Many children are not provided with additional assistance in reading until they are diagnosed with a specific disability, often not until Grade 2 or 3. Researchers have concluded that when struggling readers are not given help in their early school years, they tend to stay weak readers in the upper grades. The purpose of this quantitative case study was to identify the factors that cause children to struggle to learn to read, identify interventions that could help teachers and parents improve the reading fluency of struggling readers, determine whether reading practice with hands-on manipulatives develops children's phonemic awareness, and determine whether these manipulatives are effective. This study was based on the cultural historical theory of learning, a concept of using objects to lead children toward cognitive mastery for reading, and the constructivist theory of learning, a concept of cooperative learning practice that uses hands-on manipulatives as an intervention for struggling readers. The repeated-measures design was used to analyze change in children's phonemic awareness skills. Ten Grade 2 struggling readers participated in the Phonemic Awareness Test before and after the use of hands-on manipulatives; they were chosen to participate in this study because of the instructional recommendation that they need intensive intervention in reading. A parametric paired t test was used to assess the impact of the intervention on student reading achievement. The results indicated that the use of hands-on manipulatives was related to improvement in reading achievement. The findings of this study may influence educators and administrators to initiate professional development training in manipulatives to increase the number of children who achieve grade level expectations, thereby decreasing the achievement gap.