Abstract
The Box and Block Test (BBT) has been widely used to assess gross upper extremity (UE) motor function. We designed a haptic-feedback virtual reality (VR) system, named the VBBT, to improve the BBT for more specific assessments. The VBBT task required users to move virtual blocks from one compartment of a virtual box to the other within one minute. The focus of this pilot study was to examine the validity, reliability and motivation of the novel assessment. Totally, 113 healthy subjects and 16 post-stroke patients were recruited for a thorough evaluation. We found that scores of the BBT and VBBT were significantly correlated, both of which declined as participants’ age. The normative ranges of kinematic metrics in different age groups were used to identify deficiencies in UE motor function involving smoothness, hand dexterity and motion efficiency. Also, a significant correlation between the VBBT and Action Research Arm Test (ARAT) (|r|≥ 0.56) indicated concurrent validity of the novel assessment. Test–retest results indicated that the VBBT assessment had high reliability (ICCs = 0.62–0.80). The Intrinsic Motivation Inventory results showed that the VBBT was given higher scores for the enjoyment (p < 0.05) and completion effort (p < 0.05) than that for the BBT, indicating patients have greater motivation in the VBBT assessment. In conclusion, the VBBT can provide validated, reliable and motivative assessment for UE motor function with kinematic metrics. It suggests that the haptic-feedback VR contributes to the BBT in specific assessments of UE motor function.
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Data availability
All the data and materials in the current study are available from the corresponding author on reasonable request.
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The custom code in the current study is available from the corresponding author on reasonable request.
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This work was supported by the National Key R&D Program of China under Grant 2020YFC2007904, the National Nature Science Foundation of China under Grant U20A20390 and 11827803 and the Open Project Funding from the State Key Laboratory of Virtual Reality Technology and Systems, Beihang University under Grant VRLAB2018T01.
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YD contributed to designing and conducting the experiment, analyzing the experimental data, and drafting this manuscript. XL contributed to leading this work, securing the funding, guiding the experiment and drafting and editing the manuscript. MT contributing to programing the virtual task, conducting the experiment and interpreting the data. HH contributed to analyzing and interpreting the data. DC, ZW and RA contributed to conducting the experiment. YF contributed to leading this work, securing the funding, editing and approving the final manuscript.
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Dong, Y., Liu, X., Tang, M. et al. A haptic-feedback virtual reality system to improve the Box and Block Test (BBT) for upper extremity motor function assessment. Virtual Reality 27, 1199–1219 (2023). https://doi.org/10.1007/s10055-022-00727-2
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DOI: https://doi.org/10.1007/s10055-022-00727-2