Bilateral Integration and sequencing dysfunction include deficits coordinating two sides of the body effectively and difficulty sequencing. When working well, bilateral integration is readily observable in children’s ability to smoothly and skilfully complete developmental activities that require the use of two sides of the body together in a coordinated fashion such as jumping, hopping, skipping and riding a bicycle or using hands together to accomplish a task such as cutting with scissors. Problems in bilateral integration and sequencing skills are usually in conjunction with vestibular proprioceptive problems. Because they share a vestibular basis, difficulties in postural ocular control are also often seen with bilateral integration and sequencing dysfunction problems. Difficulties in bilateral integration and sequencing are characterized by difficulties with lateralization skills, the establishment of hand dominance and difficulties with crossing the midline. Problems with skilled coordination of actions that require smooth and efficient timing and spatial accuracy are often seen in these children and manifested in sports activities. Sequencing of motor actions tends to be particularly difficult therefore; completing multistep activities may be hard even when the child is able to easily complete the components parts individually. Children with bilateral integration and sequencing dysfunction problems typically have relatively good ideation and motor planning skills but have difficulty with anticipatory actions refined timing and spatial coordination movements. They tend to have particular activities with actions and activities that require integration of vision and movement. Projected action sequence problems a sequence of motor acts put together to accomplish a goal in future time and space such as running to catch or kick a ball or coordinating the position and timing to kick are also particularly characteristic of children with bilateral integration sequencing dysfunction.
