The Box and Block Test (BBT) is a clinical assessment of gross manual dexterity, requiring participants to move small blocks between two boxes. It is scored using the number of blocks transferred in 60 s; a high score requires rapid arm movements and accurate grasping, with no constraints on block placement accuracy. A low score cannot distinguish inaccurate movements from slow movements.
To address this, we explored two variations of the standard BBT using 16 blocks moved in a predefined sequence. The insert BBT requires inserting blocks into recesses that constrain accuracy. The targeted BBT requires placing each block onto a target, allowing measurement of movement timing and accuracy.
Across participants, movement times for the insert and targeted BBT were strongly correlated, but only weakly correlated with the standard BBT scores. Two speed-accuracy tradeoffs were evident: within participants, slower placements were generally more accurate; and across participants, those who moved more slowly were generally more accurate. Surprisingly, locations associated with faster movements were also associated with more accurate block placements, highlighting the spatial affordances of the block locations.
Our tasks capture performance features absent in the standard BBT and emphasize the value of designing dexterity tasks that evaluate both speed and accuracy. This project was funded by the Australian Research Council (DP200100179; DP2101002107; DP210103865) and by the National Health and Medical Research Council of Australia (APP1185442). MAH was supported by ARC DE180100344.
Department of Physiology and Neuroscience Program, Biomedicine Discovery Institute, Monash University, Clayton, VIC, 3800, Australia Yilin Wu, Taahirah Mangera, Maureen Ann Hagan & Nicholas Seow Chiang Price Correspondence to Nicholas Seow Chiang Price. The authors declare no competing interests. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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