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What is bilateral coordination and why does it matter?

By Noémie von Kaenel, OTS and Bearfoot OT

Does your child...

  • Trip over their own feet?

  • Seem generally clumsy?

  • Have a hard time coordinating movement?

  • Drop items often?

  • Ask for help on two-handed tasks like tying shoes, handwriting, opening, or closing jars?

These are signs of difficulty integrating bilateral coordination.

Ok, but what is bilateral coordination?

Bilateral coordination is the integration and sequencing of movement by using "two parts of the body together for motor activities"⁶. To coordinate two-sided or bilateral movements, the brain needs to communicate between both its hemispheres through the corpus callosum. This area of the brain develops at 20 weeks but connections between the two hemispheres strengthen and develop as the child grows up⁹. Bilateral coordination is closely linked to the vestibular system (where your head is in space), posture, and balanced movements¹².

If a child lacks bilateral coordination they are more likely to be delayed in mastering complex motor skills¹⁰.

A lot, we know, so let’s break it down.

Bilateral coordination development includes three stages:

  • Symmetrical (sometimes referred to as unilateral)

  • Alternating (sometimes referred to as reciprocal)

  • Use of a dominant or more active movement side together with a stabilizing side

Bilateral coordination development is sequential. So first, your kid should master symmetrical coordination, then alternating coordination, followed by a coordination of a dominant hand and supporting hand (once hand dominance is established).

Examples of symmetrical bilateral coordination:

  • Pulling socks or pants up your leg/foot

  • Squeezing a bottle of paint at the midline

  • Jumping rope

  • Jumping jacks

  • Catching a ball with two hands

  • Clapping

  • Holding a book

  • Using a rolling pin

Examples of alternating bilateral coordination:

  • Walking

  • Climbing

  • Hopscotch (jumping)

  • Riding a bike

  • Swimming

  • Animal walks

Examples of using a dominant side and stabilizing side together:

  • Cutting with scissors while stabilizing the paper on the other hand

  • Writing & coloring

  • Fasteners (tying shoes, buttoning)

  • Opening containers

  • Self-feeding by using the fork and knife

Why is bilateral coordination important?

  • You need it for two-handed skills or activities we do in everyday life

  • It improves fine motor coordination skills like hand stability and two-handed control for activities like writing and cutting for school⁴ ⁵ ¹⁰

  • It increases memory, attention, and academic skills ⁴ ⁸

  • It promotes visual perceptual skills including visual motor, visual sensation, and visual attention ⁴ ⁵ ¹⁰ ¹¹

  • Helps coordinate gross motor movements ⁴ ⁵ ¹⁰

    • Alternating bilateral movements recruit more of the brain’s cerebellum (balance center), positively impacting the vestibular sense and spatio-temporal tasks like balance and posture¹²

    • This then helps with skills like play, dressing, handwriting, driving a car

How can I assess my own child’s bilateral coordination?

Jumping jacks are said to be the most useful in determining the quality of bilateral coordination in children over 7 years old⁷. So as a quick at-home test, see how your child does on jumping jacks.

What do you notice?

  • Are their arms coming up at the same time the legs move apart?

  • Is their body making more of a “T” than a point with their arms?

  • Does it look like their body is wobbly? Either to the side or backward?

  • Is the movement rhythmic and smooth?

Here are some activities you can do at home!

For starters, think about how you set up the activity. For example, based on the child’s motor abilities and everyday life (ex: playing/cooking/dressing), incorporate bilateral challenges by setting up with items on both sides of the body and prompting to “use both hands” or “both feet.”


  • Use toys or games that require one hand to stabilize and the other to manipulate objects like building block towers

  • Play Simon says and mirror movements

  • Ex: play dough, stringing cubes together


  • Climbing rocks or stairs

  • Snow/sand angel

  • Animal walks

  • Mirroring movements with a grown-up like in Simon says

  • Jumping games (trampoline, hopscotch)

School-aged children

  • Climbing trees or rocks or stairs

  • Folding paper airplanes

  • Crafts (jewelry, art projects)

  • Lego building

  • Ball games (dribble or pass a ball)

  • Bearfoot’s velcro mitts game

  • Riding a bike

  • Cutting out shapes

  • Jumping games (trampoline, hopscotch)

  • Braiding hair

  • Getting dressed (fasteners)

  • Cooking (pouring into a cup, opening and closing jars, mixing batter)

Love research? We do too!


  1. Beck, C., (2020) Bilateral Coordination Activities. OT Toolbox. Retrieved at <>

  2. Buckner, M.K. (n.d.). Bilateral Coordination. Therapy Street For Kids. Retrieved at <>

  3. Curtis, C., (2020, Dec., 14). Bilateral Coordination: Why It’s Important and Simple Ways to Improve it. The Autism & Sensory Parenting Podcast. Ep. 19.

  4. Danto, A., Pruzansky, M., (2011). 1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions. SLACK Incorporated

  5. Fernandes VR, Ribeiro MLS, Melo T, de Tarso Maciel-Pinheiro P, Guimarães TT, Araújo NB, Ribeiro S and Deslandes AC (2016) Motor Coordination Correlates with Academic Achievement and Cognitive Function in Children. Front. Psychol. 7:318. doi:10.3389/fpsyg.2016.00318

  6. Kramer P., & Hinojosa, J., (2010). Frames of Reference for Pediatric Occupational Therapy: 3rd Edition. Baltimore, Maryland: Lippincott Williams & Wilkins

  7. Magalhães, L.C., Koomar, J.A., Cermal, S.A. (1989, July) Bilateral Motor Coordination in 5- to 9-year old children: a pilot study. The American Journal of Occupational Therapy. Volume 43 Number 7.

  8. Piek, J.P., Dyck, M.J., Nieman, A., Anderson, M., Hay, D., Smith, L.M., McCoy, M., Hallmayer, J., (2003) The relationship between motor coordination, executive functioning and attention in school-aged children. Archives of clinical neuropsychology. Elsevier’s Ltd. doi:10.1016/j.acn.2003.12.007

  9. Roeber, B.J., Gunnar, M.R. and Pollak, S.D. (2014), Early deprivation impairs the development of balance and bilateral coordination. Dev Psychobiol, 56: 1110-1118.

  10. Rutkowska, I., Lieberman, L. J., Bednarczuk, G., Molik, B., Kaźmierska-Kowalewska, K., Marszałek, J., & Gómez-Ruano, M.-Á. (2016). Bilateral Coordination of Children who are Blind. Perceptual and Motor Skills, 122(2), 595–609.

  11. Schmidt, M., Egger, F., & Conzelmann, A. (2015). Delayed Positive Effects of an Acute Bout of Coordinative Exercise on Children’s Attention. Perceptual and Motor Skills, 121(2), 431–446.

  12. Tseng, Y., & Scholz, J. P. (2005). Unilateral vs. bilateral coordination of circle-drawing tasks. Acta Psychologica, 120(2), 172-198. doi:

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1 Comment

Unknown member
Jan 09, 2023

Thank you for your post! I am wondering if you have a post on bimanual coordination, if not, would you kindly elaborate on when you would document bimanual? Thanks!

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