Nine-Hole Peg Test (9-HPT)

Background

The Nine-Hole Peg Test (9-HPT) is a quick psychomotor test to measure finger dexterity, hand-eye coordination, and arm function. Specifically, it measures how fast a person can put nine small pegs into a board and take them back out. Marilyn Kellor and colleagues designed the task in 1971 as a quick and portable test of finger dexterity that would not be impacted by fatigue or gross arm strength. Virgil Mathiowetz and colleagues published highly detailed and standardized testing instructions and established the "normative data" for the 9-HPT in 1985. This allowed clinicians to compare a patient's score against healthy averages based on their specific age and gender.

Millisecond's 9-HPT is a simple computerized adaptation of the physical board-task that works with mouse or touch input. Participants are asked to move 9 blue disks from a target zone into 9 'peg-holes' (arranged in a 3x3 grid) and then move them back, once with their dominant and once with their non-dominant hand. The task focuses on planning and movement time and drop-accuracy.

Task Procedure

Millisecond's 9-HPT starts with a brief practice of moving objects with the computer mouse or fingers to familiarize participants with the required movements of the task. Once completed, participants are introduced to the game set up and the actual task starts with the 'Dominant Hand' phase. In the 'Dominant Hand Phase' participants are instructed to use their dominant left or right hand to pick up one of nine blue disks sitting in a target zone (separated by a 'wall' from the remaining screen) at the left side of the screen and move it as fast as possible to one of nine 'peg-holes' located in the center of the screen. On touchscreen devices, the disks can be moved with fingers or a stylus pen; on non-touchscreens, the disks can be moved with the computer mouse. Once a disk is successfully placed in the board, it changes its color from dark blue to pink, and the next disk can be moved from the target zone into a peg hole. Once all nine disks have been successfully placed, their color changes back to blue. At this point, all disks need to be moved back to the intial target zone (where they change their color from blue to gray).

After an untimed training session, participants work on the timed task. Once the 'Dominant Hand', the same procedure (including the untimed training) is repeated for the non-dominant hand. At the end of the task, participants are asked to select their dominant hand (left or right).

What it Measures

The Nine-Hole Peg Test (9-HPT) measures psychomotor speed, fine motor skills and hand-eye coordination.

Psychological domains

• Fine Motor Skills: Ability to coordinate the small muscles in the hands, fingers, and wrists to make precise, exact movements
• Visuomotor Coordination: The ability of the brain, eyes, and body to work together on a task
• Psychomotor Speed: Ability of brain and muscles to work together fast to complete a physical movement task

Main Performance Metrics

• Completion Time: the completion times for Dominant vs. Non-Dominant hand for first phase and second phase; main measure of dexterity
• Movement Initialization: the time until the first peg was picked up for Dominant vs. Non-Dominant hand for first phase and second phase; measure of planning times
• Errors: number of times an object is accidentally dropped and had to be picked up again; measure of movement accuracy
• Lateralization Index: Difference of overall Left-Hand Completion Time and overall Right-Hand Completion relative to their sum

Psychiatric Conditions

The computerized Millisecond 9-HPT is primarily intended for use in academic research. The traditional 9-HPT is frequently used for clinical assessment purposes with the following patient groups:

• Multiple Sclerosis (MS)
• Parkinson's Disease (PD)
• Traumatic Brain Injury (TBI)
• Stroke
• Cerebral Palsy

References

Search Google Scholar for peer-reviewed, published research using the Inquisit Nine-Hole Peg Test (9-HPT).

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Kellor, M., Frost, J., Silberberg, N., Iversen, I., & Cummings, R. (1971). Hand strength and dexterity. American Journal of Occupational Therapy, 25(2), 77–83.

Mathiowetz, V., Kashman, N., Volland, G., Weber, K., Dowe, M., & Rogers, S. (1985). Grip and pinch strength: Normative data for adults. Archives of Physical Medicine and Rehabilitation, 66(2), 69-74.

Heller, A., Wade, Wood, Sunderland, Hewer, & Ward. (1987). Arm function after stroke: Measurement and recovery over the first three months. Journal of Neurology, Neurosurgery & Psychiatry, 50(6), 714-9.

Furby, Hayton, Altmann, Brenner, Chataway, Smith, . . . Kapoor. (2010). A longitudinal study of MRI-detected atrophy in secondary progressive multiple sclerosis. Journal of Neurology, 257(9), 1508-1516.

Earhart, G.M., Cavanaugh, J.T., Ellis, T., Ford, M.P., Foreman, K.B., & Dibble, L. (2011). The 9-Hole Peg Test of Upper Extremity Function: Average Values, Test-Retest Reliability, and Factors Contributing to Performance in People With Parkinson Disease. JNPT, 35, 157-163.

Sbardella, E., Petsas, N., Tona, F., Prosperini, L., Raz, E., Pace, G., . . . Pantano, P. (2013). Assessing the correlation between grey and white matter damage with motor and cognitive impairment in multiple sclerosis patients. PloS One, 8(5), E63250.

Wang, Y., & Bohannon, R. (2015). Assessing Dexterity Function Using the 9-Hole Peg Test (9HPT): National Institutes of Health (NIH) Toolbox Norming Data. American Journal of Occupational Therapy, 69(Suppl. 1), 6911500104p1.

Tobler-Ammann, B.C.,de Bruin, E.D., Fluet, M.C., Lambercy, O., Rob A. de Bie, R.A. & Knols, R.H. (2016). Concurrent validity and test-retest reliability of the Virtual Peg Insertion Test to quantify upper limb function in patients with chronic stroke. Journal of NeuroEngineering and Rehabilitation, 13:8.