Dovi, 7 years old, is having trouble in school. His handwriting is sloppy and often illegible and he complains that his hand hurts when he writes. He mixes up similar letters, such as lowercase B and D or gimmel and zayin, and he may write them backwards or upside down. Dovi does know the letters and can identify them on an alphabet chart, which only adds to his frustration when he gets his classwork wrong. Dovi’s parents are at a loss to understand why Dovi can’t do his schoolwork properly.


A careful analysis yielded the information that Dovi suffers from an unusual visual-perceptual problem called bilateral coordination deficiency.

“Bilateral coordination” refers to the ability of two opposing sides of the body, such as right arm and left arm, to work together. Usually, the ability to coordinate opposing sides develops in early childhood. Crawling is a great example of this skill – the entire body is involved in bilateral movement as the child crawls across the floor to reach his favorite toy.

Dovi’s difficulty is due to the fact that his ability to coordinate both sides of the body is weak. Not only does he have a hard time using both arms or both legs at the same time, he also has a hard time using both eyes at the same time! In order to differentiate between “b,” “d,” “p,” and “g,” Dovi needs to be able to discern differences in left-or-right and up-or-down orientation. Dovi’s weakness with visual bilateral coordination make it impossible for him to accurately write these letters.

During the assessment we asked Dovi to touch his left shoulder with his right arm. As is typical for children who have trouble with bilateral coordination, Dovi could not execute this direction because it involved crossing the midline of the body. “Midline” is an imaginary line going down the body dividing it into left side and right side. Crossing the midline involves getting both sides of the body to work together, which Dovi cannot do. Interestingly, when we asked Dovi to draw a “t”, he drew four separate lines that did not intersect at any point. Dovi’s visual perception was so impacted that he could not cross midline even on paper.


We divided treatment into two steps. First, we addressed Dovi’s gross motor skills, which involve large movements that move the entire body. Once his gross motor function had improved, we addressed his fine motor skills, which involve smaller movements, such as using his fingers.

To improve the bilateral weakness affecting his gross motor skills, we involved Dovi in exercises that forced him to coordinate left and right together. Crawling through a tunnel engaged right and left arms and legs and we created other fun exercise routines that strengthened his muscles and involved both sides of the body together.

To improve the bilateral functioning of Dovi’s fine motor skills, Dovi worked on squeezing a gripping device, manipulating therapy putty and other activities that strengthened the small muscles in his hands.

When Dovi was discharged from therapy, his handwriting had vastly improved. More importantly, he overcame the midline barrier and can cross midline as easily and fluidly as anyone else. When writing, he can now draw lines from left to right as well as top to bottom. By resolving Dovi’s difficulties with bilateral coordination, his reading and writing difficulties were resolved. Dovi now completes his classwork quickly and painlessly and takes a lot of pride in his work.