Both fine and gross manual dexterity are altered in most patients with multiple sclerosis (MS), according to the results of a new study published in Multiple Sclerosis and Related Disorders. The authors also found that abnormalities in gross manual dexterity were more common and pronounced in the early stages of the disease.

Moreover, bilateral alterations were more common in gross manual dexterity than in fine manual dexterity, and there were more alterations in dexterity in patients with progressive forms of the disease than in those with relapsing-remitting forms.

It is important to monitor alterations in motor dexterity in patients with MS to ensure they can participate in life activities throughout their lives, the researchers said. Led by Johanna Jonsdottir, PhD, the research team used the Box and Block Test (BBT) and the 9-Hole Peg Test (9HPT) to assess alterations in bilateral gross and fine manual dexterity in patients with different types of MS and different levels of disability.

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The researchers analyzed 215 patients with relapsing-remitting, primary progressive, or secondary progressive MS, aged 41 to 67 years. The mean disease duration was 18.91 years, and the median Expanded Disability Status Scale (EDSS) score was 6.5.

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The results showed that almost all patients (96.2%) had abnormal BBT scores, and 91.5% had an abnormal score bilaterally. In the 9HPT, 85.4% of patients had an abnormal score, and for 68.9% of patients, the abnormal score was bilateral. As patients’ disability levels increased, the mean number of blocks they could move was reduced and the time they needed to finish the 9HPT increased.

When the researchers compared patients’ left and right arms, they found that the BBT scores were similar between both arms, while there were statistically significant differences between the arms in terms of 9HPT scores. Most patients with relapsing-remitting MS (85%) had abnormal bilateral scores on the BBT, and this ratio was 96% in patients with secondary progressive MS. All patients with primary progressive MS had abnormal bilateral scores. 

In the 9HPT, 56% of patients with relapsing-remitting MS had abnormal bilateral scores. This ratio was 80% for patients with primary progressive MS and 85% for patients with secondary progressive MS. Finally, the researchers reported that patients with progressive forms of MS presented statistically different values on the BBT and 9HPT compared to those with relapsing-remitting MS.

They concluded that the BBT is a good option to detect alterations in upper limb function that cannot be detected with the 9HPT in patients with MS earlier in the disease course.


Bertoni R, Cattaneo D, Grosso C, Baglio F, Jonsdottir J. Distribution and relation of two arm function tests, Box and Blocks test and Nine Hole Peg test, across disease severity levels and types of multiple sclerosis. Mult Scler Relat Disord. Published online February 9, 2022. doi:10.1016/j.msard.2022.103683