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 p < 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 (p < 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.

Introduction: Advances in acute stroke management have increased the number of individuals living with long-term disabilities, presenting challenges in maintaining prior levels of participation in life situations. Return to active participation can be seen as the goal of rehabilitation, given its clear impact on patients‘ quality of life. In this study, we aimed to develop the Participation in Life Situations-Stroke (PILS-Stroke) questionnaire, a self-reported Rasch-built tool for measuring patients' social involvement in meaningful life situations. Methods: We assembled a 72-item experimental version of PILS-Stroke, which was grounded on patients' and experts' perspectives via an initial item content review followed by item relevance/comprehensibility assessment. We then administered the questionnaire to 105 post-stroke individuals (58% males; mean ± SD: 62 ± 14 years) discharged for at least one month from hospital. Participants rated their involvement in life situations using a 3-point scale (0: “I would like to, but I don't get involved”; 1: “I get involved a little”; 2: “I get involved a lot”; ?: “I don't know/I don't want to get involved”). The responses were analyzed using the Rasch measurement model (RUMM2030+ software) to select the items presenting the best psychometric properties, resulting in an objective and unidimensional measurement tool. Construct validity was assessed using ten clinical measures covering International Classification of Functioning, Disability, and Health (ICF) domains (body functions, activities, participation). Results: The final 38-item PILS-Stroke demonstrated good reliability [Person Separation Index (PSI) = 0.89] and defined a unidimensional and linear scale for measuring stroke patients' social participation. There was a high correlation between social participation with satisfaction regarding activities/participation (SATIS-Stroke, r _s = 0.7, P < 0.001) and weak-to-moderate correlation with performance of motor activities (ACTIVLIM-CS, ABILHAND-CS, ABILOCO-CS; 0.20 ≤ r _s ≤ 0.39, P < 0.049) and certain psychological indicators (depression [HADS], r _s = −0.45, P < 0.001; confidence [CaSM], r _s = 0.47, P < 0.001). Conclusions: PILS-Stroke is a valid and reliable unidimensional tool specifically developed to measure stroke patients' social involvement in life situations. Its psychometric properties show promising potential for monitoring patients' social participation and quantifying the effectiveness of rehabilitation programs promoting their social inclusion.