Abstract Body: BACKGROUND: Cognitive factors influence motor performance, but often this is not considered when testing motor function. Here we examined this issue using 3 versions of the Box and Blocks Test (BBT), a measure of arm motor function. First, we developed 2 new, briefer versions of BBT and then tested their validity. Second, we hypothesized that cognitive factors would be more strongly related to versions of the BBT that require a longer period of testing.
METHODS: In 71 patients <=30 days post-stroke, 3 BBT versions were scored. BBT60 is the standard one; subjects move as many blocks as possible over a divider in 60 sec. We also counted # blocks moved in the first 10 sec (BBT10) and time to move the first 3 blocks (3-BBT). Other testing included 2 motor scores, Fugl Meyer (FM) and 9-Hole Peg (9HP); and 2 cognitive scores, Trail Making Test-A (TMT-A) and Montreal Cognitive Assessment (MoCA). First, we tested the validity of the briefer BBT versions (3-BBT and BBT10) against BBT60 and FM. Second, we compared all BBT versions to measures of sustained attention (TMT-A) and cognitive function (MoCA). Comparisons used Spearman’s rank correlation coefficient (threshold p<0.05).
RESULTS: Mean time post-stroke was 13.1±5.9 days; age, 66.9±14.9 yrs; 40.8% female. Median BBT scores: 3-BBT, 17.4 sec; BBT10, 2 blocks; and BBT60, 10 blocks. Other median scores: FM, 36 points, MoCA, 21 points; 9HP, 1 peg in 60 sec; TMT-A, 49.5 sec for 25 targets. Scores on 3-BBT (r=-0.93, p<0.0001) and BBT10 (r=0.95, p<0.0001) showed strong validity with BBT60 scores. Each BBT version, respectively, was related to FM score (r=-0.81, r=0.77, r=0.82; all p<0.0001) and to 9HP score (r=-0.77, r=0.82, r=0.82; all p<0.0001). TMT-A was not significantly related to 3-BBT (r=0.20, p=0.09), but was related to BBT10 (r=-0.24, p=0.04) and BBT60 (r=-0.24, p=0.04). MoCA was not significantly related to 3-BBT (r=-0.15, p=0.21) or BBT60 (r=0.20, p=0.09), but was to BBT10 (r=0.26, p=0.03).
CONCLUSIONS: The 3-BBT and BBT10 are both valid measures of arm motor function in subacute stroke. Each is quicker and more easily assessed than BBT60. The BBT10 and BBT60 were more strongly related to TMT-A, and BBT60 to MoCA, suggesting that these 2 BBT versions are more influenced by attention or cognition compared to 3-BBT. All 3 BBT measures are valid; choice of which to use depends on whether the goal is to measure motor function with less (3-BBT) or more (BBT10 and BBT60) influence of attention or cognitive factors.