Concurrent validity of an immersive virtual reality version of the Box and Block Test to assess manual dexterity among patients with stroke

Abstract

Background After a stroke, experts recommend regular monitoring and kinematic assessments of patients to objectively measure motor recovery. With the rise of new technologies and increasing needs for neurorehabilitation, an interest in virtual reality has emerged. In this context, we have developed an immersive virtual reality version of the Box and Block Test (BBT-VR). The aim of this study was to assess the concurrent validity of the BBT-VR among patients with stroke and healthy participants. Methods Twenty-three healthy participants and 22 patients with stroke were asked to perform the classical Box and Block Test (BBT) and BBT-VR three times with both hands. Concurrent validity was assessed through correlations between these two tests and reliability of the BBT-VR through correlation on test–retest. Usability of the BBT-VR was also evaluated with the System Usability Scale. Hand kinematic data extracted from controller’s 3D position allowed to compute mean velocity (Vmean), peak velocity (Vpeak) and smoothness (SPARC). Results Results showed strong correlations between the number of blocks displaced with the BBT and the BBT-VR among patients with stroke for affected (r = 0.89; p < 0.001) and less-affected hands (r = 0.76; p < 0.001) and healthy participants for dominant (r = 0.58; p < 0.01) and non-dominant hands (r = 0.68; p < 0.001). Reliability for test–retest was excellent (ICC > 0.8; p < 0.001) and usability almost excellent (System Usability Scale = 79 ± 12.34%). On average participants moved between 30 and 40% less blocks during the BBT-VR than during the BBT. Healthy participants demonstrated significantly higher kinematic measures (Vmean = 0.22 ± 0.086 ms−1; Vpeak = 0.96 ± 0.341 ms−1; SPARC = − 3.31 ± 0.862) than patients with stroke (Vmean = 0.12 ± 0.052 ms−1; Vpeak = 0.60 ± 0.202 ms−1; SPARC = − 5.04[− 7.050 to − 3.682]). Conclusion The BBT-VR is a usable, valid and reliable test to assess manual dexterity, providing kinematic parameters, in a population of patients with stroke and healthy participants. Trial registration http://www.clinicaltrials.gov; Unique identifier: NCT04694833, Date of registration: 11/24/2020

The Use of Leap Motion in Manual Dexterity Testing by the Box and Blocks Test: A Review Study

“…Scientific studies involving box and blocks test in its virtual version are emerging in the context of rehabilitation in patients with neurological diseases, such as Parkinson's Disease (PD), Cerebral Vascular Accident (CVA), and Multiple Sclerosis (MS), among others, intending to study the validity, feasibility, and psychometric properties of the test [3,10,15]. However, few studies have developed the virtual BBT (VBBT) [10].…”

“…The interest in developing virtual tests is multiple [10]. It can reduce the interobserver subjectivity in the classic assessment, providing a complete virtual rehabilitation at home where patients can assess their cognitive and motor improvements using validated virtual evaluation.…”

“…Several models of VR headsets are on the market, such as Gear VR, Rift glasses, and HTC Vive [2,[7][8][9][10][11][12][13][14][15][16][17][18][19]. Gear VR is a more cost-effective solution because it uses the screen of a Samsung smartphone as a viewing display [18].…”

Performing a shortened version of the Action Research Arm Test in immersive virtual reality to assess post-stroke upper limb activity

“…This offers the possibility to develop quantitative and objective measures that could be used autonomously and operated without the need of clinician presence. To date, several tests have been developed to measure post-stroke upper limb functions such as motor control [ 27 ] and manual dexterity in a virtual environment [ 28 , 29 ]. For instance, in 2019, Kim et al developed a non-immersive VR version of the Fugl-Meyer Assessment (FMA-UL) to assess post-stroke upper limb motor function [ 27 ].…”

“…Regarding assessments of activity limitation, two studies developed the Box and Block Test in immersive VR [ 28 – 30 ]. The first study developed the test using controllers and data showed strong correlations between virtual and classical test scores when assessed among individuals with stroke [ 29 ]. The second study used hand-tracking technology and data showed moderate to strong correlations between scores when tested among a population of individuals with Parkinson disease [ 28 ].…”