Вы находитесь на странице: 1из 7

Applied Neuropsychology Copyright 2000 by

2000, Vol. 7, No. 4, 252–258 Lawrence Erlbaum Associates, Inc.

The Corsi Block-Tapping Task: Standardization and Normative Data THE CORSI BLOCK-TAPPING
KESSELS ET
TASK
AL.

Roy P. C. Kessels
Psychological Laboratory, Utrecht University, Utrecht, The Netherlands
Martine J. E. van Zandvoort
Psychological Laboratory, Utrecht University, Utrecht, The Netherlands, and
Department of Neurology, University Medical Center, Utrecht, The Netherlands
Albert Postma
Psychological Laboratory, Utrecht University, Utrecht, The Netherlands
L. Jaap Kappelle
Department of Neurology, University Medical Center Utrecht, The Netherlands
Edward H. F. de Haan
Psychological Laboratory, Utrecht University, Utrecht, The Netherlands

This article describes a standardized administration and scoring procedure for the widely used
Corsi Block-Tapping Task, designed to assess the visual memory span. This method was ap-
plied in a group of healthy participants (n = 70) and a group of patients with cerebral lesions (n
= 70), that were categorized on the basis of lesion location (left or right hemisphere, bilateral
or subcortical). The percentile distribution as well as cutoff points on the basis of the control
data are provided. It was found that 20% of the patients perform in the borderline range on this
task, and over 8% have an impaired performance (“retarded”). In addition, right hemisphere
patients performed worse than left hemisphere patients. These data show that the Corsi
Block-Tapping Task can be effectively used to assess visuospatial short-term memory in pa-
tients with brain damage, and is selective for the side of the lesion.

Key words: spatial span, memory test, Corsi, normative data, lateralization, stroke

The Corsi Block-Tapping Task is widely used for der. By increasing the length of the sequences, the ca-
the assessment of visuospatial short-term memory, pacity of the visuospatial short-term memory can be
both in clinical practice and in experimental research measured.
settings. Basically, it is a span task and, as such, a The Corsi test has been used in patients with Alzhei-
visuospatial analogue to the digit span as an index of mer’s disease (Carlesimo, Fadda, Lorusso, &
verbal short-term memory (Lezak, 1995). Originally Caltagirone, 1994), Korsakoff’s syndrome (Haxby,
developed by Corsi (1972), this test entails simple mea- Lundgren, & Morley, 1983), schizophrenia (Salamé,
surements that can be administered quickly and easily, Danion, Peretti, & Cuervo, 1998), and focal brain le-
even with patients who are difficult to test. The task sions following surgery or cerebrovascular disease (De
consists of nine cubes mounted on a board. The exam- Renzi, Faglioni, & Previdi, 1977; Hopkins, Kesner, &
iner taps a sequence of blocks, which the participant Goldstein, 1995; Milner, 1971; Roth & Crosson, 1985).
has to repeat subsequently in the correct sequential or- However, a standardized administration and scoring
procedure for the Corsi Block-Tapping Test is lacking.
Although adapted versions of this test have been made
Requests for reprints should be sent to Roy P. C. Kessels, Psycho- commercially available, essential differences exist with
logical Laboratory, Department of Psychonomics, Heidelberglaan the original Corsi task. For example, the Spatial Span
2, 3584 CS Utrecht, The Netherlands. E-mail: r.kessels@fss.uu.nl subtest included in the Wechsler Memory Scale–III

252
THE CORSI BLOCK-TAPPING TASK

consists of 10 blue blocks on a white board (Wechsler, mean education level was 13.8 years (SD = 3.2, range =
1997), whereas the blocks in the Block-Tapping Test 5–19).
by Schellig (1997) are considerably smaller than in the Furthermore, a group of 70 patients of the Depart-
original task (making the test less applicable in patients ment of Neurology of the University Medical Center in
with perceptual or motor dysfunction). Moreover, nor- Utrecht participated, all of them having cerebral le-
mative data for the widely used original nine-cube sions. Of these, 26 patients suffered from acute
Corsi task that can be used for clinical assessment pur- ischemic stroke (< 1 month prior to the study), 33 pa-
poses are not available (Berch, Krikorian, & Huha, tients had a nonacute ischemic stroke (> 1 month prior
1998). to the study), and 11 patients had a cerebral lesion of
This lack of standardization may be the cause of the other etiology (tumor resection or hemorrhage). Lesion
substantial variation that has been reported in the scores site was assessed on the basis of CT or MRI data.
of healthy participants (Schellig & Hättig, 1993). Vari- Twenty-five patients had left hemisphere lesions, 22
ous researchers have administered the procedure with a patients had right hemisphere lesions, and 4 patients
number of larger or smaller differences. Particularly, had bilateral damage. Furthermore, 19 patients had le-
the spatial layout of the blocks and the sequences that sions that did not affect the cerebral cortex, but were lo-
have to be repeated greatly influence test performance calized in subcortical regions, the brain stem, or the
(Kemps, 1999; Smirni, Villardita, & Zappalà, 1983). cerebellum (see Table 1 for a more detailed description
Furthermore, the administration and scoring criteria of each patient subgroup). Mean age of the patients was
vary. For example, the number of presented sequences 54.0 years (SD = 14.6, range = 19–83), mean education
of equal length varies across studies from one to five level in years was 10.1 (SD = 3.1, range = 5–19). At the
(Berch et al., 1998). A widely used administration pro- time of testing, none of the patients had hemispatial ne-
cedure in clinical settings employs two sequences of glect or visual field defects for which they could not
equal length. The test is discontinued if the participant compensate well.
fails to repeat these two sequences correctly, otherwise
the length of the sequences is increased with one. In this
administration procedure, the block span is the length Materials
of the last correctly repeated sequence (Trojano,
Chiacchio, De Luca, Fragassi, & Grossi, 1994). Figure 1 shows the Corsi Block-Tapping Task used
This study proposes a standardization of the admin- in this study. The test consisted of nine black cubes (30
istration procedure for the original Corsi × 30 × 30 mm) mounted on a black-colored board (225
Block-Tapping Task, as well as criteria for scoring the × 205 mm). The digits 1 to 9 were printed on one side of
response. Furthermore, a detailed description of the test the cubes, visible to the examiner only (for the detailed
materials is given to make this procedure freely avail- layout of the cubes see Appendix A).
able. The Corsi Block-Tapping Test was administered
to a group of healthy volunteers, whose results can be
used as (preliminary) normative data. Furthermore, the Procedure
task was applied in a group of patients with cerebral le-
sions to examine whether it is sensitive to the effects of The participant was seated in front of the examiner,
brain damage. who subsequently tapped the cubes starting with a se-
quence of two blocks. Two trials were given per block
sequence of the same length. If at least one of these was
Method repeated correctly, the next two trials of a sequence of
an increased length were administered (see Appendix B
Participants for the details of the block sequences that were used).
The cubes were touched with the index finger at a rate
Seventy paid healthy participants without a history of approximately 1 cube per sec (with no pauses be-
of neurological disease or other diseases known to af- tween the individual cubes). The participant had to tap
fect cognitive function were included to collect norma- the cube sequences in the same order immediately after
tive data within a broad age range. All participants were the examiner was finished. The following instruction
selected from a database of volunteers who responded was given: “I will tap a block sequence on this board.
to an advertisement in the local newspaper. Mean age When I have finished tapping, I want you to tap these
was 31.2 years (SD = 14.1, range = 18–72), and the blocks in the same serial order. After this, I will tap an-

253
KESSELS ET AL.

Table 1. Etiology, Lesion Characteristics, and Demographic Variables for the Patient Group

Acute Ischemia Nonacute Ischemia Nonacute Other Etiology

Site of Lesion (n)


Left Hemisphere 3 15 7
Right Hemisphere 5 13 4
Bilateral 1 3 —
Subcortical 17 2 —
Hand Used to Tap (n)
Right Hand (Preferred) 24 26 10
Left Hand (Preferred) 2 3 1
Right Hand (Nonpreferred) — 1 —
Left Hand (Nonpreferred) — 3 —
Total n 26 33 11
Male:Female 17:9 13:20 5:6
Age
M 60.3 51.3 47.2
SD 13.7 13.0 16.8
Education in Years
M 9.9 9.9 11.2
SD 3.6 2.5 3.7

the product of the Block Span and the number correctly


repeated sequences until the test was discontinued (i.e,
the number of correct trials). This latter score takes into
account the performance on both trials of an equal
length and thus is more reliable than the Block Span
alone. Cutoff scores were calculated on the basis of
these data, which can be applied as a clinical criterion.
That is, following the criteria of Lezak (1995), a perfor-
mance level of more than 1.3 SD below the control
mean is regarded as “borderline,” and a performance
level of more than 2 SD below the control mean is clas-
sified as “retarded” (p. 159). Furthermore, the percen-
tile distribution was calculated for both measures on the
Figure 1. The Corsi Block-Tapping task. basis of the performance of the healthy controls.

other sequence. The sequences will gradually increase


in length.” If a participant started the task while the ex-
aminer was still busy tapping blocks, the following in- Results
struction was given: “Please wait until I have finished.”
The test was terminated if the participant failed to re- Table 2 shows the data for the healthy controls and
produce two sequences of equal length. Only a com- the patients (categorized on the basis of the lesion site)
pletely correctly repeated sequence was scored as for the Block Span and the Total Score. Figure 2 dis-
correct; self-corrections were permitted here. plays the frequency distribution for the Total Score for
the healthy participants and patients together. All pa-
tients were able to perform the task according to the in-
Analyses struction. Four patients used their nondominant hand to
tap (3 left hemisphere patients and 1 right hemisphere
Two different scores were computed for each partic- patient) as a result of a hemiparesis of the preferred
ipant. First, the Block Span equals the length of the last hand, contralateral to the side of the lesion. The healthy
correctly repeated sequence. Second, the Total Score is participants and the overall patient group were subdi-

254
THE CORSI BLOCK-TAPPING TASK

vided into three age groups, and an analysis of variance = 2.9, p < .04, and on the Total Score, F(3, 66) = 2.6, p <
(ANOVA) of group (patients vs. healthy participants) × .06. Post hoc analyses showed that the right hemisphere
age group (three levels) was performed for each perfor- patients performed worse than the left hemisphere pa-
mance measure separately. For the Block Span, no tients on both measures, respectively, t(45) = 2.4, p <
main effect of group was found, F(1, 134) = 0.7, but .02; t(45) = 2.4, p < .02; all other post hoc comparisons
there was an effect of age group, F(2, 134) = 4.6, p < were not significant. Also, no significant differences on
.05, as well as a Group × Age Group interaction, F(2, the two performance measures were found between the
134) = 3.0, p = .05. Analysis of the Total Score revealed type of lesion, that is, acute stroke, nonacute stroke, and
no significant main effect of group, F(1, 134) = 0.4, but other etiology, F(2, 67) = 1.3; F(2, 67) = 1.7.
a significant main effect of age group, F(2, 134) = 15.6, Applying the aforementioned cutoff criterion on the
p < .001, and a significant Group × Age Group interac- Total Score for the individual patients showed that 4
tion, F(2, 134) = 8.1, p < .001, were found. patients (22.0%) performed in the borderline range
Although the overall ANOVA did not reveal a main (Total Score < 29.3) and 6 patients (8.6%) performed in
effect of group for both Block Span and Total Score, the retarded range (Total Score < 15.1). Moreover, in-
this was probably due to the uneven distribution of the dividual data can also be classified using the percentile
patients over the three age groups (i.e., a relatively distribution for the three age groups (listed in Table 3).
large proportion of the patients was included in the old-
est age group compared to the younger age groups).
Therefore, post hoc t tests were performed subse- Discussion
quently, comparing the patients and controls directly in
each age group. In the youngest age group (≤ 20 years), The goal of this study was to develop and apply a
the patients (n = 2) performed worse than the healthy standardized administration and scoring procedure for
volunteers (n = 21) on the Total Score, t(21) = 2.1, p < the original Corsi Block-Tapping Task, as well as to
.05, but did not differ on Block Span, t(21) = 1.4. The provide preliminary normative data. The use of two dif-
patients (n = 12) in the second age group (20–40 years) ferent performance measures was suggested: the clas-
performed worse than the healthy participants (n = 27) sic Block Span (the longest block sequence that was
on both measures, Block Span: t(37) = 3.3, p < .002; repeated correctly) and the Total Score (a product of the
Total Score: t(37) = 3.2, p < .003. Finally, the patients Block Span and the number of correctly repeated tri-
(n = 56) in the oldest age group (≥ 40) also performed als). It was found that, overall, patients with cerebral le-
worse on the Block Span, t(76) = 3.0, p < .004, and the sions performed worse than the healthy volunteers both
Total Score, t(76) = 2.8, p < .006, than the healthy vol- on the Block Span and on the Total Score. However, the
unteers (n = 22). Overall analysis did not demonstrate Block Span appears to be the less sensitive measure,
sex differences on both measures, F(1, 138) = 0.91; because the range of possible scores is limited (i.e.,
F(1, 138) = 0.25. varying from 2–9). Therefore, determining a firm cut-
To study function localization for this task, the pa- off score only on the basis of this measure is not possi-
tient groups were analyzed separately with localization ble. Moreover, it does not take into account the
as the between-subject factor (left or right hemisphere, performance on both trials within each level, because
bilateral or subcortical). Overall, a significant effect of only one of the two trials has to be correct. The perfor-
localization was found both on the Block Span, F(3, 66) mance on both trials is, however, included in the Total

Table 2. Mean Performance on the Block Span and Total Score and Demographic Characteristics for the Healthy Controls and the Patient
Groups Categorized on the Basis of Lesion Sites

Healthy Controls Left Hemisphere Right Hemisphere Bilateral Subcortical

Measure M SD M SD M SD M SD M SD

Block Span 6.2 1.3 5.3 1.4 4.4 1.2 4.8 0.5 5.3 1.0
Total Score 55.7 20.3 43.5 25.6 28.4 15.1 31.5 10.6 42.0 19.1
Age 31.2 14.1 49.6 17.1 52.8 13.3 53.0 15.2 61.3 10.2
Education (Years) 13.8 3.2 11.0 3.3 10.1 2.6 8.6 2.0 9.4 3.5
n 70 25 22 4 19
Male:Female 43:27 11:14 10:12 1:3 13:6

255
KESSELS ET AL.

We did not find differences in performance between


males and females on this task. Sex differences are of-
ten reported in tasks assessing spatial-memory func-
tions (Postma, Izendoorn, & De Haan, 1998). Only one
study examined sex differences on the Corsi
Block-Tapping Task, and found that males outper-
formed females (Capitani, Laiacona, & Ciceri, 1991).
However, the absolute difference on the equivalent of
our Block Span between the males and females in the
latter study was rather small (0.27 blocks), yet signifi-
cant in a large sample.
Comparing patients with lesions in the left hemi-
sphere to patients with right hemisphere lesions re-
sulted in a worse performance on both measures of the
group of patients with right hemisphere lesions. It is un-
likely that this is primarily the result of impairments in
visual detection, because none of the patients had
hemispatial neglect, or hemianopia for which they did
not compensate well. Additionally, this finding is in
Figure 2. Frequency distribution of the total score (n = 140). agreement with the results of previous studies (De
Renzi et al., 1977; Milner, 1971), and supports the no-
tion that the right hemisphere is more important for the
Table 3. Percentiles for the Total Score of the Corsi processing of visuospatial short-term memory tasks
Block-Tapping Task Based on the Data of 70 Healthy Participants such as the Corsi test. In this light, however, it must be
(Divided Into Three Age Groups) noted that there is also evidence for a left hemisphere
contribution for specific functions in spatial cognition
Age Group (e.g., Laeng, 1994; Mehta, Newcombe, & Damasio,
Percentiles ≤ 20a 20–40b > 40c 1987). Furthermore, it should be mentioned that the
Corsi test might not be a “pure” spatial memory task. It
5 28.7 37.0 16.6 does not only measure visuospatial memory, but it also
10 35.0 40.0 20.0 relies heavily on memory for temporal information, be-
20 37.0 40.0 38.0 cause the block sequences have to be remembered in
30 44.8 44.4 40.0
the correct sequential order (Della Salla, Gray,
40 54.0 54.0 41.6
Baddeley, Allamano, & Wilson, 1999; Ferreira et al.,
50 60.0 54.0 48.0
60 60.6 60.0 52.8
1998). Thus, other brain regions than those specialized
70 65.8 70.0 54.0
in spatial memory per se—for example the frontal lobes
80 74.2 78.2 60.0 (D’Esposito & Postle, 1999)—might also be involved
90 92.2 86.4 68.4 in this task, and lesions in these structures could poten-
95 131.1 100.8 76.3 tially explain a low performance on the Corsi test.
a For future research purposes, it would be interesting
n = 21. bn = 27. cn = 22.
to apply the aforementioned administration and scoring
procedure in patients with other neurological diseases,
Score. Also, the range of scores is much wider here such as Alzheimer’s dementia or Parkinson’s disease.
(with possible scores between 2 and 144), which results Moreover, the group of healthy participants must be ex-
in a more sensitive and statistically reliable measure for panded (e.g., elderly persons or children). In this way, a
analyzing the performance of individual patients in large set of normative data can make the Corsi test more
clinical practice, as shown in the percentile distribu- reliable than it is now and a helpful tool for both clinical
tion. Using the cutoff criteria shows that the perfor- assessment and research purposes.
mance of 20% of the patients can be regarded as In sum, a standardized administration and scoring
borderline on this task. Over 8% can be classified as re- procedure for the original widely used Corsi
tarded, which is indicative for an impaired performance Block-Tapping Task is described in detail. This proce-
on this test. dure was applied to a group of healthy volunteers, as

256
THE CORSI BLOCK-TAPPING TASK

well as in neurological patients. Furthermore, two per- Roth, D. L., & Crosson, B. (1985). Memory span and long-term
formance measures were recorded—the Block Span memory deficits in brain-impaired patients. Journal of Clinical
Psychology, 41, 521–527.
and the Total Score. The Total Score is probably the Salamé, P., Danion, J. M., Peretti, S., & Cuervo, C. (1998). The state
more sensitive measure both for clinical and experi- of functioning of working memory in schizophrenia. Schizo-
mental purposes. The percentile distribution and cutoff phrenia Research, 30, 11–29.
points are provided on the basis of the control data, Schellig, D. (1997). Block-Tapping test. Frankfurt, Germany: Swets
which can be used as (preliminary) norms in the assess- Test Services.
Schellig, D., & Hättig, H. A. (1993). Die Bestimmung der visuellen
ment of individual patients.
Merkspanne mit dem Block-Board [Assessment of visual
memory span with the block board]. Zeitschrift für
Neuropsychologie, 4, 104–112.
References Smirni, P., Villardita, C., & Zappalà, G. (1983). Influence of differ-
ent paths on spatial memory performance in the Block-Tapping
Test. Journal of Clinical Neuropsychology, 5, 355–359.
Berch, D. B., Krikorian, R., & Huha, E. M. (1998). The Corsi
Trojano, L., Chiacchio, L., De Luca, G., Fragassi, N. A., & Grossi,
Block-Tapping Task: Methodological and theoretical consid-
D. (1994). Effects of testing procedure on Corsi’s
erations. Brain and Cognition, 38, 317–338.
Block-Tapping Task in normal subjects and Alzheimer-type
Capitani, E., Laiacona, M., & Ciceri, E. (1991). Sex differences in
dementia. Perceptual and Motor Skills, 78, 859–863.
spatial memory: A reanalysis of block tapping long-term mem-
Wechsler, D. (1997). Wechsler Memory Scale–Third Edition. San
ory according to the short-term memory level. Italian Journal
Antonio, TX: Psychological Corporation.
of the Neurological Sciences, 12, 461–466.
Carlesimo, G. A., Fadda, L., Lorusso, S., & Caltagirone, C. (1994).
Verbal and spatial memory spans in Alzheimer’s and multi-in-
farct dementia. Acta Neurologica Scandinavica, 89, 132–138.
Corsi, P. M. (1972). Human memory and the medial temporal region
of the brain. Dissertation Abstracts International, 34, 819B.
Della Salla, S., Gray, C., Baddeley, A., Allamano, N., & Wilson, L.
(1999). Pattern span: A tool for unwelding visuospatial mem-
ory. Neuropsychologia, 37, 1189–1199. Original submission February 25, 2000
De Renzi, E., Faglioni, P., & Previdi, P. (1977). Spatial memory and Accepted July 19, 2000
hemispheric locus of lesion. Cortex, 13, 424–433.
D’Esposito, M., & Postle, B. R. (1999). The dependance of span and
delayed-response performance on prefrontal cortex.
Neuropsychologia, 37, 1303–1315. Appendix A
Ferreira, C. T., Vérin, M., Pillon, B., Levy, R., Dubois, B., & Agid, Description of the Test Materials
Y. (1998). Spatio-temporal working memory and frontal le-
sions in man. Cortex, 34, 83–98.
Haxby, J. V., Lundgren, S. L., & Morley, G. K. (1983). Short-term
retention of verbal, visual shape and visuospatial location in-
formation in normal and amnesic subjects. Neuropsychologia,
21, 25–33.
Hopkins, R. O., Kesner, R. P., & Goldstein, M. (1995). Memory for
novel and familiar spatial and linguistic temporal distance in-
formation in hypoxic subjects. Journal of the International
Neuropsychological Society, 1, 454–468.
Kemps, E. (1999). Effects of complexity on visuo-spatial working
memory. European Journal of Cognitive Psychology, 11,
335–356.
Laeng, B. (1994). Lateralization of categorical and coordinate spa-
tial funtions: A study of unilateral stroke patients. Journal of
Cognitive Neuroscience, 6, 189–203.
Lezak, M. D. (1995). Neuropsychological assessment (3rd ed.).
New York: Oxford University Press.
Mehta, Z., Newcombe, F., & Damasio, H. (1987). A left hemisphere
contribution to visuospatial processing. Cortex, 23, 447–461.
Milner, B. (1971). Interhemispheric differences in the localization
of psychological processes in man. British Medical Bulletin,
27, 272–277.
Postma, A., Izendoorn, R., & De Haan, E. H. F. (1998). Sex differ- The coordinates (in mm) are measured from the left-bottom
ences in object location memory. Brain and Cognition, 36, corner of the board to the left-bottom corner of each cube. The
334–345. digits 1 through 9 were visible to the examiner only.

257
KESSELS ET AL.

Appendix B 3–7–8–2–9–4
Block Sequences 5–9–1–7–4–2–8
5–7–9–2–8–4–6
8–5 5–8–1–9–2–6–4–7
6–4 5–9–3–6–7–2–4–3
4–7–2 5–3–8–7–1–2–4–6–9
8–1–5 4–2–6–8–1–7–9–3–5
3–4–1–7
6–1–5–8
5–2–1–8–6 The sequences with a length of four or greater are re-
4–2–7–3–1 ported in Smirni et al. (1983). The other sequences are
3–9–2–4–8–7 derived from Capitani, Laiacona, and Ciceri (1991).

258