Nine Hole Peg Test (NHPT)

Purpose of the measure

The Nine Hole Peg Test (NHPT) was developed to measure finger dexterity, also known as fine manual dexterity. It can be used with a wide range of populations, including clients with stroke. Additionally, the NHPT is a relatively inexpensive test and can be administered quickly.

The NHPT should be used in association with other upper extremity performance tests, in order to estimate upper limb function with more accuracy.

Available versions

The NHPT was first introduced by Kellor, Frost, Silberberg, Iversen, and Cummings in 1971. In 1985, norms for the NHPT in healthy individuals were established by Mathiowetz, Weber, Kashman, and Volland.

Features of the measure

Items:
The NHPT is composed of a square board with 9 pegs. At one end of the board are holes for the pegs to fit in to, and at the other end is a shallow round dish to store the pegs. The NHPT is administered by asking the client to take the pegs from a container, one by one, and placing them into the holes on the board, as quickly as possible. Clients must then remove the pegs from the holes, one by one, and replace them back into the container. In order to practice and register baseline scores, the test should begin with the unaffected upper limb. The board should be placed at the client’s midline, with the container holding the pegs oriented towards the hand being tested. Only the hand being evaluated should perform the test. The hand not being evaluated is permitted to hold the edge of the board in order to provide stability (Mathiowetz et al., 1985; Sommerfeld, Eek, Svensson, Holmqvist, & Arbin, 2004).

Scoring:
Clients are scored based on the time taken to complete the test activity, recorded in seconds. The stopwatch should be started from the moment the participant touches the first peg until the moment the last peg hits the container. (Grice, Vogel, Le, Mitchell, Muniz, & Vollmer, 2003; Mathiowetz et al., 1985).

Mathiowetz et al. (1985) reported that on average, healthy male adults complete the NHPT in 19.0 seconds (SD 3.2) with the right hand, and in 20.6 seconds (SD 3.9) with the left hand. For healthy female adults, the NHPT was completed in 17.9 seconds (SD 2.8) and 19.6 seconds (SD 3.4) with the right and left hand, respectively.

Alternative scoring – the number of pegs placed in 50 or 100 seconds can be recorded. In this case, results are expressed as the number of pegs placed per second (Jacob-Lloyd, Dunn, Brain, & Lamb, 2005; Sunderland, Trinson, Bradley, & Langton-Hewer, 1989).

Time:
Not typically reported. Norms indicated above indicate approximate testing times in normals.

Subscales:
None

Equipment:
The standardized equipment consists of:

  • A board, in wood or plastic, with 9 holes (10 mm diameter, 15 mm depth), placed apart by 32 mm (Mathiowetz et al., 1985; Sommerfeld et al., 2004) or 50 mm (Heller, Wade, Wood, Sunderland, Hewer, & Ward, 1987).
  • A container for the pegs. Initially the container was a square box (100 x 100 x 10 mm) apart from the board. The most current container is a shallow round dish at the end of the board (Grice et al., 2003).
  • 9 pegs (7 mm diameter, 32 mm length) (Mathiowetz et al., 1985).
  • Stopwatch.

Training:
None typically reported.

Alternative forms of the Nine Hole Peg Test

None.

Client suitability

Can be used with:

  • Clients with stroke.
  • Clients should have a satisfactory level of upper limb fine motor skills as they must be able to pick up the pegs to complete the test.

Should not be used in:

  • The NHPT cannot be used with clients who have severe upper extremity impairment.
  • The NHPT cannot be used with clients with severe cognitive impairment.
  • Scoring with an upper time limit of 50 or 100 seconds requires caution especially in the acute post-stroke period due to the possibility of floor effects (Jacob-Lloyd et al., 2005; Sunderland et al.,1989).
In what languages is the measure available?

There are no official translations of the NHPT.

Some publications from Netherlands, Japan and Sweden have used the NHPT as an outcome measure, which shows its use in languages other than English. (Dekker, Van Staalduinem, Beckerman, Van der Lee, Koppe, & Zondervan, 2001; Hatanaka, Koyama, Kanematsu, Takahashi, Matsumoto, & Domen, 2007; Sommerfeld et al., 2004).