What is bilateral integration?
Bilateral integration is the ability to utilize both upper extremities simultaneously. Both extremities can either move at the same time, or one stabilizes and the other manipulates. An example of moving at the same time is jump roping, while an example of stabilizing and manipulating is writing.
Development:
Bilateral integration is typically developed in infancy and toddlerhood, between the ages of 18-24 months. The skills is typically mastered by 4 years old. It is required for everyday routines and activities, such as: self-care and play. For example: zipping or buttoning clothing, using utensils to cut, writing on looseleaf paper, doing jumping jacks.
Dysfunction:
When bilateral integration is not mastered, challenges with development occur. Lack of bilateral integration can impact crossing the midline, which is when each arm can cross over the middle of the body to the opposite side. Hand dominance can be delayed or not established, which affects handwriting. Activities of daily living (ADLs) and instrumental activities of daily living (IADLs) are impacted, such as getting dressed, feeding, and grooming.
How to practice: 
- Drawing/handwriting
- TheraPutty/Play dough
- Simon Says/Yoga
- Zoom ball
- Sports
- Exercise: jumping jacks
