Bilateral Coordination Activities

Bilateral coordination activities are essential for coordinated and fluid movements that require both sides of the body.  Also called bilateral integration, the movements of both hands together in activities requires processing and integration of both hemispheres of the brain to enable both hands working together at the same time, or bilateral movements.  Without bilateral coordination, a child might appear to be clumsy or drop items, use primarily one hand in activities, or switch hands during tasks that require a dominant hand and a helper hand.    Development of bilateral coordination skills is powerful in functional skills like self-feeding, handwriting, self-dressing, grooming, and more. 

Bilateral coordination activities for kids to use to develop bimanual coordination in tasks.

Bilateral Coordination Activities 

First, let’s talk a little more about bilateral coordination. What is bilateral coordination, and how do bilateral movements impact learning, functional tasks, and play in child development?    

Activities that support development of bilateral coordination skills integrate several areas of development:

  • Visual motor
  • Core strength and stability
  • Attention and focus
  • Sensory processing: vestibular, proprioceptive, and visual sensory systems
  • Balance and coordination
  • Body awareness
  • Development of a dominant side of the body

Each of the areas listed above are both needed for participation in tasks requiring bilateral skills and developed, or strengthened through participation. Play is a powerful tool to support these areas.

Check out these bilateral coordination toys to help kids build skills through play and games.

Why is bilateral coordination important? 

Bilateral coordination is important for a variety of skills.

When bilateral coordination or bilateral integration is intact and progressing appropriately through development, it is an indicator that both sides of the brain are communicating effectively and sharing information during functional tasks.

Younger toddlers and babies can be observed using both hands in play as they pick up objects in their line of sight. However, they typically will pick up items with the hand that is closest to the object or toy.

As toddlers progress in development, they will begin to establish a dominant hand and crossing midline. Read more about this in our resource on cross crawl exercises.

This ability to utilize a dominant hand and a non-dominant hand in activities indicates a maturation of the brain and lateralization in functional tasks, which is very important for motor planning, directionality, and visual motor skills.

When a child is challenged in development of bilateral coordination skills, there can be resulting difficulties.

In fact, impaired bilateral coordination skills can lead to difficulty in the classroom. Science tells us that problems with bilateral coordination can have an impact on academic performance, with slowness and disinterest in schoolwork.

In the school setting there are many areas that can be a challenge as a result of bilateral coordination struggles:

  • performance in school tasks that require coordination
  • using scissors
  • writing- including holding the paper and erasing
  • tracing
  • using tools such as rulers
  • managing clothing- buttons, zippers, snaps
  • managing lunch containers
  • putting on and taking off a backpack
  • turning pages in books
  • managing and organization skills in folders and backpacks

Development of bilateral coordination in self-feeding depends greatly on the child’s developmental level. The baby who is learning to place dry cereal in their mouth will be vastly different level than the child who is scooping soup or cutting a piece of chicken. Development of fine motor skills and visual motor skills have an impact on coordination of the hands in self-feeding.

Bilateral coordination activities to help kids develop and build the skills needed for symmetrical coordination activities, alternating arm and leg movements, and hand dominance activities.

What makes up bilateral coordination?

In fact, there are three components of bilateral coordination:

  • Symmetrical movements
  • Alternating movements
  • Dominant hand/supporting hand movements

types of bilateral coordination:

There are three different types of bilateral coordination. Let’s break these down.

1.) Symmetrical movements– Both hands do the same thing at the same time.  An example of this would be pulling up pants or socks.  Other activities that can work on this skill include   

  • Holding a squeeze bottle with both hands at the midline to paint.
  • Jumping rope
  • Jumping Jacks
  • Catching a ball with two hands
  • Holding onto a swing as it moves back and forth
  • Holding onto a rope in tug of war
  • Pushing oneself against an object to propel oneself forward or backward against a stable object
  • Pushing oneself forward or backward against an unstable object

  2.) Alternating Movements– Using the two extremities in alternating motions.  You will see alternating bilateral coordination with swimming or climbing a ladder. Activities to work on this skill include:

  • Riding a bike
  • Marching
  • Holding onto a swing, slide, or other object while using the other hand to move and manipulate toys or objects
  • Alternating movements with the arms or legs

3.) Dominant hand/Non-dominant hand– Using one hand to perform a task while the other assists is needed for many fine motor skills.  This type of bilateral coordination is needed for writing, and cutting with scissors.  Activities to work on this skill include:

  • Threading
  • Lacing cards
  • Coloring
  • Writing
  • Tying shoes

This occupational therapy tool is Easter-themed but it builds the skills needed for kids to cut with scissors while refining and building accuracy with scissor skills.

Bilateral Coordination and the Vestibular System

Bilateral coordination is closely related to the vestibular system.  When our body registers movement and gravity it allows us to respond with appropriate movement, balance, and posture.  The vestibular system and our body’s ability to register information and integrate it into movements enables bilateral coordination and body awareness of the upper and lower body.   Below, you will find all of our activities that build and develop bilateral coordination.  Try these activities to work on many skills like visual motor integration and fine motor skills while encouraging bilateral coordination.  Be sure to stop back, because this page will be updated often!

Related: Need some indoor bilateral coordination activities like this one? Try our list of Winter Bilateral Coordination Activities that kids will love!

bilateral coordination goals occupational therapy

Occupational therapy practitioners target underlying skills like bilateral coordination because these skills impact function. OTs will work on bilateral coordination goals in occupational therapy with a focus on function. This means that a daily functional task like getting dressed requires bilateral coordination in order to pull up ones pants and put on a shirt. OTs and OTAs don’t just have a goal for bilateral coordination because their client or patient can’t put on their clothing. They focus the goal around getting dressed with a focus on bilateral coordination skills which are used in the task.

We’ve discussed above, that bilateral coordination refers to the ability to use both sides of the body together in a coordinated and controlled manner. When it comes to ADLs and IADLs, you can see how bilateral coordination is used all day long! Occupational therapy goals related to bilateral coordination are often tailored to improve a person’s ability to perform various functional tasks.

Occupational therapy bilateral coordination goals target skills such as:

  • Play Skills
  • Functional Activities (ADLs and IADLs)
  • Fine Motor Skills
  • Gross Motor Skills
  • Bilateral Hand Use
  • Visual-Motor Integration
  • Tool Use

Here are some examples of bilateral coordination goals in occupational therapy:

  1. Dressing Goal: Patient will improve bilateral coordination during dressing tasks to button their shirt using both hands within 2 minutes.
  2. Playing with Beads goal: The client will string 10 beads onto a string using both hands simultaneously, without assistance to enhance fine motor skills using bilateral coordination.
  3. Throwing a Ball goal: The client will throw and catch a ball with both hands, maintaining eye contact with the ball, for 5 consecutive throws and catches, using gross motor skills that require bilateral coordination.
  4. Cutting with Scissors Goal: To increase the ability to use both hands together effectively, the client will use scissors to cut along a straight line with both hands coordinating together, demonstrating improved accuracy and control.
  5. Copying Geometric Shapes Goal: To improve coordination between visual input and motor output with both hands, the client will copy geometric shapes (e.g., squares, circles) using both hands simultaneously, maintaining appropriate spatial orientation and size.
  6. Using a Knife and Fork Goal: To improve bilateral coordination for using tools and utensils, the client will use a knife and fork to cut and eat food independently, demonstrating efficient bilateral coordination and grasp patterns.
  7. Building block tower goal: To engage in play activities that require bilateral coordination, the client will build a tower of blocks using both hands simultaneously, achieving a height of 6 inches without assistance.

These goals can be tailored to the individual’s specific needs and abilities, taking into account factors such as age, developmental level, and underlying conditions. It’s essential for occupational therapists to select goals that are functional and meaningful to the client’s everyday life, promoting independence and participation in desired activities.

Bilateral Coordination activities for kids:

We’ve included many bilateral coordination activities that are founded through play.

Bilateral coordination in feeding
winter bilateral coordination activities
development of bilateral coordination in feeding

Development of Bilateral Coordination in Self-Feeding

Winter Bilateral Coordination Activities

Bilateral coordination visual motor integration
What is crossing midline
Bilateral coordination tubes activity

Bilateral Coordination Shamrock

Crossing Mid-line Gross Motor March

Bilateral Coordination with Pop Tubes

Extended wrist bilateral coordination activity
bilateral coordination lacing plate
burlap feathers lacing activity

Bilateral Coordination Lacing Plate

Fine Motor Burlap Feather Lacing

Extended Wrist Fine Motor Activity

letter puzzle activity
bilateral coordination and in hand manipulation with coins
bilateral coordination threading activity

In-hand Manipulation Letter Puzzles
In-Hand Manipulation with Coins

Jumbo Fine Motor Skills Threading Activity

bilateral coordination activity with an egg carton
letter game with spoons
pencil grasp exercise for bilateral coordination

Intrinsic Muscle Strength with an Egg Carton

Magnetic Spoons and Handwriting Game

Pencil Grasp Trick Thumb IP Flexion

Opposition pencil grasp trick
fine motor play dough activity
hundreds chart activity for bilateral coordination

Thumb Opposition

Fine Motor Play Dough Intrinsic Muscle Strength

Rainbow Hundreds Chart

pencil control exercises
Easter writing activity to help kids wrok on pre-writing lines and pencil control with an Easter egg theme.
neat pincer grasp bilateral coordination activity

Pencil Control Exercises
Pre-Writing Handwriting Lines

Neat Pincer Grasp Fine Motor Activity

bilateral coordination activity
stickers for fine motor and bilateral coordination
pouring and scooping with beads

Benefits of Stickers in Occupational Therapy

Buttoning Tips and Tricks

Hand Dominance and Fine Motor with Scooping and Pouring

homemade pegboards for bilateral coordination
Grip exercises for kids
coloring for bilateral coordination

Homemade Pegboard Activities

The Benefits of Coloring

Clothes Pin Exercises and Pinch Grasp Types

Scissor activities
Precision grasp
Color sorting activity

Creative Scissor Skills Practice

Precision in Grasp and Release of Fine Motor Skills

Chain Link Counters Color Sort

Heart fine motor and eye hand coordination activity
play dough handwriting warm up activity
Homemade lacing cards
Homemade Lacing Cards

Hand-Eye Coordination Heart Math

Handwriting Warm Up Exercises

Homemade Lacing Cards

motor planning activity
hand strengthening with blocks
bilateral coordination lacing

Motor Planning Fine Motor Maze

Hand Strengthening Building Activity

Fall Leaves Craft

Scarecrow craft to help with math skills
bilateral coordination sensory bottle
bilateral coordination sensory writing activity

Alphabet Discovery Bottle

Scarecrow Math Craft

Crayon shaving art 

shape building bilateral coordinaiton activity
dyed lollipop sticks
sorting activity

Shape building 

 Dyed lollipop sticks 

Rainbow color sort

soap bilateral coordination activity
waterbead sensory bin
letter formation with cookie cutters

Foam Workout 

 Water Bead Sensory Box 

Handwriting With Cookie Cutters 

play dough cursive letters
DIY rhythm sticks craft
Letter formation with push pins

 Cursive Lines Fizzy Dough

Mini Rhythm Sticks

Push Pin Can Letters 

marble run activity
empathy activity
butterfly craft

 Marble Run Water Table

Empathy Beads 

Butterfly Craft 

Handwriting on Resistive Foam Trays 

block light sabers
Teach letters activity
color match

Snap Block Light Sabers 

Handwriting with Foam Strips

Fine Motor Pincer Grasp Color Match 

Finger Dexterity Exercise 

Fine Motor Play With Crafting Pom Poms 

Fine Motor Tripod Grasp with Cereal

Sparkle Collage Art 

Visual-Motor Letter Match 

Bunny Scissor Tongs 

Cherry Blossom Trees

Fine Motor And Auditory Fireworks 

In Hand Manipulation Ideas for Kids 

Color Matching with Play Dough 

Feather Beading

Fireworks Art 

Color Sort Scissor Activity 

Fine Motor Grow a Garden 

Play Dough and Rocks

bilateral coordination keys
bilateral coordination letter activity
brain building for letters

Fine Motor with Keys 

Hand-Eye Coordination Cookies 

Brain Building with Balls in a Muffin Tin

Using Pipe Cleaners for Fine Motor Skills

Crayon Play Dough 

Fine Motor Play with Tissue Paper

Golf Tee Hammering

Fine Motor Table Top Play with Tape

Rainbow Bracelets 

Pipe Cleaner Fine Motor Fun 

Icicle Scissor Skills 

Sunflower Craft

Fine Motor with Keys 

Straw Fine Motor Sort 

Easy Scissor Practice 

Threading Lids

Creative Scissor Skills Practice

Scissor Skills Crash Course

Improving Scissor Skills with Play Dough

Cutting Foam Beads

Finger-painting Fireworks for Scissor Use

Bilateral coordination activities to help kids develop and build the skills needed for symmetrical coordination activities, alternating arm and leg movements, and hand dominance activities.

Bilateral Coordination Problems

We covered a lot here about activities to support the development of bilateral coordination. But what if there are challenges that impact coordinated movement of the two sides of the body?

There are several areas to explore when it comes to bilateral coordination:

  • Praxis-
  • Modulation- Challenges with sensory defensiveness, gravitational insecurity, and aversive responses to movement can also manifest as a result of modulation problems.
  • Sensory integration dysfunction- This includes visual, proprioceptive input, and vestibular input that are not registered or are not processing.
  • Balance and core strength

bilateral coordination activities occupational therapy

The following are some occupational therapy interventions to use in developing strengthening bilateral coordination skills. These bilateral coordination exercises may not be appropriate for every individual.

  1. Child prone on floor scooter as the child moves the scooter with their hands on the floor to propel through an obstacle course
  2. Child prone on a sensory swing to push away from the OT using a dowel rod or ball
  3. Pulling on ropes against the resistance of the OT while sitting on a floor scooter, therapy ball, or sensory swing
  4. Child sitting on a therapy ball, scooter, platform swing and pulling a hula hoop against the resistance of the therapy provider
  5. Child prone in a therapy net and using ropes to push and pull rhythmically against the therapy provider’s resistance.
  6. Kicking a ball or toy suspended from the ceiling with both feet
  7. Catching a ball while on a stabile base of support or an unstable base (on a wobble disk, sitting on a platform swing, or standing on a therapy mat)
  8. Sitting or laying on a platform swing and throwing bean bags into targets with both hands
  9. Sitting on a ring swing or inner tube swing with ropes to pull from side to side
  10. Climbing activities: climbing a slide or on overhead monkey bar equiptment
  11. Swinging on a traditional swing and tossing objects into a target
  12. Hand clapping games
  13. Opening a jar, food containers
  14. Zippering, snapping, buttoning clothing
  15. Tying shoes
  16. Typing on a keyboard
  17. Cutting with scissors
  18. Writing and holding the paper on a table surface
  19. Putting on pants, shoes, and socks
  20. Finger painting with both hands
  21. Sign language

All of the bilateral coordination strategies listed above can be modified to include discrete or sequenced bilateral movements. They can also include symmetrical or alternating bilateral movements.

These exercises and therapy activities, combined with the bilateral coordination activities listed in the links above can provide a great collection of ideas to support development.

Colleen Beck, OTR/L has been an occupational therapist since 2000, working in school-based, hand therapy, outpatient peds, EI, and SNF. Colleen created The OT Toolbox to inspire therapists, teachers, and parents with easy and fun tools to help children thrive. Read her story about going from an OT making $3/hour (after paying for kids’ childcare) to a full-time OT resource creator for millions of readers. Want to collaborate? Send an email to