Sand Play vs. Cuff Training: Visual-Motor Skills in Autism

Effects of Image-Sand Play Therapy Versus Table Top Training Program With Weighted Cuffs on Visual Motor Integration in Children With Autism

This study compares Image-Sand Play Therapy and Tabletop Training with Weighted Cuffs for improving Visual-Motor Integration (VMI) in children with autism. A 12-week randomized controlled trial will be conducted at Tanzeem-ul-Nisan, Faisalabad. Beery VMI will assess outcomes. Data will be analyzed using SPSS-23. Non-probability conventional sampling will be used. Sessions occur twice weekly.

Study Overview

• Status: Not yet recruiting
• Conditions: Autism Spectrum Disorder
• Intervention / Treatment: Other: Image-Sand Play Therapy; Other: Table Top Training Program with Weighted Cuff

Detailed Description

This study compares the effectiveness of Image-Sand Play Therapy and Tabletop Training with Weighted Cuffs in improving Visual-Motor Integration (VMI) in children with autism.

Methods: A randomized controlled trial will be conducted with children diagnosed with autism from Tanzeem-ul-Nisan, Faisalabad. Participants will be randomly assigned to either intervention group. Both therapies will run for 12 weeks, with two sessions per week.

Image-Sand Play Therapy: Creative sand tray play guided by a therapist.

Tabletop Training: Structured tasks with weighted cuffs for proprioceptive input.

Assessment Tool: Beery VMI

Sampling: Non-probability conventional sampling

Data Analysis: SPSS version 23, using baseline, mid, and post-intervention scores to compare effectiveness.

• Study Type: Interventional
• Enrollment (Estimated): 30
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: MRAN AMJAD, PhD; Phone Number: 033224390125; Email: imran.amjad@riphah.edu.pk
• Study Contact Backup: Name: Muhammad Asif Javed, MS-PPT; Phone Number: 03224209422; Email: a.javed@riphah.edu.pk

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age 5-8 yrs

  • A diagnosed by Autism
  • Guardian of child patients signed the informed consent
  • Both gender male and female

Exclusion Criteria:

• Complication of serious medical disease

  • Children and parents who cannot comply with the research
  • Surgical procedures performed in the year prior to the study
  • Poor medical conditions preventing participation

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Image-Sand Play Therapy; Group A will perform Image-Sand Play Therapy Group had 12 week the one to one intervention provided once a week 30 min in each.	Other: Image-Sand Play Therapy; Over the course of seven sessions, the child initially engaged in chaotic sandbox play, showing difficulty in altering or organizing his scenes. By the fourth session, he began experimenting with different symbols, including familiar TV characters. From the fifth session onward, his play gained structure, evolving into strategic battle scenarios involving animals, loggers, and castles. By the seventh session, hero figures emerged, and the therapist noted improved classroom behavior and cooperation, though social challenges with peers remained.
Active Comparator: Table Top Training Program with Weighted Cuff; Table Top training Program Duration: 12 week Patient perform twice a week each item 5 min with 1 min preparation between task	Other: Table Top Training Program with Weighted Cuff; Task include: Stacking cones Lift a cone with one hand and stack it on top of a fixed cone. (The difficulty level was controlled by using resistance bands of varying weights or instructing patients to sit or stand while performing the task.) Task Therapy Program Stacking 3 × 3 cm blocks Pick up blocks one at a time by using one hand and stack them. (The difficulty level was controlled by using resistance bands of varying weights.) Tailwind Use both hands to push the handles of an instrument up and down to the sounds of a metronome. (The difficulty level was controlled by varying the angle.) Pinch exerciser Take a pinch pin and put it on a rod. (The difficulty level was controlled by varying the resistance of the pinch pin (5 grades) and the diameter of the rod (3 grades).) O'Connor Tweezer Dexterity Test Pick up a pin (2.5 cm long) and put it in a 15 mm hole. (The difficulty level was controlled by using different tweezers.)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Berry Visual Motor Integration	The Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery VMI) is the gold standard for identifying difficulties in the coordination of visual and motor skills in adults and children. The Beery VMI based on the construction of test items, the Beery VMI has strong construct validity and strong predictive validity for academic outcomes. Visual motor Coordination takes around 10-15 min. The task is completed in three minutes. Excellent test-retest reliability (0.84-0.88)(16) Interrater reliability of (0.90 0.98). Internal consistency (0.81-0.82)	Baseline,4th week, 8th week and 12th week
Nine Hole Peg Board	The Nine Hole Test (9HPT) is used to measure finger dexterity in patients with various neurological diagnoses(18, 19). Table (wooden or plastic): with 9 holes (diameter 10 mm, depth 15 mm) separated by 32 mm or 50 mm(20). Stick container: a square box (100 x 100 x 10 mm) separate from the boards or a shallow round container on top of the board. 9 pins (diameter 7 mm, length 32 mm)(21). Stopwatch Instruct the patient to remove the needles one by one from the container and insert them into the holes in the plate as quickly as possible, using only their hands. Ask the patient to remove the needles one by one from the holes and return them to the container. Excellent Test-retest reliability (ICC = 0.85). Excellent interrater reliability for the right hand (r = 0.984) and the left hand (r = 0.993) (22).	Baseline, 4th week ,8th week and 12th week

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Hamna Faisal, MA-PPT, Rihah International University

Publications and helpful links

General Publications

• Patil O, Kaple M. Sensory Processing Differences in Individuals With Autism Spectrum Disorder: A Narrative Review of Underlying Mechanisms and Sensory-Based Interventions. Cureus. 2023 Oct 31;15(10):e48020. doi: 10.7759/cureus.48020. eCollection 2023 Oct.

Study record dates

Study Major Dates

• Study Start (Estimated): April 15, 2025
• Primary Completion (Estimated): June 15, 2025
• Study Completion (Estimated): August 15, 2025

Study Registration Dates

• First Submitted: April 17, 2025
• First Submitted That Met QC Criteria: April 17, 2025
• First Posted (Actual): April 24, 2025

Study Record Updates

• Last Update Posted (Actual): April 24, 2025
• Last Update Submitted That Met QC Criteria: April 17, 2025
• Last Verified: April 1, 2025

More Information

Terms related to this study

• Keywords: Sand play, Table-top training, Beery VMI
• Additional Relevant MeSH Terms: Mental Disorders; Neurodevelopmental Disorders; Child Development Disorders, Pervasive; Autism Spectrum Disorder; Autistic Disorder
• Other Study ID Numbers: REC/RCR/AHS/24/0750

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No