Concurrent validity of an immersive virtual reality version of the Box and Block Test to assess manual dexterity among patients with stroke

Gauthier Everard, Yasmine Otmane-Tolba, Zélie Rosselli, Thomas Pellissier, Khawla Ajana, Stéphanie Dehem, Edouard Auvinet, Martin Gareth Edwards, Julien Lebleu, Thierry Lejeune, Gauthier Everard, Yasmine Otmane-Tolba, Zélie Rosselli, Thomas Pellissier, Khawla Ajana, Stéphanie Dehem, Edouard Auvinet, Martin Gareth Edwards, Julien Lebleu, Thierry Lejeune

Abstract

Background: After a stroke, experts recommend regular monitoring and kinematic assessments of patients to objectively measure motor recovery. With the rise of new technologies and increasing needs for neurorehabilitation, an interest in virtual reality has emerged. In this context, we have developed an immersive virtual reality version of the Box and Block Test (BBT-VR). The aim of this study was to assess the concurrent validity of the BBT-VR among patients with stroke and healthy participants.

Methods: Twenty-three healthy participants and 22 patients with stroke were asked to perform the classical Box and Block Test (BBT) and BBT-VR three times with both hands. Concurrent validity was assessed through correlations between these two tests and reliability of the BBT-VR through correlation on test-retest. Usability of the BBT-VR was also evaluated with the System Usability Scale. Hand kinematic data extracted from controller's 3D position allowed to compute mean velocity (Vmean), peak velocity (Vpeak) and smoothness (SPARC).

Results: Results showed strong correlations between the number of blocks displaced with the BBT and the BBT-VR among patients with stroke for affected (r = 0.89; p < 0.001) and less-affected hands (r = 0.76; p < 0.001) and healthy participants for dominant (r = 0.58; p < 0.01) and non-dominant hands (r = 0.68; p < 0.001). Reliability for test-retest was excellent (ICC > 0.8; p < 0.001) and usability almost excellent (System Usability Scale = 79 ± 12.34%). On average participants moved between 30 and 40% less blocks during the BBT-VR than during the BBT. Healthy participants demonstrated significantly higher kinematic measures (Vmean = 0.22 ± 0.086 ms-1; Vpeak = 0.96 ± 0.341 ms-1; SPARC = - 3.31 ± 0.862) than patients with stroke (Vmean = 0.12 ± 0.052 ms-1; Vpeak = 0.60 ± 0.202 ms-1; SPARC = - 5.04[- 7.050 to - 3.682]).

Conclusion: The BBT-VR is a usable, valid and reliable test to assess manual dexterity, providing kinematic parameters, in a population of patients with stroke and healthy participants. Trial registration http://www.clinicaltrials.gov ; Unique identifier: NCT04694833, Date of registration: 11/24/2020.

Keywords: Assessment; Self-rehabilitation; Stroke; Tele rehabilitation; Virtual reality.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Representation of the BBT-VR (Oculus Quest). A The picture shows the virtual environment seen by the participant headset. It consisted of the BBT-VR, the virtual hands (which corresponded to the controllers) and the indication of the time, the score, the number of collisions with the virtual separation and the number of cubes out. B The picture represents a participant performing the BBT-VR with his right hand. C The picture shows the controller hold by a right hand. Three buttons are presented: one next to the thumb, one next to the index and one next to the middle-finger. D Representation of the recommended position to grab the virtual blocks in virtual reality
Fig. 2
Fig. 2
Typical graph of 3D hand movements. The blue line represents the hand position on the virtual vertical axis in relation to the virtual lateral axis. Left graph. Typical graph of a paretic hand. Right graph. Typical graph of a healthy hand
Fig. 3
Fig. 3
Correlation between the classical BBT score and BBT-VR score. Each point represents the score obtained by each participant’s hand during the third trial of the BBT-VR in relation to the score obtained during the third trial of the BBT. Pearson correlation coefficients (r) and their p-value (p) are presented at the left side of each graph. Linear regressions are plotted for each graph (in red). Scores of healthy participants are presented in green (dominant hand = circle; non-dominant hand = square) and scores of patients with stroke in blue (less-affected hand = triangle; paretic hand = diamond)
Fig. 4
Fig. 4
Scatter plots representing kinematic measures of participants in relation to their BBT score. Each point represents the SPARC smoothness unit obtained by each participant’s hand during the best trial of the classical BBT-VR in relation to the score obtained during the best trial of the BBT. The red lines represent the mean SPARC obtained among healthy participants ± 1 standard deviation

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