Bilateral Integration

Bilateral Integration

Posted by Brainspring on 15th Feb 2024

Bilateral integration is the ability to use both sides of the body at the same time. This underappreciated ability, along with crossing the midline, refers to the ability of both sides of the brain to work together in a coordinated effort. The right side of the brain controls the left side of the body, while the left side of the brain controls the right side of the body. The midline is the imaginary line that divides the left and right sides of the body. Crossing this imaginary line requires both sides of the brain to coordinate their efforts to complete a task. Poor bilateral integration may impact reading and writing difficulties. 

Bilateral integration development begins during infancy as babies learn to clap. Its complexity grows as they begin crawling. Simultaneously, crossing the midline begins as infants reach for food and toys. These abilities are not considered early childhood developmental milestones. Rather, they are essential components in completing daily living tasks such as getting dressed. If children cannot use both sides of their body and cross the midline by the time they leave first grade, it could be overlooked as an underlying area of concern during future essential student services evaluations unless an occupational therapist consult has been requested. 

When students have difficulty crossing the midline, it can impact reading fluency. During reading, the eyes must cross the midline as they follow the horizontal text across the page. Students may read the first few words before pausing as their eyes cross the midline of the page. 

Both crossing the midline and bilateral integration are necessary for writing tasks. Students begin writing on the left side of the paper, working across their body to the right side of the page. As students write, they should anchor their paper with their nonwriting hand as their writing hand manipulates their pencil to complete tasks. 

Asymmetrical bilateral integration is an essential component of dictation in Phonics First and Structures. These programs ask students to hold their pencil in their writing hand as they pound and fingertap with their nonwriting hand. Students struggling with simultaneously holding their pencil as they pound and fingertap may need additional opportunities to develop bilateral integration. 

Stages of Bilateral Integration 

1. Crossing the Midline 

Crossing the imaginary divide between the left and right sides of the body requires the right and left hemispheres of the brain to coordinate their efforts. Many young children begin developing this skill as they reach across their bodies for an object. 

2. Symmetrical Bilateral Integration 

During this stage of development, both sides of the body mirror each other while completing tasks. In babies this may present as clapping both hands together. Older children with the ability to simultaneously use both sides of their body can jump rope or bang cymbals together using both arms. 

3. Reciprocal Bilateral Integration 

Reciprocal bilateral integration requires the use of the opposite sides of the body in the same task at opposite times. As babies begin creeping and crawling, they engage both arms in developing this skill. One arm reaches out while the other arm supports the baby’s weight, and then the child’s arms switch roles. Children who skip crawling miss this natural opportunity for developing reciprocal bilateral integration. Children can also develop reciprocal bilateral integration through climbing stairs, jogging, skipping, and swimming. 

4. Asymmetrical Bilateral Integration 

This critical stage of development engages both arms in separate tasks that are coordinated to complete an activity. Both sides of the brain are engaged, working in conjunction to complete a common goal. Consider stringing beads, children cannot be successful if the arm holding the string cannot bring it closer to the hand holding the bead. Asymmetrical bilateral integration is essential to cutting with scissors, writing, as well as daily living tasks such as stirring food, tying shoes, and buttoning a shirt. 

Activities to support bilateral integration

1. Gross motor activities 

  • Crawling 
  • Marching 
  • Jumping Jacks 
  • Hopscotch 
  • Climbing a ladder 
  • Skipping 
  • Riding a bike 

2. Fine motor activities 

  • Playing with clay 
  • Tearing strips of paper 
  • Coloring Beading activities 
  • Lacing activities 
  • Peg Boards 

3. Crossing the midline activities 

  • Hokey Pokey 
  • Simon Says
  • Dancing the “Macarena” 
  • Follow the Leader


“Bilateral Integration.” The OT Toolbox. Sept. 15, 2022. Nov. 27, 2023.

“Bilateral Integration: Stages of Bilateral Integration for Reading, Tracking, Writing, and Crossing the Midline.” Integrated Learning Strategies. May, 2016. Nov. 26, 2023.

McIlroy, Tanja. “The Simple Guide to Bilateral Coordination +30 Activities.” Empowered Parents: Teaching kids through play. Updated: Nov. 15, 2023. Nov. 27, 2023.