The Box and Block Test (BBT) measures unilateral gross manual dexterity. It is a quick, simple and inexpensive test. It can be used with a wide range of populations, including clients with stroke.
The original version of the BBT was developed, in 1957, by Jean Hyres and Patricia Buhler. This version was modified into the current one by E. Fuchs and P. Buhler (Cromwell, 1976). In 1985, normative data on the BBT was established by Mathiowetz, Volland, Kashman, and Weber.
The BBT is composed of a wooden box divided in two compartments by a partition and 150 blocks. The BBT administration consists of asking the client to move, one by one, the maximum number of blocks from one compartment of a box to another of equal size, within 60 seconds. The box should be oriented lengthwise and placed at the client’s midline, with the compartment holding the blocks oriented towards the hand being tested. In order to practice and register baseline scores, the test should begin with the unaffected upper limb. Additionally, a 15-second trial period is permitted at the beginning of each side. Before the trial, after the standardized instructions are given to clients, they should be advised that their fingertips must cross the partition when transferring the blocks, and that they do not need to pick up the blocks that might fall outside of the box (Mathiowetz, Volland, Kashman, & Weber, 1985-1).
Clients are scored based on the number of blocks transferred from one compartment to the other compartment in 60 seconds (Mathiowetz et al., 1985-1). Higher scores are indicative of better manual dexterity. During the performance of the BBT, the evaluator should be aware of whether the client’s fingertips are crossing the partition. Blocks should be counted only when this condition is respected. Furthermore, if two blocks are transferred at once, only one block will be counted. Blocks that fall outside the box, after trespassing the partition, even if they don’t make it to the other compartment, should be counted.
Mathiowetz et al. (1985-1) reported that healthy male adults, aged 20 to 80 years, transfer an average of 77 blocks (SD ±11.6) with the right hand and 75 blocks (SD ±11.4) with the left hand within the 60 second limit. Scores for normal healthy men, aged 60 years old or more ranged from 61 to 70 blocks. Healthy female adults, aged 20 to 80 years, transfer an average of 78 blocks (SD ±10.4) with the right hand and 76 blocks (SD ±9.5) with the left hand. Scores for normal healthy women, aged 60 years old or more, ranged from 63 to 76 blocks. The score on the BBT and age are inversely correlated, meaning that average scores on the BBT decrease with older age.
The BBT requires 2 to 5 minutes to administer (Finch, Brooks, Stratford, & Mayo, 2002; Mathiowetz et al., 1985-1).
The standardized equipment consists of:
A wooden box dimensioned in 53.7 cm x 25.4 cm x 8.5 cm. The partition should be placed at the middle of the box, dividing it in two containers of 25.4 cm each. (Mathiowetz et al., 1985-1).
150 wooden cubes – 2.5 cm in size (Mathiowetz et al., 1985-1). Stopwatch.
Training of administrator:
None typically reported.
Can be used with:
Clients with stroke.
Should not be used in:
The BBT cannot be used with clients who have severe upper extremity impairment.
The BBT cannot be used with clients with severe cognitive impairment.
There are no official translations of the BBT. The specific instructions provided to the client are in English. Clinicians and researchers may be using “home-grown” translations of the instructions as evidenced from peer-reviewed publication from Sweden, French Canada, Italy and Germany that have used the BBT as an outcome measure. (Broeren, Rydmark, Bjorkdahl, & Sunnerhagen, 2007; Dannenbaun, Michalsen, Desrosiers, & Levin, 2002; Mercier & Bourbonnais, 2004; Platz, Pinkowski, Kim, di Bella, & Johnson, 2005; Schneider, Schonle, Altenmuller, & Munte, 2007).