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 <i>p</i> < 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 (<i>p</i> < 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.