Bilateral coordination activities you can do with a simple ruler to address pre-writing skills, muscle grading & more.

Bilateral coordination activities you can do with a simple ruler to address pre-writing skills, muscle grading & more.
(Reading Time: 9 min)

Bilateral coordination activities are the foundation for everything we do….from holding a bottle as infants to more sophisticated tasks like dressing and writing.  While general bilateral activities are often sprinkled throughout a child’s school day or therapy session, targeting bilateral coordination activities to address specific goals can make a big difference.  

In this article we will discuss a way to grade a bilateral coordination activity, which can be targeted to address specific goals for example: handwriting. You will learn how to use a simple school item (the ruler) to address the very important skill of bilateral coordination and more.

What are bilateral coordination activities ?

“Bilateral coordination activities are specifically designed to use both sides of the body and more body parts simultaneously to perform bilateral movements while crossing the midline of the body.” (2015 Schmidt)   They are essential prerequisite for almost everything we do in everyday life: walking, dressing, grooming and more.

The corpus callosum is the part of the brain that plays the most significant role in the development of bilateral coordination.  It is responsible for communication between the left and right hemispheres of the brain so that we can perform movements in a synchronous and coordinated manner.  

So when we incorporate activities like hopscotch, animal walks or stringing beads into our treatment plan, we are often facilitating the communication and synchronicity between the two hemispheres in the brain.

Research indicates that even “short bursts of fine and gross motor bilateral coordination activities can improve attention, processing speed, and focus.” (Harris 2018 )  So not only are bilateral coordination activities important for everyday function, but they also serve an academic purpose.  

Many OTs include bilateral activities in our global treatment planning as preparatory activities to address functional goals to make sure this component skill is always addressed.  However, there is a benefit in pinpointing the actual type of bilateral coordination skill required for the functional goal and making sure we address it in a systematic and graded manner.   

Case example: Jenna

Jenna is a 4 yr old student attending pre-school who has been diagnosed with a birth defect called agenesis of the Corpus Collosum.  A condition where the Corpus Collosum (a bundle of nerves that connect the left side of the brain to the right side of the brain) is missing or incomplete.    

Clinical Observations

Jenna requires maximum prompting to use her left hand and tends to favor her right side.  She often requires prompts to use both hands and does not consistently initiate use of both hands independently.  She is able to grasp and color using a crayon with her right hand, but is not yet stabilizing her paper while coloring or writing.  Jenna does attempt to scribble, but is just beginning to imitating any pre-writing strokes.

So in this case Jenna is presenting difficulties related to the more sophisticated stage of bilateral coordination.  This stage involves using one side of the body while stabilizing with the other side.  One of the many functional goals that require this foundational skill, is writing/coloring.  So here we will look how we can target this type of goal with a targeted bilateral coordination activity.  

Given Jenna’s diagnosis, it will be very important to not only to ensure that bilateral coordination is occurring spontaneously and independently, but it will be equally important to build this skill to fluency. 

Since Jenna is inconsistent with using both hands, the goal would be to engage her in a series of bilateral coordination activities designed in such a way that she masters each sequential stage of bilateral coordination.  

So what are the 3 stages of bilateral coordination?

  1.  Symmetrical bilateral coordination (using both sides of our body together). Jumping rope, putting headphones on, catching a ball etc.
  2. Asymmetrical or reciprocal bilateral coordination (using both sides but they are doing different things).  Activities in this category include: climbing stairs, skipping, hopscotch etc.
  3. Use and stabilize bilateral coordination. (This is the most sophisticated type of bilateral coordination involving use of one side of the body to hold or stabilize, while coordinating the other side of the body actively). Activities like buttoning, writing, coloring etc.


Building fluency in bilateral coordination 

Building fluency in bilateral coordination is important for Jenna because if she is fluent in this skill, then her movements will be more fluid, automatic and effortless. She won’t have to think about coordinating both her hands for a task… she just will.

Another bonus of building fluency is that it can facilitate activation of neurons on both sides of the brain, encouraging them to fire more frequently and faster.  Research also shows that in certain circumstances, this process can promote new neuronal connections and pathways.

How to build fluency with bilateral coordination activities?

Fluency or timed practice can be added to any bilateral coordination activity.  All you need to do is figure out how many times a person who is  fluent in the skill can complete the task independently and accurately, in a minute.  That then becomes your fluency goal.

For Jenna, I choose to build fluency with a very simple symmetrical bilateral coordination activity. Mainly because I wanted her to be successful early on, and also because I wanted to make sure she has truly mastered this foundational skill to fluency.

I used connecting magnetic tiles for various reasons.  One of them being that they do not require refined coordination abilities like many other bilateral activities i.e. stringing beads, connecting pop beads etc.   The other reason is that activity isolates the skill of bringing both hands together without requiring the more complex coordination components, so I can focus on building fluency on the desired skill.  

Now I don’t need a lot of tiles, because I will plan on using a short 15 or 30 second timing of connecting magnetic tiles.  The goal would be to have Jenna connect approximately 10 magnets in 15 seconds, and that would mean her fluency is close to the average of 40/minute.

Click here to learn more about why fluency matters in OT.

Once Jenna is able to achieve this fluency goal she can move onto the next activity which requires more precision and stabilization skills.

How to use a ruler to address bilateral coordination?

Do you remember using a ruler growing up?  Not necessarily for measuring, but before that.   Did you ever use it to draw, make lines and/or create margins?  Well what you probably did not realize is that was your first exposure to a structured bilateral coordination activity at school.

You know what I have noticed working in the US schools, using a ruler is often a lost skill.  I could be mistaken… but that is how it appears anyway.   

Sure, rulers are often introduced as a measuring tool, or perhaps in art class, but that seems to occur later on.. in middle school or even high school.  Not sure if it is a cultural thing… but growing up in Zambia, I remember using rulers all the time…to make lines on my worksheets, to create simple drawings, to rip paper in strips for crafts and also to fold paper.  It was one of the most frequently used items in my school kit.

So I often try to incorporate rulers into my therapy plan, and what I have noticed is that almost all students struggle with this bilateral coordination activity initially.  Even students who supposedly have stellar bilateral coordination skills, seem to need extra instruction and practice to use a ruler.

If you think about the motor mechanics involved with using a ruler, it is the ultimate bilateral coordination activity requiring the active use of one hand while stabilizing with the other.   It really makes your brain work.  So it seems like the ideal activity.  Plus it is cheap and readily always available.

Using a ruler can help with more than just bilateral coordination.

When you use a ruler to draw, not only are you engaging both sides of your brain and body, but you are also working on visual motor coordination and muscle grading skills.  

The hand which is responsible for stabilizing the ruler requires the student to push down with enough force, so that it does not move in the process.  The hand that is holding the pencil requires the student to maintain the pressure of the pencil against the ruler to draw the line. It truly is a complex process that incorporates all the sensorimotor aspects of coordination.

The other aspect I love about this bilateral coordination activity is that, while it works on the underlying skill of bilateral coordination, it  also serves as an adaptation/ pre-writing skill for imitating strokes.  Yay!

In our case example, Jenna is not consistent with using both hands to complete tasks, so I would probably start by grading the activity to the simplest level (symmetrical bilateral coordination) and then build the skill up from there. 

Here are some steps to grade this activity:

  • Bilateral coordination activities with adaptation to stabilize the ruler:

Using masking tape to temporarily ‘stick’ the ruler to the paper, I may have Jenna practice placing/ maintaining her hand on it while I guide her to use a marker with the other hand. This is a great way to not only introduce the activity, but also create some ‘motor memory’ of how it feels to use both sides of your body.

  • Bilateral coordination activities with a ruler to create crafts.

Now that Jenna no longer requires tactile assistance to stabilize the ruler, I will incorporate the use of a pincer grasp to pinch and tear paper (while using the other hand to stabilize the paper using the ruler) for any cut/paste craft activity.  Since the paper only tears if there is a firm hold with the ruler, this becomes a necessary component of the activity.

  • Bilateral coordination activity with a ruler to draw strokes

In this activity we are adding a visual motor and muscle grading component.   Plus it is great practice for pre-writing goals like drawing vertical/ horizontal and diagonal.  Below is a picture of the ‘Lion in a cage’ worksheet I often use with students for this activity.


  • Bilateral coordination activity with a ruler to trace lines.

The next stage is to add a more sophisticated visual motor and motor planning component to the activity.   This aspect also helps with motor control since the lines of varied lengths and this will require stopping and starting at different points.   Click here to download this worksheet.


There are many bilateral coordination activities to choose from when creating your treatment plan, and all of these can help develop the skill of bilateral coordination.  However, by pinpointing the exact type of bilateral coordination skill you need and adding the science of fluency building; this can help you master your goals faster!

By the way if I am completely off the mark on students not really using rulers to draw in schools.

Do let me know in the comments below…


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