Child DevelopmentNCT07872293
Effects of Five Stones Pebble Game on In-Hand Manipulation and Hand Writing Skills of School-going Children
A study testing Five Stones Pebble Game and Unstructured Play Group in people with Child Development, run by Riphah International University at 1 site in Pakistan.
Trial summary
This randomized controlled trial will be conducted on 26 school-going children (aged 8-12 years) from The City School and Classic School System, randomly assigned to a traditional play group or an unstructured gameplay group (n=13 each). Read more about this study
- Who is it for?
- Ages 8 to 12 yearsHealthy volunteers can take part
- Conditions the study is for
- Child Development
- What is being tested?
- Five Stones Pebble Game and Unstructured Play Group
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 68 participants
- Where
- 1 sitePakistan
- Study dates
- 28 Oct 2025to 15 Jun 2026
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 8 to 12 years
- All sexes
- Healthy volunteers accepted
- Child
Who may be able to join
- Typically developing children
- Age 8 to 12 years
- Have English as their primary language of education, regardless of their home language
Who cannot join
- Children having and physical, emotional or cognitive disability
- Children whose parents had not given consent for participation
- Children who had previously received or currently receiving occupational therapy for hand function difficulties
Trial locations and contacts
1 site in 1 country.
Pakistan1 site
The Children Hospital and University of Child Health Sciences
Lahore, Punjab Province, 51310
About this study
This randomized controlled trial will be conducted on 26 school-going children (aged 8-12 years) from The City School and Classic School System, randomly assigned to a traditional play group or an unstructured gameplay group (n=13 each). The Five Stones Pebble Game intervention will be administered for 5 weeks, with 30-minute sessions, four times per week. In-hand manipulation will be assessed using Timed-TIHM, Box and Blocks Test, and Nine Hole Peg Test, while handwriting will be evaluated using ETCH. Ethical approval will be obtained from Riphah International University, and data will be analyzed using SPSS version 23.0.
Read the detailed description
A child's ability to use fine motor skills is essential for both academic and everyday functioning, especially when it comes to writing, clothing, and object manipulation. Effective handwriting and hand function are directly impacted by in-hand manipulation (IHM), an aspect of fine motor abilities that includes precise control over tiny items in the hand. Writing by hand is an intricate technique that calls for dexterity, hand strength, and fine motor coordination. The ability of traditional games to improve fine motor skills in an entertaining and captivating way has drawn attention recently. One of them is the Five Stones Pebble game, which is a traditional game in many Asian nations that requires players to hold, throw, and manipulate tiny stones with just one hand. Although it's a widespread recreational game, little is known about its academic or developmental benefits, particularly when it comes to helping school-aged kids with their hand function. The purpose of this study is to close that gap by investigating how playing the Five Stones Pebble Game affected the handwriting and in-hand manipulation abilities of school-age children who were normally developing. The goal is to determine whether a traditional game that is inexpensive, non-intrusive, and readily available may be a useful intervention to support children's academic performance and fine motor development.
The study design will be Randomized Controlled Trial. The data will be collected from The city school and Classic School System. The study will be compiled in 10 months after the approval of synopsis. 26 school-going children age ranged from 8 to 12 years will randomly be assigned either in to traditional play group (n=13) or unstructured game play (n=13). the intervention five Stone Pebble Game will continue for five weeks, with 30 minutes session, four times a week. All the referred participants will be assessed for the eligibility criteria. Guardians of participants fulfilling the eligibility criteria will be asked to sign the consent forms before entering them to the study. In-Hand manipulation will be asses by Times Test of In-Hand Manipulation (Timed-TIHM) test, Box and Blocks Test and Nine Hole Peg Test. Handwriting will be assessed by Evaluation Tool of Children's Handwriting (ETCH) tool. The synopsis will be presented to the Research Ethical Committee of Riphah International University, Lahore, for ethical approval to conduct this study. Data will be analyzed through SPSS version 23.0
- Conditions
- Child Development
- Being tested
- Five Stones Pebble Game, Unstructured Play Group
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Five Stones Pebble GameOther
Group A (Traditional Group): The traditional group will be taught the Five Stones Pebble Game consisting of five levels. In Level 1, five stones are scattered and the child throws one stone in the air, picks one from the surface, and catches the airborne stone, repeating until all are collected. In Level 2, the child picks two stones at a time, and in Level 3, three stones at a time using the same method. In Level 4, one stone is tossed while the remaining four are scattered, then picked together before catching the airborne stone. In Level 5, the child tosses all five stones and catches them on the back of the hand, then tosses again and catches them in the palm.
Unstructured Play GroupOther
The child will go through unstructured play in the indoor environment. During this time, he is free to explore and initiate activities. The child may involve in activities such as block play, dough play and arts and crafts.
| Study group | Role | What they receive |
|---|---|---|
| Five Stones Pebble Game Group | Experimental | Group A (Traditional Group): The traditional group will be taught the Five Stones Pebble Game consisting of five levels. In Level 1, five stones are scattered and the child throws one stone in the air, picks one from the surface, and catches the airborne stone, repeating until all are collected. In Level 2, the child picks two stones at a time, and in Level 3, three stones at a time using the same method. In Level 4, one stone is tossed while the remaining four are scattered, then picked together before catching the airborne stone. In Level 5, the child tosses all five stones and catches them on the back of the hand, then tosses again and catches them in the palm. Receives: Other: Five Stones Pebble Game |
| Unstructured Play Group | Experimental | The child will go through unstructured play in the indoor environment. During this time, he is free to explore and initiate activities. The child may involve in activities such as block play, dough play and arts and crafts. Receives: Other: Unstructured Play Group |
What is being measured
The primary outcome is the main question the study is designed to answer.
The Box and Block Test (BBT).
The Box and Block Test measures unilateral gross manual dexterity by recording the number of blocks transferred from one compartment to another within 60 seconds
Measured: Baseline, 5 weeks
Secondary outcomes (1)
Nine-Hole Peg Test (NHPT)
The Nine-Hole Peg Test measures fine motor speed and finger dexterity by recording the time required to place and remove nine pegs.
Measured: Baseline, 5 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted13 Oct 2026
- Study start28 Oct 2025
- Primary completion15 Jun 2026
- Study completion15 Jun 2026
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Child DevelopmentStudies of the same condition, open and under way.
- More trials run by Riphah International UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- This randomized controlled trial will be conducted on 26 school-going children (aged 8-12 years) from The City School and Classic School System, randomly assigned to a traditional play group or an unstructured gameplay group (n=13 each). The Five Stones Pebble Game intervention will be administered for 5 weeks, with 30-minute sessions, four times per week. In-hand manipulation will be assessed using Timed-TIHM, Box and Blocks Test, and Nine Hole Peg Test, while handwriting will be evaluated using ETCH. Ethical approval will be obtained from Riphah International University, and data will be analyzed using SPSS version 23.0.
- Masking
- Single blind
- Who is masked
- Participant
- Enrolment
- 68 participants (actual)
Sponsor and investigators
- Lead sponsor
- Riphah International University
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Sheeza Sami, MS-PT, Principal investigator, Riphah International University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07872293
- Sponsor's protocol ID
- REC/RCR&AHS/25/0720
- Status last verified
- Oct 2026
- First submitted
- 4 May 2026
- Last updated
- 13 Oct 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Duncan GJ, Dowsett CJ, Claessens A, Magnuson K, Huston AC, Klebanov P, Pagani LS, Feinstein L, Engel M, Brooks-Gunn J, Sexton H, Duckworth K, Japel C. School readiness and later achievement. Dev Psychol. 2007 Nov;43(6):1428-1446. doi: 10.1037/0012-1649.43.6.1428.
PubMed 18020822
Study at a glance
From the registry record, last updated by the sponsor on 13 Oct 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effects of Five Stones Pebble Game on In-Hand Manipulation and Hand Writing Skills of School-going Children
- ClinicalTrials.gov ID
- NCT07872293
- Acronym / sponsor ID
- REC/RCR&AHS/25/0720
- Conditions
- Child Development
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 68 participants (actual)
- Lead sponsor
- Riphah International UniversityUniversity, hospital or other
- Study start
- 28 Oct 2025 (actual)
- Primary completion
- 15 Jun 2026 (actual)
- Study completion
- 15 Jun 2026 (actual)
- First posted
- 13 Oct 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This randomized controlled trial will be conducted on 26 school-going children (aged 8-12 years) from The City School and Classic School System, randomly assigned to a traditional play group or an unstructured gameplay group (n=13 each). The Five Stones Pebble Game intervention will be administered for 5 weeks, with 30-minute sessions, four times per week. In-hand manipulation will be assessed using Timed-TIHM, Box and Blocks Test, and Nine Hole Peg Test, while handwriting will be evaluated using ETCH. Ethical approval will be obtained from Riphah International University, and data will be analyzed using SPSS version 23.0.
Detailed description
A child's ability to use fine motor skills is essential for both academic and everyday functioning, especially when it comes to writing, clothing, and object manipulation. Effective handwriting and hand function are directly impacted by in-hand manipulation (IHM), an aspect of fine motor abilities that includes precise control over tiny items in the hand. Writing by hand is an intricate technique that calls for dexterity, hand strength, and fine motor coordination. The ability of traditional games to improve fine motor skills in an entertaining and captivating way has drawn attention recently. One of them is the Five Stones Pebble game, which is a traditional game in many Asian nations that requires players to hold, throw, and manipulate tiny stones with just one hand. Although it's a widespread recreational game, little is known about its academic or developmental benefits, particularly when it comes to helping school-aged kids with their hand function. The purpose of this study is to close that gap by investigating how playing the Five Stones Pebble Game affected the handwriting and in-hand manipulation abilities of school-age children who were normally developing. The goal is to determine whether a traditional game that is inexpensive, non-intrusive, and readily available may be a useful intervention to support children's academic performance and fine motor development.
The study design will be Randomized Controlled Trial. The data will be collected from The city school and Classic School System. The study will be compiled in 10 months after the approval of synopsis. 26 school-going children age ranged from 8 to 12 years will randomly be assigned either in to traditional play group (n=13) or unstructured game play (n=13). the intervention five Stone Pebble Game will continue for five weeks, with 30 minutes session, four times a week. All the referred participants will be assessed for the eligibility criteria. Guardians of participants fulfilling the eligibility criteria will be asked to sign the consent forms before entering them to the study. In-Hand manipulation will be asses by Times Test of In-Hand Manipulation (Timed-TIHM) test, Box and Blocks Test and Nine Hole Peg Test. Handwriting will be assessed by Evaluation Tool of Children's Handwriting (ETCH) tool. The synopsis will be presented to the Research Ethical Committee of Riphah International University, Lahore, for ethical approval to conduct this study. Data will be analyzed through SPSS version 23.0
Study design
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (participant)
- Number of arms
- 2
- Model description
- This randomized controlled trial will be conducted on 26 school-going children (aged 8-12 years) from The City School and Classic School System, randomly assigned to a traditional play group or an unstructured gameplay group (n=13 each). The Five Stones Pebble Game intervention will be administered for 5 weeks, with 30-minute sessions, four times per week. In-hand manipulation will be assessed using Timed-TIHM, Box and Blocks Test, and Nine Hole Peg Test, while handwriting will be evaluated using ETCH. Ethical approval will be obtained from Riphah International University, and data will be analyzed using SPSS version 23.0.
| Arm | Type | Receives |
|---|---|---|
| Five Stones Pebble Game Group | Experimental | Other: Five Stones Pebble GameGroup A (Traditional Group): The traditional group will be taught the Five Stones Pebble Game consisting of five levels. In Level 1, five stones are scattered and the child throws one stone in the air, picks one from the surface, and catches the airborne stone, repeating until all are collected. In Level 2, the child picks two stones at a time, and in Level 3, three stones at a time using the same method. In Level 4, one stone is tossed while the remaining four are scattered, then picked together before catching the airborne stone. In Level 5, the child tosses all five stones and catches them on the back of the hand, then tosses again and catches them in the palm. |
| Unstructured Play Group | Experimental | Other: Unstructured Play GroupThe child will go through unstructured play in the indoor environment. During this time, he is free to explore and initiate activities. The child may involve in activities such as block play, dough play and arts and crafts. |
Who may qualify
- Ages
- 8 to 12 years
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Child
Key inclusion criteria (3 listed)
- Typically developing children
- Age 8 to 12 years
- Have English as their primary language of education, regardless of their home language
Key exclusion criteria (3 listed)
- Children having and physical, emotional or cognitive disability
- Children whose parents had not given consent for participation
- Children who had previously received or currently receiving occupational therapy for hand function difficulties
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Five Stones Pebble GameGroup A (Traditional Group): The traditional group will be taught the Five Stones Pebble Game consisting of five levels. In Level 1, five stones are scattered and the child throws one stone in the air, picks one from the surface, and catches the airborne stone, repeating until all are collected. In Level 2, the child picks two stones at a time, and in Level 3, three stones at a time using the same method. In Level 4, one stone is tossed while the remaining four are scattered, then picked together before catching the airborne stone. In Level 5, the child tosses all five stones and catches them on the back of the hand, then tosses again and catches them in the palm. | Other | Five Stones Pebble Game Group |
| Unstructured Play GroupThe child will go through unstructured play in the indoor environment. During this time, he is free to explore and initiate activities. The child may involve in activities such as block play, dough play and arts and crafts. | Other | Unstructured Play Group |
Primary outcome
The Box and Block Test (BBT).
Time frame: Baseline, 5 weeks
The Box and Block Test measures unilateral gross manual dexterity by recording the number of blocks transferred from one compartment to another within 60 seconds
1 secondary outcome
Nine-Hole Peg Test (NHPT)
Time frame: Baseline, 5 weeks
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 13 Oct 2026.
- Background: PubMed 18020822Duncan GJ, Dowsett CJ, Claessens A, Magnuson K, Huston AC, Klebanov P, Pagani LS, Feinstein L, Engel M, Brooks-Gunn J, Sexton H, Duckworth K, Japel C. School readiness and later achievement. Dev Psychol. 2007 Nov;43(6):1428-1446. doi: 10.1037/0012-1649.43.6.1428.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Sheeza Sami, MS-PT principal investigator
Riphah International University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Five Stones Pebble Game and Unstructured Play Group in people with Child Development, run by Riphah International University at 1 site in Pakistan.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 13 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Pakistan. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
The Box and Block Test (BBT). (time frame: Baseline, 5 weeks). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07872293, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 13 Oct 2026.