Publication Date



American Journal of Occupational Therapy


Importance: There is a need for a pediatric hand function test that can be used to objectively assess movement quality. We have developed a toy-based test, the Bead Maze Hand Function (BMHF) test, to quantify how well a child performs an activity. This is achieved by assessing the control of forces applied while drawing a bead over wires of different complexity.

Objective: To study the psychometric properties of the BMHF test and understand the influence of age and task complexity on test measures.

Design: A cross-sectional, observational study performed in a single visit.

Setting: Clinical research laboratory.

Participants: Twenty-three participants (ages 4–15 yr) were recruited locally. They were typically developing children with no illness or conditions that affected their movement.

Interventions/Assessments: Participants performed the BMHF test and the Box and Block test with both hands.

Outcomes and Measures: Total force and completion time were examined according to age and task complexity using a linear mixed-effects model. We calculated intraclass correlation coefficients to measure interrater reliability of the method and estimated concurrent validity using the Box and Block test.

Results: Total force and completion time decreased with age and depended on task complexity. The total force was more sensitive to task complexity. The Box and Block score was associated with BMHF completion time but not with total force. We found excellent interrater reliability.

Conclusions and Relevance: A familiar toy equipped with hidden sensors provides a sensitive tool to assess a child’s typical hand function.

Plain-Language Summary: We developed the Bead Maze Hand Function (BMHF) test to determine how well a child performs an activity with their hands. The BMHF test is a toy equipped with hidden sensors. Twenty-three typically developing children with no illnesses or conditions that affected their hand movement participated in the study. We asked the children to perform the BMHF test with both hands. Our study found that occupational therapists can reliably use the BMHF test to assess a child’s hand function.


Humans, Child, Cross-Sectional Studies, Child, Preschool, Male, Female, Hand, Adolescent, Reproducibility of Results, Psychometrics, Play and Playthings, Task Performance and Analysis, Age Factors, Hand Strength, Motor Skills


PMID: 38900916



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