Date Presented 04/05/2025
While completing a validation study on the Complete Minnesota Dexterity Test for pediatrics, we discovered that children’s performance on the Box and Block Test has changed in the past 40 years, suggesting a decline in manual dexterity.
Primary Author and Speaker: Tami Konieczny
Contributing Authors: Nellie Butler, Ashley Binkowski, Lynne Allen-Taylor, Sabrina Gmuca
PURPOSE: A study was completed to validate the Complete Minnesota Dexterity Test (CMDT) in pediatrics. The Box and Blocks Test (BBT) was utilized in this study for concurrent validity. Upon noting incidental findings showing changes in performance on BBT compared to the 1985 pediatric normative study, we further statistically analyzed these results.
DESIGN: Cross-sectional observational quantitative study was completed. The study sample was recruited from a socioeconomically diverse urban and suburban area and were healthy volunteers.
METHOD: Participants were 181 healthy volunteers, aged 7 to 18 years, with no known physical, cognitive, or emotional conditions. Each subject completed 1 trial of the BBT with each hand. For each gender-by-age group-by-hand category, we compared our sample to the normative sample using means and standard error of the means. Two-tailed, one sample t-tests were conducted at alpha = 0.0036 per comparison, which results in an overall experiment-wise error rate at alpha = 0.10.
RESULTS: In all gender-age group categories, the current sample’s means were statistically significantly lower than the 1985 normative sample as indicated by nonoverlapping 95% confidence intervals, and the t-test results. For males, the difference in blocks placed in 60 seconds ranged from 9.1 to 31.3 fewer blocks, and for females, the difference ranged from 11.8 to 18.9 fewer blocks.
CONCLUSION: As technology and use of hands has changed over the past 40 years, including the rise in handheld electronic devices, this study suggests that children’s manual dexterity performance has changed as well. Clinicians should consider this when using the Box and Blocks Test to evaluate performance. This study lacked enough subjects for new normative data, but hand enough data to confidently suggest that the 1985 norms need to be updated.
References
Mathiowetz V, Federman S, Wiemer D. Box and Block Test of Manual Dexterity: Norms for 6–19 Year Olds. Canadian Journal of Occupational Therapy. 1985;52(5):241–245. https://doi.org/10.1177/000841748505200505
Jongbloed-Pereboom M, Nijhuis-van der Sanden MWG, Steenbergen B. Norm Scores of the Box and Block Test for Children Ages 3–10 Years. The American Journal of Occupational Therapy. 2013;67(3):312–318.
