I am a school OT.  I have a student who has trouble writing in the morning and in the evening.  His hand starts out very shaky, so much so that he writes with the right hand and has now started holding the top of the pencil with the left hand to help keep it still.  After a few minutes of writing (up to 10) the shakiness disappears and he can write OK.  He is 13 and it has always been this way.  The father states that he had the same issue in school, but not quite as pronounced.  There does not appear to be a lack of strength when performing daily tasks. The student does not have any difficulty manipulating other school tools or performing self-care tasks, such as buttoning.  However, he does use a fisted grasp on a spoon or fork.  The shakiness is reportedly just with writing, and just for the first few minutes of writing.  The parent reports that the child does not appear tired when writing, such as in the evening.  The parents have had the student do activities to warm up the hand before starting to write, with no change.  There are no medical conditions known. 

 Any thoughts would be appreciated. 

Thanks. Kathy 

I have another questions.  If he holds the spoon or fork in a "normal" grip does the shakiness appear?  The fisted grip may be a way of compensating.  Has his blood sugar been checked since the shakiness appears mostly in the morning and evening?

Thanks, Lyn