Development and Validation of a Virtual Version of the Box and Block Test to Assess Manual Dexterity at Home for Adults with Stroke and Children with Cerebral Palsy.

The REAtouch Lite device was recently developed to support motor skill learning-based interventions, integrating both games/activities and assessment tools to enable home-based telerehabilitation. Given the importance of hand functions in rehabilitation of patients with brain lesions, this study aimed to validate a virtual version of the Box and Block Test (vBBT) implemented in the REAtouch device. A total of 205 healthy participants, 37 post-stroke adults, and 37 children with cerebral palsy (CP) performed the standard BBT, various versions of the newly designed vBBT (with/without a separation wall; with 6, 4, and free zones) and the Tower of London test assessing executive function/planning abilities. Friedman's ANOVA revealed significant differences between the BBT and all versions of the vBBT scores in healthy participants (all < 0.001). However, the vBBT-4 zones showed the largest intraclass correlation coefficient (ICC) with the BBT in healthy participants (0.58) and even higher correlations in participants with CP and stroke (>0.8). Only the vBBT-6 zones version showed a significant correlation with patients' planning abilities ( < 0.01; r = -0.28). These findings highlight the vBBT-4 zones as the most relevant version to assess hand dexterity directly with the REAtouch device, potentially within telerehabilitation modalities. Further normative data must be established.