Children’s Occupational Therapy
Bilateral Integration
Bilateral refers to ‘both sides.’ Humans are symmetrical beings- we have two
body sides that are identical and both are used for most activities. As we
develop our bodies we first learn to do activities which use both sides of the
body together, such as crawling. Later our body sides start to specialise, e.g.
one hand writes the other holds the paper. It appears that until both sides can
work together they tend not to specialise and are therefore not as skilled.
Bilateral Integration is the integration of the two sides of the body and the
ability to co-ordinate the left and right hands. Difficulty with bilateral
integration results in confusion regarding direction or instruction, particularly
when the child has no time to think about which side is which. When the child is
asked to turn left they may go right. Difficulty co-ordinating the two sides
makes following rhythms difficult. The child may learn to compensate for poor
ability to discriminate between left and right as they grow older by using
thought processes. This is, however not as efficient. Specialisation is also
affected. The child develops similar skills with each hand and cerebral
hemisphere of the brain. Instead of using just one hand for fine motor task
they tend to use right hands on the right side and left on the left side.
The child may be considered ambidextrous for some time; however they do not
become skilled with either hand. Lack of specialisation of hands can lead to
difficulties with speech and writing.
Activities should be carefully graded to enable the child to progress. Begin
doing more activities form the first sections A-D and progress to sections E-G
(fine motor and crossing midline activities).
A
Activities using the Whole Body Symmetrically

Hand ball- team game handling ball over and under each person standing in
a line using 2 hands.

Body ball- children stand in a line. First child rolls ball up the front of
their body with both hands, next child rolls the ball down the back and
then up their own body. Continue along the line.

Trampolining.

Sack races- Hold the top with two hands, and jump forwards with both
feet together.

Star jumps.

Skipping with a rope.

Bunny hops.

Frog leaps

Swinging on a trapeze.
B
Using the Whole Body Reciprocally

Animal walks- move on all fours like an animal e.g.: bear, cat, elephant.

Reciprocal skipping.

Tin can stilt walking.

Marching

Crawling round an obstacle course.

Climbing up a ladder/climbing frame.

Stepping through a hoop held vertically.
C
Using Arms or Legs Symmetrically

Ball games-with two hands roll, catch and throw ball.

Knee soccer- roll ball to child who must push it back with their ball.

Jumping with both feet together.

Rolling playdoh with rolling pin.

Flip the kipper game- cut out a large fish shape from paper, bend up the
tail and place on the floor. Hold a magazine in both hands and wave up
and down to create a draught to move the kipper along the floor. Have
races or create obstacle courses to ‘flip’ the kipper around.

Smack- holding a cardboard tube/rolling pin with one hand at each end,
the child hits a suspended ball or balloon.

Bursting bubbles- by clapping hands together.

Draw the same shape simultaneously with the right and left hand on chalk
board e.g.
D
Using Arms or Legs Reciprocally

Hopping- e.g. one leg then the other leg, hopping in and out of hoops.

Swimming- front crawl.

Riding a bicycle.

Clapping and tapping rhymes and rhythms- e.g. tap on lap; right, left, left,
right, left, left, or more complicated patterns.

Kicking a ball.
E
Activities to Encourage Rotation and Crossing of the Midline
The midline is an imaginary line down the middle of our body from head to feet.
The child who is reluctant to cross their midline is likely to constantly move
their body to avoid using hands or feet on the opposite side of the body. This is
a sign that communication between the two side for the brain is not fully
developed. The ability to cross the midline is important for the development of
hand dominance.
During these activities ensure the child crosses their midline and does not
adjust their body position in order to avoid doing so.
Do not make the child aware that you are wanting them to cross the midline.
1. Rolling Games
2. Roll ball
3. Criss-cross walking
4. Balloon tennis
5. Newspaper rolls
6. Simon says
7. Suspended ball or swing ball
8. Ball catch
Rolling games on the carpet or grass, you
could include rolling to fetch objects. Roll up
in a blanket/mat and unroll. Make a ‘hotdog’
roll. Ensure that rolling is segmented with
the body rotating a bit at a time-not all at
once.
Child in four point kneeling rolls ball to a
target. Position targets to either side and
encourage rolling with the left hand to the
target on the right and vice versa.
Tape a line on the floor and get the child to
walk along the line crossing their legs over.
Child holds racquet/bat with two hands and
bats balloon thrown to each side of them.
A rolled up newspaper can be used to hit a
balloon. Grade from using two hands to using
one hand. It is important to encourage
reaching across the midline. Grade from
sitting to kneel sitting to upright kneeling.
Encourage movement across the midline e.g.
right hand touching left knee.
Grade from two hand holding bat to one
hand-preferred hand holding bat.
Catching a small ball in a container/cut down
detergent bottle held in first two then one
hand.
9. Tennis ball and stocking
10. Drive a car
11. Ball bouncing
12. Sports like:
Child holds end of stocking in one hand and
stands with back to wall. He then lifts the
other arm swings the stocking so that the
ball hits the wall beneath his arm, crossing
midline.
Child holds a small hoop with both hands and
‘steers’ their car, or use a large hoop and lie
back steering using both hands and feet
together.
Use two hands then one hand (preferred
hand). The child stands on one spot and
bounces the ball to the left and the right.
This can be graded to bouncing round
obstacles.
Cricket, tennis, rounders, are also good for
encouraging crossing of the midline.
F
Fine Motor Activities Using Dominant and Stabilising Hand

Threading- beads, cotton reels.

Wind up toys.

Linking things together e.g. staples together paper chains

Cutting activities

Templates and stencil

Using a ruler

Tracing activities.

Cake making- e.g. that requires holding a large bowl with one hand and
stirring or whisking with the other.

Fishing- Have paper fish with magnets on. Have a rod with a magnet.
Child holds end of the rod and has to collect fish one at a time on the
magnet.

Paper folding- very simple origami, paper plans or hats.

Tearing paper- Shapes, strips for paper machè.

Dressing a doll.

Screw tops- use two hands to undo screw top jars or lidded boxes.

Fastenings on clothing.

Hand and finger action songs- e.g. ‘Incy Wincy Spider,’ ‘The wheels on
the Bus’.

Playing rhythms on a tambourine, drum or xylophone.
G
Fine Motor Activities Crossing the Body Midline

Clapping games with hands crossing over.

Drawing/painting/printing on large sheets.

‘Lazy 8’ on large sheet of paper.

Using large stencils on a vertical or horizontal surface.

Position tasks e.g. pieces of a jigsaw or pegs for a peg-board to
encourage crossing of the midline.