Design a Haptic-Combined Virtual Reality System to Improve Box and Block Test (BBT) for Upper Extremity Function Assessment

Abstract

Background: The Box and Block Test (BBT) has been widely used to assess gross upper extremity (UE) motor function. We designed a haptic-combined virtual reality (VR) system, named VBBT, to improve BBT with kinematic parameters for more specific assessments.Methods: According to the block-transfer task in BBT, we designed a VBBT system with a haptic device to provide a sense of the grasping force and block's gravity during task performance for UE function assessment. Besides the number of transferred blocks (N-TB), some kinematic parameters were also collected in VBBT for more specific assessment, including the number of zero-crossings of moving acceleration (NZC-ACC), the number of zero-crossings of derivative of releasing force (NZC-DRF), the ratio of path length and linear length (PLR) and the distance between barrier partition and drop position (DDP). 16 post-stroke patients and 113 healthy subjects were recruited to examine quantitative performances, concurrent validity, test-retest reliability and subjective preference between the BBT and VBBT.Results: Based on the measurements of 95% healthy subjects, the normative ranges of quantitative performances were established for BBT and VBBT. Deficiencies in patients’ UE function could be identified when their measurements fell outsides. A moderate correlation was found in the N-TBs between the VBBT and BBT (r = 0.42). The measurements in VBBT presented a stronger age-related correlation than that in BBT (R2 = 0.57 and R2 = 0.16). The N-TBs in both BBT and VBBT were strongly correlated to the Action Research Arm Test (ARAT) (|r| = 0.84 and 0.83), and the NZC-ACC and NZC-DRF in VBBT also showed significant correlations. (|r| = 0.76 and 0.79). The N-TB, NZC-ACC and NZC-DRF in VBBT showed a good test-retest reliability (ICC = 0.75, 0.78 and 0.80) while a moderate reliability was found in BBT (ICC = 0.62). For the patient preference, VBBT was given a higher score than the BBT (p < 0.05) for its enjoyment and completion effort performing.Conclusion: The VBBT improved a gross manual assessment in BBT, which can provide clinically validated, reliable and motivative assessment with kinematic parameters for specific UE motor functions of post-stroke patients.

Clip-On IMU System for Assessing Age-Related Changes in Hand Functions

“…This could be partially attributed to individual habits in transferring movements. A similar pattern was observed in the study of virtual reality-based BBT [14]. However, this should be interpreted with caution, as our study did not collect relevant kinematic parameters at the elbow and shoulder.…”

“…Similarly, few digitalised BBTs [13,14] have attempted to provide additional kinematic information in the BBT, using a depth camera [13] or a 3D virtual environment that allows spatial visualisation and operation [14]. However, considering some known disadvantages of the optical-based approach in Section 2, earlier investigations are unsuitable for measuring fine-motor hand movement in the BBT, which involves precise and rapid movement of the fingers.…”

“…To date, recent advancements in virtual reality and sensing technologies have contributed to improving the sensitivity, automation, and accessibility of the BBT. Examples include digital BBT (dBBT) with depth camera detections [13] and a haptic-combined virtual reality BBT [14].…”

What Is the Relationship between Trunk Control Function and Arm Coordination in Adults with Severe-to-Moderate Quadriplegic Cerebral Palsy?

“…One of the most used tools in the clinical setting for assessing MD is the Box and Block (BB) test [17]. This test evaluates the ability to grasp and release objects, an appropriate test in the assessment of adults with neurological conditions [18], such as a prior stroke [19,20] and CP [14,21]. On the other hand, to assess specific throwing coordination, Connick et al [11] proposed using different tapping tests to identify the impact of the coordination impairment on the activity limitation.…”