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

Bilateral Coordination Activities 

First, let's talk a little more about bilateral coordination:

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. 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.

In fact, impaired bilateral coordination skills can lead to difficulty in the classroom.

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.

What makes up bilateral coordination?

In fact, there are three components of bilateral coordination:
Symmetrical movements
Alternating movements
Dominant hand/supporting hand movements

There are different types of bilateral coordination:

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

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
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

Bilateral Coordination and the Vestibular System

Bilateral coordination is closely related to the vestibular system.  When our baody 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 ideas for kids:


  Bilateral coordination shamrock teach kids to slow down and cut on the lines 

 fine motor writing activity Pencil Grasp Activity Pencil Grasp Exercise Thumb opposition activity

Neat Pincer Grasp Fine Motor Activity Buttoning Tips and Tricks

 Scooping and pouring fine motor and hand dominance with beads 


 Motor Planning Fine Motor Maze hand strengthening activity

 Alphabet Discovery Bottle



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.

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