Assessment of reliability and validity of the mental chronometry task based on the box and block test in multiple sclerosis patients


Motor imagery
Multiple sclerosis
Mental chronometry
Test-retest reliability

How to Cite

Rezaeian, M. . ., Assadollahi, Z. . ., Azin, H. . ., Kaeidi, A. . ., & Azin, M. (2021). Assessment of reliability and validity of the mental chronometry task based on the box and block test in multiple sclerosis patients. Iranian Red Crescent Medical Journal, 23(3).


Objectives:  Motor imagery (MI) is the visualization of action without its overt performance.  One of the measures of explicit MI is mental chronometry which  has  been  applied  to  multiple sclerosis (MS)  patients; nonetheless,   the  reliability  and  validity of this tool  has    been  never confirmed.  Therefore,  the present study aimed to assess the reliability and validity of mental chronometry in  MS  patients.

Methods: A number of 60 MS patients who met the inclusion criteria were included in the present study via the census method. Thereafter, 20  MS  patients  were tested  via  mental  chronometry  based  on  the  box  and  block  test, as well as kinesthetic  and  visual  imagery  questionnaire-20 (KVIQ-20) in  two  sessions  with  a  10-day  interval.  Intra-class  correlation  coefficients  (ICCs)  were  calculated to determine  the  test-retest  reliability  of  mental  chronometry.  Pearson’s correlation analysis  was  used  to  evaluate  criterion  validity  with  the  KVIQ-20.

Results:   The  test-retest  reliability  for  the  mental  chronometry  was  good  (ICCs: visual  analogue  scale=0.88, mean  execution  and  motor  imagery  absolute  difference= 0.75, imagery  duration=0.91, and execution  duration=0.97).  Moreover, the concurrent validity  between  the  visual  analogue  scale  of  mental  chronometry  and  KVIQ-20 was  good.

Conclusion:  As evidenced by the results  of  the  present  study,  the  mental  chronometry based on box and block is  a  reliable  and  valid  tool  for the  assessment  of  motor imagery  in  MS patients.


  1. Dobson R, Giovannoni G. Multiple sclerosis-a review. Eur J Neurol. 2019;26(1):27-40. doi: 10.1111/ene.13819. [PubMed: 30300457].
  2. Morgen K, Sammer G, Courtney SM, Wolters T, Melchior H, Blecker CR, et al. Evidence for a direct association between cortical atrophy and cognitive impairment in relapsing–remitting MS. Neuroimage. 2006;30(3):891-8. doi: 10.1016/j.neuroimage.2005.10.032. [PubMed: 16360321].
  3. Ascherio A. Environmental factors in multiple sclerosis. Expert Rev Neurother. 2013;13(12 Suppl):3-9. doi: 10.1586/14737175.2013.865866. [PubMed: 24289836].
  4. Guimarães J, Sá MJ. Cognitive dysfunction in multiple sclerosis. Front Neurol. 2012;3:74. doi: 10.3389/fneur.2012.00074. [PubMed: 22654782].
  5. Clemens L, Langdon D. How does cognition relate to employment in multiple sclerosis? A systematic review. Mult Scler Relat Disord. 2018;26:183-91. doi: 10.1016/j.msard.2018.09.018. [PubMed: 30268039].
  6. Schiavolin S, Leonardi M, Giovannetti AM, Antozzi C, Brambilla L, Confalonieri P, et al. Factors related to difficulties with employment in patients with multiple sclerosis: a review of 2002-2011 literature. Int J Rehabil Res. 2013;36(2):105-11. doi: 10.1097/MRR.0b013e32835c79ea. [PubMed: 23238667].
  7. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). Arlington, VA: American Psychiatric Pub; 2013.
  8. Jongen PJ, Ter Horst AT, Brands AM. Cognitive impairment in multiple sclerosis. Minerva Med. 2012;103(2):73-96. [PubMed: 22513513].
  9. Di Filippo M, Portaccio E, Mancini A, Calabresi P. Multiple sclerosis and cognition: synaptic failure and network dysfunction. Nat Rev Neurosci. 2018;19(10):599-609. doi: 10.1038/s41583-018-0053-9. [PubMed: 30158590].
  10. Jeannerod M. Mental imagery in the motor context. Neuropsychologia. 1995;33(11):1419-32. doi: 10.1016/0028-3932(95)00073-c. [PubMed: 8584178].
  11. Decety J. The neurophysiological basis of motor imagery. Behav Brain Res. 1996;77(1-2):45-52. doi: 10.1016/0166-4328(95)00225-1. [PubMed: 8762158].
  12. Jeannerod M, Frak V. Mental imaging of motor activity in humans. Curr Opin Neurobiol. 1999;9(6):735-9. doi: 10.1016/s0959-4388(99)00038-0. [PubMed: 10607647].
  13. McAvinue LP, Robertson IH. Measuring motor imagery ability: a review. Eur J Cogn Psychol. 2008;20(2):232-51. doi: 10.1080/09541440701394624.
  14. Heremans E, D’hooge AM, De Bondt S, Helsen W, Feys P. The relation between cognitive and motor dysfunction and motor imagery ability in patients with multiple sclerosis. Mult Scler. 2012;18(9):1303-9. doi: 10.1177/1352458512437812. [PubMed: 22389414].
  15. Tabrizi YM, Zangiabadi N, Mazhari S, Zolala F. The reliability and validity study of the Kinesthetic and Visual Imagery Questionnaire in individuals with multiple sclerosis. Braz J Phys Ther. 2013;17(6):588-92. doi: 10.1590/S1413-35552012005000124. [PubMed: 24271091].
  16. Azin M, Zangiabadi N, Tabrizi YM, Iranmanesh F, Baneshi MR. Deficiency in mental rotation of upper and lower-limbs in patients with multiple sclerosis and its relation with cognitive functions. Acta Med Iran. 2016;54(8):510-7. [PubMed: 27701721].
  17. Tabrizi YM, Mazhari S, Nazari MA, Zangiabadi N, Sheibani V, Azarang S. Compromised motor imagery ability in individuals with multiple sclerosis and mild physical disability: an ERP study. Clin Neurol Neurosurg2013;115(9):1738-44. doi: 10.1016/j.clineuro.2013.04.002. [PubMed: 23639730].
  18. Tabrizi YM, Mazhari S, Nazari MA, Zangiabadi N, Sheibani V. Abnormalities of motor imagery and relationship with depressive symptoms in mildly disabling relapsing-remitting multiple sclerosis. J Neurol Phys Ther. 2014;38(2):111-8. doi: 10.1097/NPT.0000000000000033. [PubMed: 24531344].
  19. Malouin F, Richards CL, Durand A, Doyon J. Reliability of mental chronometry for assessing motor imagery ability after stroke. Arch Phys Med Rehabil. 2008;89(2):311-9. doi: 10.1016/j.apmr.2007.11.006. [PubMed: 18226656].
  20. Heremans E, Vercruysse S, Spildooren J, Feys P, Helsen WF, Nieuwboer A. Evaluation of motor imagery ability in neurological patients: a review. Movem Sport Sci. 2013;4:31-8. doi: 10.3917/sm.082.0031.
  21. Macías Islas MÁ, Ciampi E. Assessment and impact of cognitive impairment in multiple sclerosis: an overview. Biomedicines. 2019;7(1):22. doi: 10.3390/biomedicines7010022. [PubMed: 30893874].
  22. Heremans E, Feys P, Nieuwboer A, Vercruysse S, Vandenberghe W, Sharma N, et al. Motor imagery ability in patients with early-and mid-stage Parkinson disease. Neurorehabil Neural Repair. 2011;25(2):168-77. doi: 10.1177/1545968310370750. [PubMed: 21239707].
  23. Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol. 2011;69(2):292-302. doi: 10.1002/ana.22366. [PubMed: 21387374].
  24. Oldfield RC. The assessment and analysis of handedness: the Edinburgh inventory. Neuropsychologia. 1971;9(1):97-113. doi: 10.1016/0028-3932(71)90067-4. [PubMed: 5146491].
  25. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. 1983;33(11):1444-52. doi: 10.1212/wnl.33.11.1444. [PubMed: 6685237].
  26. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189-98. doi: 10.1016/0022-3956(75)90026-6. [PubMed: 1202204].
  27. Mathiowetz V, Volland G, Kashman N, Weber K. Adult norms for the box and block test of manual dexterity. Am J Occup Ther. 1985;39(6):386-91. doi: 10.5014/ajot.39.6.386. [PubMed: 3160243].