Box And Block Test Research Articles

Effect of visual biofeedback on fine motor function and activity daily of life in stroke patients: A pilot study

IntroductionMany stroke patients suffer from dysfunction in their upper limbs, which can lead to difficulties in performing activities of daily living (ADL) as well as social and work interactions. This is particularly true for patients whose dominant side has been affected. The aim of the current study was to explore how effective visual biofeedback could improve fine motor function in the hand and ADL for people suffering from a stroke. MethodsTen individuals who had experienced a stroke with aged from 60 to 74 years old (mean: 64.3 years) were randomly divided into two groups. Patients in study group (n: 5) received 15 sessions of visual biofeedback therapy along with routine occupational therapy. Control group (n: 5) received only routine occupational therapy. Fine motor function was measured by Fugl Meyer Scale (FMS), box and block test (BBT), and Purdue pegboard test (PPBT). Also, ADL was measured by functional independence measure (FIM). These clinical outcomes were evaluated before, after, and 1.5 months following the interventions. ResultsThe results showed that the study group experienced a significant increase in fine motor function after receiving visual biofeedback, compared to the control group. The ADL also improved in both the study and control groups after the intervention, but there was no significant difference between the two groups during the intervention and follow-up stages for ADL. ConclusionIt seems that combining biofeedback with routine occupational therapy could be a promising method to enhance fine motor function in individuals with stroke.

Functional outcome of mirror therapy versus task oriented training on hand function in children with unilateral cerebral palsy

Background. Unilateral cerebral palsy (UCP) is a kind of spastic cerebral palsy which is characterized by atypical posture of upper limb, poor eye-hand coordination, and reduced hand skills. These symptoms can restrict a child’s ability to engage in life activities. Purpose. To compare the effectiveness of mirror therapy as well as task-oriented training on hand functions improvement among UCP children. Methods. Sixty children suffering from UCP were randomly allocated into three equal groups. A schemed physical therapy protocol was utilized to the control, mirror therapy (MT), and task-oriented training (TOT) groups. The protocols of mirror therapy and task-oriented training were administered to MT and TOT groups respectively. Assessments of upper extremity skills, hand dexterity, wrist extension range of motion, along with overall grip strength were conducted at baseline and after intervention using the Quality of Upper Extremity Skills Test (QUEST), Box and Block Test (BBT), universal goniometer, as well as pneumatic squeeze handheld dynamometer respectively. Throughout a total of twelve consecutive weeks, the intervention session was held three days a week. Results. The change amount in all measured hand outcomes were significantly improved following the intervention in all three groups, with the TOT group showing a larger significant effect. Conclusion. Task-oriented training had superior impact than mirror therapy in enhancing hand functions among children having UCP.

The Use of Diagnostic Transcranial Magnetic Stimulation as a Predictor of the Functional Outcome in Ischemic Stroke

ABSTRACT. Determination of rehabilitation potential (RP) is necessary for optimal rehabilitation strategy and the best rehabilitation measures. Navigational transcranial magnetic stimulation (nTMS) has been proposed as a method for PR determination in after-stroke patients.THE AIM. was to study the importance of navigational diagnostic transcranial magnetic stimulation as a neurofunctional predictor of motor function recovery after ischemic stroke.MATERIAL AND METHODS. The study included 28 after-stroke patients, 19 men and 9 women, the mean age was 60.07±5.67 years, who underwent a course of inpatient medical rehabilitation at the Moscow Research and Practice Center for Medical Rehabilitation, Restorative and Sports Medicine named after S.I. Spasokukotsky in 2022–2023. Clinical examination and assessment were conducted before and after the rehabilitation course using validated scales and questionnaires — the Medical Research Committee (MRCs) scale, the Box and Block Test (BBT), the modified Rankin scale (mRS); the rehabilitation routing scale (RRS). The patients were also examined using nTMS at the N.V. Sklifosovsky Research Institute for Emergency Medicine with the determination of motor evoked potential (MEP) parameters from the muscles of the upper and lower extremities.RESULTS. In patients with preserved MEP, there was a significant increase in the strength of the paretic limb on the MRCs scale from 4.00 (2.94–4.06) to 4.22 (3.83–4.89) points (p <0.001) for the upper limb and from 4.00 (3.67–4.00) to 4.44 (3.83–4.61) (p<0.001) for the lower limb. Improvements were revealed according to the mRS scale — the number of patients with an mRS score of 2 points in the group of patients with defined MEP increased by 26.1%, reached values of 1 point — 13.0% of patients, and the number of patients with an assessment of disability and self-care ability of 4 points decreased by 8.7%.CONCLUSION. Navigational transcranial magnetic stimulation is one of the methods for assessing the rehabilitation potential in patients with ischemic stroke. But TMS should not be used as the only method of evaluating rehabilitation potential. The assessment of RP should be comprehensive and based on the complex data obtained.

Effect of modified constraint-induced movement therapy along with bimanual massed practice on upper extremity functions in tetraplegics: a pilot study

Background and objectiveConstraint-induced movement therapy is a widely used rehabilitation program in the stroke population, but its application in spinal cord injury is limited. The objective of the study is to determine the feasibility of modified constraint-induced movement therapy (mCIMT) in incomplete tetraplegia exhibiting upper limb weakness and activities of daily living (ADLs) difficulty.MethodThis is a quasi-experimental one-group pilot study, consisting of 12 subjects diagnosed with incomplete tetraplegia. They received 2-h sessions of modified constraint-induced movement therapy of the weaker hand along with a 1-h session of bimanual massed practice, 5 days a week for 3 weeks. Apart from this, they were asked to do 3 h of constrained-induced movement therapy daily 5 days a week for 3 weeks at their home as a part of a home exercise program. Box and block test (BBT) and Spinal Cord Independence Measure version III (SCIM-III) were taken as the primary measure, and manual function test (MFT) and capabilities for upper extremity (CUE) were used as secondary measures to access hand functions and ADLs. Subjects were examined during pre-intervention and post-intervention.ResultsAfter 3 weeks of intervention, the mean change of the score for the trained hand showed significant changes in the scores of the box and block test (p = 0.03), manual function test (p = 0.02), SCIM-III (p = 0.03), and CUE (p = 0.02).ConclusionThis preliminary study revealed that modified CIMT may be a feasible and effective alternative for hand rehabilitation in incomplete tetraplegia.

Effects of wearable device training on upper limb motor function in patients with stroke: a systematic review and meta-analysis.

To evaluate the effect of wearable device training on improving upper limb motor function in patients who experienced strokes. The PubMed, Embase, Cochrane Library, Web of Science, MEDLINE, SCOPUS, China National Knowledge Infrastructure, WanFang, and VIP databases were searched for randomized controlled trials (RCTs) that assessed the effectiveness of wearable device training in improving upper limb motor function in patients with stroke. Two investigators independently screened studies by their titles and abstracts and cross-checked, downloaded, and evaluated the results. Disagreements were resolved by a third highly experienced researcher. Risk of bias was evaluated using the Cochrane risk-of-bias tool. This meta-analysis was registered in PROSPERO (registration No. CRD42023421633). This study comprised 508 patients from 14 RCTs. The experimental group assessed various wearable devices, including 3D-printed dynamic orthoses, inertial measurement unit (IMU) sensors, electrical stimulation devices, and virtual reality (VR) devices for virtual interactive training. The control group received traditional rehabilitation therapies, including physical and conventional rehabilitation. The experimental group scored better on the Fugl-Meyer Assessment (FMA-UE) scale (standardized mean difference [SMD] 0.26, 95% confidence interval [CI] 0.07, 0.45) and Box and Block Test (BBT) (SMD 0.43, 95% CI 0.17, 0.69) versus controls. No significant intergroup differences were observed in the Action Research Arm Test (SMD 0.20, 95% CI -0.15, 0.55), motor activity log (mean difference [MD] 0.32, 95% CI -0.54, 0.33), and modified Ashworth scale (MD -0.08, 95% CI -0.81, 0.64). The probability rankings of wearable devices that improved FMA-UE scores in patients with stroke were: orthotic devices, with the highest probability ranking of 0.45, followed by sensor devices at 0.23, electrical stimulation devices at 0.21, and VR devices at 0.11. Wearable device training was found to significantly improve upper limb motor function in patients with stroke, particularly for large-range movements. Improvements in FMA-UE and BBT scores reflected reduced impairment and enhanced manual dexterity, respectively. However, the training had no significant effect on hand movement frequency, fine motor skills, or spasticity. Among the different wearable devices tested, orthoses produced the most effective results.

A Single-Blind Randomized Controlled Pilot Study of Electroacupuncture with Transcranial Direct Current Stimulation for Improving Motor Function in Stroke Patients

Objectives: This study aimed to confirm the effectiveness and safety of electroacupuncture (EA) with transcranial direct current electrical stimulation (tDCS) on motor function improvement in stroke patients.Methods: This study was conducted on patients diagnosed with stroke more than 2 weeks but within 12 months of onset. A total of 22 patients were randomly assigned to the experimental and control groups. The experimental group received EA and tDCS treatment, while the control group received sham EA and sham tDCS treatment. Assessments were conducted using the Korean version of the Fugl-Meyer Assessment (K-FMA) scores, grip and pinch strength tests, Box and Block test (BBT), Nine-hole peg test (9HPT), Berg balance scale (BBS), and the Korean version the Modified Barthel Index (K-MBI) scores. Adverse events were recorded at each intervention.Results: No statistically significant differences were observed in general characteristics between the two groups. The K-FMA, BBS, and K-MBI scores of both groups increased significantly after the intervention, but there was no significant difference between the two groups. Although hand strength and dexterity improved after intervention in both groups, the changes were not statistically significant. In the experimental group, the lateral pinch score increased significantly after the intervention, but this increase was not significant compared to the control group. There was no significant difference in the incidence of adverse events between the two groups. All nine reported adverse reactions were minor, with no moderate or severe adverse reactions reported.Conclusion: This study confirmed the potential effectiveness and safety of EA with tDCS in improving motor function in stroke patients.

Spanish translation and cross-cultural adaptation of the Box and Block Test: a pilot study in adults with chronic acquired brain injury.

Background The Box and Block Test (BBT) is a highly recommended outcome measure to assess unilateral gross motor activity of the upper limbs. The BBT has not previously been available in a version adapted to the Spanish context. Thus, this study aimed to cross-culturally adapt and translate the BBT's instructions and pilot test the Spanish version of BBT in adults with acquired brain injury (ABI). Methods The BBT was translated and cross-culturally adapted following standard procedures. An expert committee approved the final Spanish version of BBT and it was conceptually validated by four therapists with expertise in ABI. The tool was tested on 14 adults with ABI. Results The Spanish version of BBT included a new section of materials for the test and a record to count the number of blocks transferred from one compartment of the box to the other. Following the pilot study, a modification in terminology was implemented for referring to the dominant and non-dominant hands. Conclusions Our results suggest that the Spanish version of BBT is suitable for assessing manual dexterity in Spanish-speaking adults with ABI.

Feasibility of a home-based home videogaming intervention with a family-centered approach for children with cerebral palsy: a randomized multiple baseline single-case experimental design

BackgroundWorldwide, children with cerebral palsy (CP) living in underserved communities face barriers to accessing motor therapy services. This study assessed the implementation and effectiveness of an 8-week, upper limb (UL) home-based intervention with a movement-tracking videogame (Bootle Blast) in Costa Rican children with CP.MethodsChildren established a weekly playtime goal and two UL activities of daily living (ADLs) that they would like to improve on. A multiple-baseline, single-case experimental design, was used with the Performance Quality Rating Scale (PQRS) as the repeated measure to track changes in performance of the selected ADLs between the baseline (usual care) and intervention (Bootle Blast) phases. The Canadian Occupational Performance Measure (COPM), the Box and Blocks Test (BBT) and the Children’s Hand-Use Experience Questionnaire (CHEQ) were collected before and after the intervention. Technical barriers were documented during weekly video calls with a monitoring therapist. Treatment effect size, slope changes and percentage of non-overlapping data were identified for the PQRS. Descriptive statistics summarized results for the BBT, CHEQ, videogame logs (e.g., playtime) and technical barriers.ResultsFifteen children participated and 13 completed the intervention. Both participants who dropped out did so after completing baseline assessments, but before experiencing Bootle Blast. Children’s mean active playtime (i.e., mini-games targeting the UL) across the 8-weeks was 377 min, while mean total time spent engaging with Bootle Blast (active + passive play time [e.g., time navigating menus, reviewing rewards]) was 728 min. In total, eight technical issues (from five children) were reported, and all but three were resolved within 48 h. Partial effectiveness was associated with the intervention. Specifically, 85% of participants improved on the PQRS and 69% achieved clinically important improvements ≥ 2 points in performance on the COPM. Children improved by 1.8 blocks on average on the BBT, while on the CHEQ, five children had a clinically important increase of 10% of the total number of UL activities performed with both hands.ConclusionBootle Blast is a feasible and effective option to facilitate access and engage children with cerebral palsy in UL home rehabilitation.Trial registration Trial registration number: NCT05403567.

Realizing computer vision rehabilitation assessment tests & evaluation applications for mobile devices

Upper extremity impairments are a common consequence of stroke, necessitating thorough rehabilitation monitoring and kinematic assessments to facilitate motor recovery. The Box and Block Test (BBT) and Sollerman Hand Function Test (SHFT) are two widely utilized and recommended tools for objectively measuring upper limb dexterity and evaluating fine motor skill rehabilitation in patients. However, these tests rely on specific equipment and therapist attendance, making the process time-consuming and clinic-dependent. This paper introduces a computer vision-based hand rehabilitation assessment suite specifically designed for mobile devices, such as smartphones and tablets, which serves as a virtual alternative to traditional methods while also incorporating an interactive exergame. Our application faithfully integrates the original tests’ guidelines and procedures into an engaging computer vision experience, utilizing advanced technologies like MediaPipe Hands for precise hand and finger tracking. This innovative solution obviates the need for additional computer peripherals such as smart gloves or VR headsets, as well as physical equipment like wooden boxes and blocks, relying solely on the built-in camera of everyday mobile devices. In addition, we address several technical challenges encountered in our approach and outline future directions for score normalization and feature expansion, ensuring the continued improvement and efficacy of our hand rehabilitation assessment suite.

Psychometric properties of the modified reaching performance scale in persons with multiple sclerosis

BackgroundA valid and reliable assessment tool to describe the quality of the movement pattern of reaching can provide valuable insights into motor performance deficits in persons with MS (pwMS). The Reaching Performance Scale, developed for stroke, is a promising scale to assess movement patterns in pwMS. However, psychometric properties of the scale are lacking in pwMS. ObjectivesFirstly, to investigate the content validity of the modified Reaching Performance Scale for application in patients with MS (mRPS). Secondly, to investigate the psychometric properties (within- and between-session reliability and concurrent validity) of the mRPS for pwMS. MethodsForty-five pwMS (mean EDSS 6.6 pt, IQR 6–7.5) executed the mRPS that rates the quality of movement patterns and compensations during reach to grasp tasks. The content validity was determined by an expert panel based on observations of subjects performing the RPS. The reliability was based on five repetitions within one day, and between two days. For the concurrent validity, outcome measures at two levels of the International Classification of Functioning were correlated with the mRPS: Body Structure and Function level: Fugl-Meyer Assessment of the Upper Limb (FMA-UL), maximal isometric hand grip strength (HGS; Activity level: Action Research Arm Test (ARAT), Box and Blocks Test (BBT), Nine Hole Peg Test (NHPT) and Trunk Impairment Scale 2.0 (TIS 2.0) as well as perceived performance by the Manual Ability Measure-36 (MAM-36). ResultsScale modifications were made only on the ratings of the trunk displacement subscale. The mRPS had excellent agreement scores for within-session reliability (range of Kappa between 0.85 and 0.98) and moderate-to-excellent agreement scores for between-session reliability (K: 0.66–1.00). Regarding validity, the mRPS was highly correlated with the ARAT (rho=0.74, p < 0.001), followed by moderate correlations with trunk performance (TIS 2.0, rho= 0.61, p < 0.001), hand function (BBT: rho=0.64, p < 0.001; NHPT: rho=-0.61, p < 0.001) and perceived performance (MAM36 rho= 0.53, p < 0.001). ConclusionThe mRPS is a reliable measurement tool to describe the movement pattern quality and motor compensations used during reaching in pwMS. Concerning concurrent validity, the mRPS is partially related to other measures of upper limb and trunk performance.

A Systematic Review of Structured Exercises and Music Therapy on the Functional Status of Stroke Survivors

Background: Stroke, a leading cause of disability worldwide, often leaves survivors grappling with functional impairments that significantly impact their daily lives. Enhancing the functional status of stroke survivors is not only a personal achievement but also a critical public health concern. Aim: A systematic review of literature was conducted to identify the various forms of structured exercises and music therapy used in enhancing the functional status of stroke survivors, and the various outcome measures used in measuring the functional status of the stroke survivors. Design: A systematic review Data Sources: A systematic literature search was performed for publications using PubMed, Scopus, Google Scholar, Embase, CINAHL, ISI, and ScienceDirect Databases. Eligibility Criteria: The review included published studies which reported use of structured exercises and Music therapy in enhancing the functional status of stroke survivors aged 18 years and above, and published in English between June 2012 and June 2022. Data Extraction: The titles and abstracts of articles were screened and studies that did not meet the eligibility criteria were excluded. Full texts of eligible studies were further scrutinized. The results were interpreted and reported with respect to their level of evidence, design, sample size, duration, quality appraisal and risk of bias. Result: A total of 2,427 studies were identified through initial search of the databases. Additional 8 records were identified through other sources making it a total of 2,435 records. 2,350 duplicate studies were removed after screening. The remaining 85 full-text articles were screened for eligibility criteria and further reduced to 26. Of these 26 studies, 17 were Randomized Controlled Trials (RCTs), 7 quasi-experimental studies, 1 case series, and 1 case study. Hand function exercise (23.0%) was the most used form of structured exercise while music-supported therapy (29.1%) was the most used music therapy intervention. Motor function (41.6%) was the most investigated construct of functional status. The most used outcome measures were Box and Blocks Test (BBT) (10.4%) and 9 Hole Pegboard Test (9HPT) (10.4%) which were used for measuring motor function of the stroke survivors. Conclusion: Various forms of structured exercises and music therapy were found to improve the functional status of stroke survivors. Also, various outcome measures for measuring the functional status of the stroke survivors were reported as well. Clinicians and researchers should choose the appropriate outcome measures for the right constructs in the course of their practice and research programmes.

Task-Oriented Training by a Personalized Electromyography-Driven Soft Robotic Hand in Chronic Stroke: A Randomized Controlled Trial

Background Intensive task-oriented training has shown promise in enhancing distal motor function among patients with chronic stroke. A personalized electromyography (EMG)-driven soft robotic hand was developed to assist task-oriented object-manipulation training effectively. Objective. To compare the effectiveness of task-oriented training using the EMG-driven soft robotic hand. Methods A single-blinded, randomized controlled trial was conducted with 34 chronic stroke survivors. The subjects were randomly assigned to the Hand Task (HT) group (n = 17) or the control (CON) group (n = 17). The HT group received 45 minutes of task-oriented training by manipulating small objects with the robotic hand for 20 sessions, while the CON group received 45 minutes of hand-functional exercises without objects using the same robot. Fugl-Meyer assessment (FMA-UE), Action Research Arm Test (ARAT), Modified Ashworth Score (MAS), Box and Block test (BBT), Maximum Grip Strength, and active range of motion (AROM) of fingers were assessed at baseline, after intervention, and 3 months follow-up. The muscle co-contraction index (CI) was analyzed to evaluate the session-by-session variation of upper limb EMG patterns. Results The HT group showed more significant improvement in FMA-UE (wrist/hand, shoulder/elbow) compared to the CON group (P < .05). At 3-month follow-up, the HT group demonstrated significant improvements in FMA-UE, ARAT, BBT, MAS (finger), and AROMs (P < .05). The HT group exhibited a more significant decrease in muscle co-contractions compared to the CON group (P < .05). Conclusions EMG-driven task-oriented training with the personalized soft robotic hand was a practical approach to improving motor function and muscle coordination. Clinical Trial Registry Name: Soft Robotic Hand System for Stroke Rehabilitation. Clinical Trial Registration-URL: https://clinicaltrials.gov/. Unique Identifier: NCT03286309.

Relationship between Hand grip strength and Hand function in patients with Stroke: A Cross-Sectional Study

BackgroundHands are vital and inevitable organs. It's essential to evaluate hand function post-stroke as it is a major source of impairment. Grip strength gives a guide to hand function as a measure of impairment. The modified Sphygmomanometer Test (MST) offers an intriguing alternative method for assessing hand grip strength as compared to using hand-held dynamometers. ObjectivesThe study aimed to investigate the correlation between hand grip strength and hand function in stroke patients. MethodsA cross-sectional research was carried out on a group of 45 stroke patients, ranging in age from 40 to 70 years. The assessment included the measurement of hand grip strength through the Modified Sphygmomanometer Test (MST), as well as the evaluation of hand function using the Box and Block Test (BBT) and the Jebsen Taylor Hand Function Test (JTHFT). Correlation analysis was performed using the Pearson correlation coefficient test. ResultsThe outcomes showed a strong to excellent between MST and BBT (r = 0.909, p = 0.000); and between MST and JTHFT Non Dominant Hand (JTHFTNDH, r = −0.669 and p = 0.000). However, there was a weak correlation between MST and JTHFT Dominant Hand, and this correlation was not statistically significant (r = −0.243 and p = 0.108). ConclusionThe findings indicated a relationship between hand grip strength and hand function among stroke patients. MST holds potential as a convenient, objective and cost-effective alternative in clinical settings for evaluating hand grip strength and predicting hand function.

Validation of upper extremity kinematics using Markerless motion capture

Movement research has typically been performed using three-dimensional (3D) marker-based motion capture, which is considered the “gold-standard” for biomechanical assessment. However, limitations exist due to the lack of portability, extensive preparation for data collection, marker placement training, error due to marker movement, and possible skin irritation due to marker adhesives. There is inherent error due to motion artifact stemming from skin movement and differences in marker placement between testers. Markerless motion capture systems are emerging as a new method of kinematic assessment. These methods require little preparation and there is no need to alter participant clothing. Markerless motion capture has also been validated for the lower extremity in healthy older adults during gait. However, it has not been validated for other populations or for the assessment of upper extremity (UE) motion. Therefore, the purpose of this study was to examine differences in calculated UE kinematics between marker-based and a markerless motion capture system. Participants attended two data collection sessions. Marker-based and markerless motion capture data was collected simultaneously while participants completed the Box and Blocks test (BBT). Kinematic and spatiotemporal data from both systems was exported using identical time series to ensure the same conditions for comparisons. Intraclass Correlation Coefficients (ICCs) were calculated to determine between session reliability for both systems on range of motion and peak joint angular data to ensure movement variability was not affecting measurement consistency. ICCs and Bland Altman statistics were also calculated between the systems. Root mean square deviation (RMSD) values were determined between demeaned UE joint angles for the two systems to examine movement pattern differences. The resulting between-session ICCs for each system showed that the markerless system shared similar reliability during this task as the marker-based system, further supporting the effect of variability on between-session reliability. Between-system ICCs resulted in good (0.7<ICC<0.9) to excellent (ICC>0.9) agreement. Bland Altman results confirmed the existence of measurement bias between the systems. RMSD values for all UE joint angles were found to be less than 6°. Overall, the results from this study support the use of markerless motion capture in clinical settings to examine upper extremity biomechanics in children.

Clinical Utility and Usability of the Digital Box and Block Test: Mixed Methods Study.

The Box and Block Test (BBT) is a clinical tool used to measure hand dexterity, which is often used for tracking disease progression or the effectiveness of therapy, particularly benefiting older adults and those with neurological conditions. Digitizing the measurement of hand function may enhance the quality of data collection. We have developed and validated a prototype that digitizes this test, known as the digital BBT (dBBT), which automatically measures time and determines and displays the test result. This study aimed to investigate the clinical utility and usability of the newly developed dBBT and to collect suggestions for future improvements. A total of 4 occupational therapists participated in our study. To evaluate the clinical utility, we compared the dBBT to the BBT across dimensions such as acceptance, portability, energy and effort, time, and costs. We observed therapists using the dBBT as a dexterity measurement tool and conducted a quantitative usability questionnaire using the System Usability Scale (SUS), along with a focus group. Evaluative, structured, and qualitative content analysis was used for the qualitative data, whereas quantitative analysis was applied to questionnaire data. The qualitative and quantitative data were merged and analyzed using a convergent mixed methods approach. Overall, the results of the evaluative content analysis suggested that the dBBT had a better clinical utility than the original BBT, with ratings of all collected participant statements for the dBBT being 45% (45/99) equal to, 48% (48/99) better than, and 6% (6/99) lesser than the BBT. Particularly in the subcategories "acceptance," "time required for evaluation," and "purchase costs," the dBBT was rated as being better than the original BBT. The dBBT achieved a mean SUS score of 83 (95% CI 76-96). Additionally, several suggested changes to the system were identified. The study demonstrated an overall positive evaluation of the clinical utility and usability of the dBBT. Valuable insights were gathered for future system iterations. These pioneering results highlight the potential of digitizing hand dexterity assessments.

Effects of Maitland mobilization technique on upper extremity function in stroke survivors with spasticity: An experimental study.

The recovery of upper limb function is of great significance for stroke patients to regain their self-care ability, yet it is still a difficult point in clinical practice of neurological rehabilitation. This study aimed to investigate the effect of Maitland joint mobilization technique on the recovery of upper extremity function in patients with spasticity after stroke. From August to December 2023, 71 patients with upper extremity flexor spasm after stroke were recruited and randomly divided into experimental group (n = 35) and control group (n = 36). The control group was given conventional rehabilitation treatment, while the experimental group was treated with Maitland mobilization technique treatment of upper extremity joints on the basis of the control group. The experiment lasted for 8 weeks. Participants of the 2 groups were observed for Fugl-Meyer motor assessment-upper extremity (FMA-UE), box and block test (BBT) and Brunnstrom stage, modified Ashworth scale (MAS), and functional independence measure (FIM) at pre- and post-8 weeks study. There was no significant difference in gender distribution, hemiplegic side, diagnosis, past history, age, duration, body mass index, and mini-mental state examination between the 2 groups (P > .05). After 8 weeks of intervention, both groups showed significant improvement in FMA-UE, Brunnstrom stage, BBT, FIM, and MAS of the shoulder (P < .05); however, there was no significant change in MAS of the elbow, wrist, and finger joints (P > .05). The posttreatment values showed a significant improvement in FMA-UE, BBT, and FIM in the experimental group compared to the control group. Comparing the changes in pretreatment and posttreatment, FMA-UE, BBT, and FIM in the experimental group were significantly improved compared with those in the control group (P < .05). Maitland joint mobilization can improve the motor function of upper extremity and the spasticity of shoulder joint complex in patients with stroke.

Ηand dexterities assessment in stroke patients based on augmented reality and machine learning through a box and block test

A popular and widely suggested measure for assessing unilateral hand motor skills in stroke patients is the box and block test (BBT). Our study aimed to create an augmented reality enhanced version of the BBT (AR-BBT) and evaluate its correlation to the original BBT for stroke patients. Following G-power analysis, clinical examination, and inclusion–exclusion criteria, 31 stroke patients were included in this study. AR-BBT was developed using the Open Source Computer Vision Library (OpenCV). The MediaPipe's hand tracking library uses a palm and a hand landmark machine learning model to detect and track hands. A computer and a depth camera were employed in the clinical evaluation of AR-BBT following the principles of traditional BBT. A strong correlation was achieved between the number of blocks moved in the BBT and the AR-BBT on the hemiplegic side (Pearson correlation = 0.918) and a positive statistically significant correlation (p = 0.000008). The conventional BBT is currently the preferred assessment method. However, our approach offers an advantage, as it suggests that an AR-BBT solution could remotely monitor the assessment of a home-based rehabilitation program and provide additional hand kinematic information for hand dexterities in AR environment conditions. Furthermore, it employs minimal hardware equipment.

Nonlinear EEG Analysis During Motor and Cognitive Tasks in Patients With Long COVID: A Dynamic Systems Approach.

Introduction. Nonlinear EEG provides information about dynamic properties of the brain. This study aimed to compare nonlinear EEG parameters estimated from patients with Long COVID in different cognitive and motor tasks. Materials and Methods. This 12-month prospective cohort study included 83 patients with Long COVID: 53 symptomatic and 30 asymptomatic. Brain electrical activity was evaluated by EEG in 4 situations: (1) at rest, (2) during the Trail Making Test Part A (TMT-A), (3) during the TMT Part B (TMT-B), and (4) during a coordination task: the Box and Blocks Test (BBT). Nonlinear EEG parameters were estimated in the time domain (activity and complexity). Assessments were made at 0 to 3, 3 to 6, and 6 to 12 months after inclusion. Results. There was a decrease in activity and complexity during the TMT-A and TMT-B, and an increase of these parameters during the BBT in both groups. There was an increase in activity at rest and during the TMT-A in the COVID-19 group at 0 to 3 months compared to the control, an increase in activity in the TMT-B in the COVID-19 group at 3 to 6 months compared to the control, and reduced activity and complexity at rest and during the TMT-A at 6 to 12 months compared to the control. Conclusion. The tasks followed a pattern of increased activity and complexity in cognitive tasks, which decreased during the coordination task. It was also observed that an increase in activity at rest and during cognitive tasks in the early stages, and reduced activity and complexity at rest and during cognitive tasks in the late phases of Long COVID.

Reliability and Construct Validity of a Mobile Application for the Finger Tapping Test Evaluation in People with Multiple Sclerosis.

The finger tapping test (FTT) is a tool to evaluate the motor performance of the hand and fingers and eye-hand coordination with applicability in people with multiple sclerosis (pwMS). The aim of this study was to evaluate the intra- and inter-rater reliability of the TappingPro® mobile app and the construct validity between this app and validated clinical scales for motor performance in healthy subjects and pwMS. 42 healthy subjects (mean age 25.05) and 13 pwMS (mean age 51.69, EDSS between 3 and 7.5E) participated. FTT was performed with the TappingPro® mobile app. All participants were examined twice, with a one-week interval between the two appointments. For the analysis of construct validity, the Jamar® hydraulic hand dynamometer, Box and Blocks Test (BBT), and Nine Hole Peg Test (NHPT) were used. The intra-rater reliability showed a good correlation (Intraclass Correlation Coefficient, ICC > 0.787) for both upper limbs and both times of FTT for healthy subjects, and an excellent correlation (ICC > 0.956) for upper limbs and both times of FTT for pwMS. The ICC for the inter-rater reliability was good (ICC = 0.869) for the non-dominant upper limb in the FTT 10 s of the healthy subjects, and excellent (ICC > 0.904) for all the other measurements of the healthy subjects and pwMS. However, the Bland-Altman plots showed disagreement between observers and measurements that should be considered in the interpretation of clinical evaluations. The correlation analysis for healthy subjects showed poor associations between all variables, except for the association between hand grip strength and the FTT 60 s in the non-dominant upper limb, which had a moderate coefficient. For pwMS, there were moderate to excellent associations between BBT and the NHPT and FTT for both upper limbs. The correlations between hand grip strength and FFT were poor. This mobile app could be a useful and low-cost assessment tool in pwMS, allowing a simple evaluation and follow-up that has excellent correlation with clinical scales validated in this pathology.

Neuroanatomical correlates of gross manual dexterity in children with unilateral spastic cerebral palsy.

Unilateral spastic Cerebral Palsy (UCP) results from congenital brain injury, and Magnetic Resonance Imaging (MRI) has a role in understanding the etiology and severity of brain insult. In UCP, functional impairment predominantly occurs in the upper limb (UL) of the more affected side, where manual ability and dexterity are typically reduced. Also, mirror movements (MMs), are often present in UCP, with a further possible negative functional impact. This study aims to investigate the relationships among neuroanatomical characteristics of brain injury at MRI, manual functional impairment and MMs, in children with UCP. Thirty-five children with UCP participated in the study (20, M = 15, F, mean age 9.2 ± 3.5 years). Brain lesions at MRI were categorized according to the Magnetic Resonance Classification System (MRICS) and by using a semi-quantitative MRI (sqMRI) scale. Gross manual performance was assessed through Manual Ability Classification System (MACS) and the Box and Block Test (BBT), and MMs by Woods and Teuber scale, for both hands. Non-parametric correlation analyses were run to determine the relationship between neuroanatomical and functional features. Regression models were run to explore the contribution of neuroanatomical features and MMs to UL function. Correlation analyses revealed moderate to strong associations between sqMRI scores contralateral to the more affected side and UL functional impairment on MACS and BBT, with more severe brain injuries significantly correlating with poorer function in the more affected hand. No association emerged between brain lesion severity scores and MMs. MRICS showed no association with MACS or BBT, while a significant correlation emerged between MRICS category and MMs in the more affected hand, with brain lesion category that are suggestive of presumed earlier injury being associated with more severe MMs. Finally, exploratory regression analyses showed that neuroanatomical characteristics of brain injury and MMs contributed to the variability of UL functional impairment. This study contributes to the understanding of the neuroanatomical and neurological correlates of some aspects of manual functional impairment in UCP by using a simple clinical brain MRI assessment.