Bilateral coordination refers to the ability to coordinate both sides of the body at the same time in a controlled and organized manner; for example, stabilizing paper with one hand while writing/ cutting with the other. Good bilateral integration/ coordination is an indicator that both sides of the brain are communicating effectively and sharing information. Children who have difficulty coordinating both sides of their body can have difficulty completing daily living tasks (dressing, tying shoes), fine motor activities (banging blocks together, stringing beads, buttoning), visual motor tasks (drawing, writing, cutting, catching/ throwing), and gross motor activities (crawling, walking, climbing stairs, riding a bike).

“Crossing the midline” is an integral skill related to bilateral coordination. Crossing the midline refers to the ability to spontaneously cross over the midline of the body during motor completion/ functional tasks- moving one hand, foot, or eye into the space of the other hand, foot, or eye (i.e. sitting with legs crossed, scratching the opposite elbow, successfully intersecting lines to draw a cross- without switching hands, reading left to right, etc.). Babies and toddlers may use both hands equally and initiate picking up or interacting with an object with whichever hand is closer (i.e. if the item is on the left side of the table he will likely use the left hand, if it the object is on the right side, he will likely use the right hand). However, by 3-4 yrs. of age a child should typically have mastered the skill of “crossing midline.” Establishing hand dominance (a “worker hand” vs. a “helper hand”) is an indicator that the brain is maturing and lateralization is occurring- this is strongly correlated with the ability to cross midline. The child who avoids midline crossing can have difficulty coordinating both sides of the body and often times, has difficulty establishing hand dominance; tends to alternate hand use when coloring, writing, eating, throwing, etc.

Body Awareness refers to the ability to know where your body is in space without necessarily using vision (i.e. how high to lift your leg when climbing stairs, etc.); it involves proprioception, which is feedback from muscle and joint sensations. Children who do not have adequate body awareness may appear a bit clumsy, be cautious with movement or fearful with feet off ground (tossing in air, swinging, etc.), seek (or avoid) deep input or be too rough with peers/ toys (wrestling, crashing, carrying/ pushing/ pulling heavy objects). Subsequently, children who do not have a good sense of where their body’s/ body parts’ are in space can present with difficulty coordinating both sides of their body to complete bilateral tasks (i.e. putting on socks and shoes, throwing/ catching a large ball with 2 hands).


OT’s work on a variety of skills to help improve your child’s handwriting. Lowcountry Therapy frequently uses Handwriting Without Tears and other writing programs to evaluate and address handwriting difficulties. Pre-writing skills begin early, starting with using appropriate grasp patterns, copying shapes, and developing hand dominance. Some concerns you may have about your child’s handwriting that can be addressed in OT include:

  • pencil grasp
  • forming letters from memory
  • letter/number orientation
  • placement of letters on a line
  • letter sizing
  • starting points and sequencing to form letters
  • spacing between letters and words
  • overall control, neatness, and legibility
  • compensatory strategies, including typing, use of pencil grips, and modified paper

By beginning to address these issues early, we can prevent frustration, low self-esteem, and falling behind in written tasks.

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