Computer Vision for Movement Observation and Recovery Enhancement (C-MORE): Box and Blocks Test

Stroke is a leading cause of chronic disability, with heterogeneous sensorimotor impairments that are not well captured by standard clinical assessments. While advanced motion capture and robotic systems provide precise measurements, they are not scalable for widespread clinical use. We developed C-MORE (Computer Vision for Movement Observation and Recovery Enhancement), a smartphone-based framework that uses computer vision and machine learning to automatically score the Box and Blocks Test (BBT) and extract quantitative kinematic metrics. The system combines hand tracking with a custom machine learning (ML) architecture to identify valid block transfers and segment task phases. We evaluated C-MORE in 7 individuals with chronic stroke and a cohort of 10 healthy adults. The system achieved 99.0% agreement with ground-truth scoring, with errors below clinically meaningful thresholds. Kinematic measures derived from the system were sensitive to stroke-related impairments, including reduced movement velocity and increased task duration in affected limbs. Exploratory analyses indicated that grasp-related metrics, particularly the ratio of grasp-to-transfer duration, were correlated with independent measures of proprioception. These findings demonstrate that smartphone-based computer vision can provide accurate, scalable assessment of upper-extremity function. C-MORE offers a practical approach for enhancing clinical evaluation and enabling more precise, individualized rehabilitation strategies.