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Box and Blocks Test of Manual Dexterity
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Exploratory: Cerebral Palsy (CP)
Short Description of Instrument
Construct measured: It is a timed, norm-referenced measure of unilateral dexterity.
Generic vs. disease specific: Generic.
Means of administration: Examiner administered.
Intended respondent: Child.
Background: The Box and Blocks is a generic clinical tool developed to measure unilateral manual dexterity. Norms are available for ages 3–65+. Child norms were derived from 471 typical children ages 6–19 years (Mathiowetz et al., 1985). Newer child norms (Jongbloed-Pereboom et al., 2013) were derived from 215 Dutch children ages 3–10 years. The test measures capacity, i.e., what a child does in a
standardized environment.
Comments/Special Instructions
The test consists of an oblong box with a partition across the middle and 150, 2-inch wooden blocks. The patient is seated with the box on the table in front of him/her. The patient is asked to grasp and move the blocks from one compartment to another as quickly as possible for one minute. The dominant dominant hand is tested first, then the procedure is repeated with the non-dominant hand. The examiner sits opposite the patient. The patient is allowed a 15 second trial prior to testing each
The examiner counts the number of blocks moved from one compartment to another in one minute.Each hand is scored separately. If the patient picks up two or more blocks, they are not counted.
Administration and scoring procedures are outlined in Mathiowetz et al, 1985. A full description is available from: Box and Blocks Test Instructions, provided courtesy of Virgil Mathiowetz, PhD, OTR/L.
Administration time: 5 minutes.
Strengths/Weaknesses: Can be administered quickly and easily in a clinical setting. Children have to be able to follow directions. Validity and reliability not established in CP population, however the test has been used in multiple studies to evaluate the hand skills of children with unilateral CP after intervention. Most recent child norms and psychometric properties derived from a study of Dutch children.
Psychometric Properties: ICC for interrater reliability was .99. ICC for test-retest reliability was .85. Concurrent validity: significant correlations to the manual dexterity subtests of the Movement Assessment Battery for Children–2: correlations were moderate to strong for children aged 3–6 years and weak to moderate for
children aged 7–10 years (215 Dutch children ages 3–10 years).
Key References:
Mathiowetz V, Ferderman S, Wiemer D. Box and Block Test of Manual Dexterity: Norms for 6-19 Year Olds. Can J Occup Ther. 1985;52(5):241-246.
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.
Jongbloed-Pereboom M, Nijhuis-van der Sanden MW, Steenbergen B. Norm scores of the box and block test for children ages 3-10 years. Am J Occup Ther. 2013;67(3):312-318.
Additional References:
Tomhave WA, Van Heest AE, Bagley A, James MA. Affected and contralateral hand strength and dexterity measures in children with hemiplegic cerebral palsy. J Hand Surg. 2015;40(5):900-907.


Document last updated July 2019