When I first met Danny for an occupational therapy assessment, he was a six year old kindergarten student who had a few academic challenges. During the assessment I observed him using his right hand for certain tasks and the left hand for others. Moreover, he also tended to switch hands in the middle of executing a task and essentially used his hands only on the same side of the body. When a task required him to cross the midline of his body, such as to pick up an object from the other side, he immediately changed hands.
When a child constantly switches between hands, hand mastery is delayed. What essentially occurs is that the dominant hand cannot achieve proficiency as an efficient working hand and the in-dominant hand cannot achieve mastery as the helping hand.
Parents were tasked with recording a log concerning what hand Danny chooses first to perform a task when the tool or object that was offered to him was placed directly in the midline. Danny began occupational therapy intervention targeting the establishment of a dominant hand and promoting his ability of crossing the center of the body. Crossing the midline of the body is an integral part of a mature bilateral motor coordination.
Bilateral motor coordination refers to the coordinated use of the two sides of the body and implies a good connection between the two sides of the brain. A child first coordinates the use of the two sides of his body symmetrically (as in pat-a-cake) and then coordinates them in a reciprocal or asymmetrical manner (as in climbing a ladder). Bilateral coordination gradually leads to an awareness of the two sides of the body, selection of one side as dominant (laterality) and a sense of left/right discrimination (directionality). Therefore, the development of bilateral coordination is necessary not only for the coordinated use of the two sides of the body, but also in the execution of related functions, which depend on it.
Examples for symmetrical bilateral activities are: Playing ball with both hands, propelling a swing, using a rolling pin with clay, jumping with both feet together, Jumping Jacks, clapping hands and playing with snap toys.
Examples for reciprocal or asymmetrical bilateral activities are: Crawling games (animal walks), playing tug of war, hopping from one foot to another, swimming, climbing a ladder, riding a bike, cutting with scissors, using fork and knife together.
Activities where one hand is required to stabilize while the other performs the activity: writing and coloring, sharpening a pencil, using an eraser, building with blocks, stringing beads, opening jars, fastening clothes, working on a pegboard and more.
It is recommended to refer a child to a pediatric occupational therapist when at the age of four years old the child still has not yet established a dominant hand, switches often between hands, does not pick up objects from the contralateral space or neglects one hand while the other is working on a task.