer D. Box And Block Test Of Wan Al Dex, Norms For 6-19 Year Olds. Cjot 1985;52(5):241-245.

15. 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.

16. Arnould C, Penta M, Renders A, Thonnard JL. Abilhand-Kids: a measure of manual ability in children with cerebral palsy. Neurology, 2004;63:1045–1052.

17. Page SJ, Levin L, Hermann V, Dunning K, Levine P. Longer versus shorter daily durations of electrical stimulation during task-specific practice in moderately impaired stroke. Arch Phys Med Rehabil, 2012;93:200-206.

18. Priosti P, Assis S, Cymrot R, Vianna DL, Caromano FA. Força de preensão e destreza manual na criança com síndrome de Down. Fisioter Pesq. 2013;20(3):278-285.

19. Mendes MF, Tilbery CP, Balsimelli S, Moreira MA, Cruz AMB. Teste de destreza manual da caixa e blocos em indivíduos normais e em pacientes com esclerose múltipla. Arq. Neuro-Psiquiatr. 2001;59(4):889-894.

20. Nunes CMP, Cavalcante A, Galvão CR. Avaliação e técnicas de avaliação nas áreas de desempenho ocupacional. Terapia Ocupacional, Fundamentação E Prática. Rio De Janeiro: Guanabara Koogan, 2007.

21. Guimarães R, Blascovi-Assis S. Uso do Teste Caixa e Blocos na avaliação de destreza manual em crianças e jovens com síndrome de Down. Rev. Ter. Ocup. Univ. São Paulo, 2012;23(1):98-106.

22. McCarthy M, Silberstein CE, Atkins EA, Harryman SE, Sponseller PD, Miller NAH. Comparing reability and validity of pediatric instruments for measuring health and well-being of children with spastic cerebral palsy. Developmental Medicine & Child Neurology. 2002;44,468-476.

23. Cavaco NS, Alouche SR. Instrumentos de avaliação da função de membros superiores após acidente vascular encefálico: uma revisão sistemática. Fisioterapia e Pesquisa. 2010;17(2):178-83.

24. Thompson-Butel AG, Lin GG, Shiner CT, McNulty PA. Two Common Tests of Dexterity Can Stratify Upper Limb Motor Function After Stroke. Neurorehabilitation and Neural Repair 2014;28(8):788–796.

25. Cauraugh JH, Naik S, Lodha N, Coombes SA, Summers JJ. Long-Term rehabilitation for chronic stroke arm movements: a randomized controlled trial. Clin. Rehabil. 2011;25(12):1086 – 1096.

26. Franceschini M, Ceravolo M, Agosti M, Cavallini P, Bonassi S, Dall’Armi V, et al. Clinical relevance of action observation in upper-limb stroke rehabilitation: a possible role in recovery of functional dexterity. A randomized clinical trial. Neurorehabil Neural Repair, 2012;26:456.

27. Sin HH, Lee GC. Additional. Virtual Reality Training Using Xbox kinect in stroke survivors with hemiplegia. Am.J. Phys. Med. Rehabil. 2013;92(10):871-80.

28. Masiero S, Armani M, Ferlini G, Rosati G, Rossi A. Randomized trial of a robotic assistive device for the upper extremity during early inpatient stroke rehabilitation. Neurorehabil. Neural. Repair, 2013;28(4):377-386.

29. Kim H, Lee G, Song C. Effect of functional electrical stimulation with mirror therapy on upper extremity motor function in poststroke patients. J Stroke Cerebrovasc Dis. 2014;23(4):655-661.

30. Gilliaux M, Renders A, Dispa D, Holvoet D, Sapin J, Dehez B, et al. Upper Limb Robot-Assisted therapy in cerebral palsy: a single-blind randomized controlled trial. Neurorehabilitation and Neural Repair 2015;29(2)-183-192.

31. Keh-Chung Lin, Pai-Chuan Huang, Yu-Ting Chen Wu CY, Huang WL. Combining afferent stimulation and mirror therapy for rehabilitating motor functions after stroke. Neurorehabilitation and Neural Repair 2014;28(2)-153-162.

32. Sakzewski L, Ziviani J, Boyd R. Systematic review and meta-analysis of therapeutic management of upper limb dysfunction in children with congenital hemiplegia. Pediatrics 2009;123:E1111-E1122.

33. Sakzewski L, Ziviani J, Boyd R. Efficacy of upper limb therapies for unilateral cerebral palsy: A meta-analysis. Pediatrics 2014;133(1):e175-e204.

34. Sposito MMM, Riberto M. Avaliação da funcionalidade da criança com paralisia cerebral espastica. Acta Fisiatrica. 2010;17(2):50–61.

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