Sixty days in — the first prescription is exercise

Early Parkinson’s is the window the exercise evidence was built on. The APTA guideline recommends amplitude-based and aerobic exercise from diagnosis, the Berlin LSVT BIG study showed four weeks of intensive amplitude training moves the motor examination in mild disease, and the longitudinal cohort work links regular exercise of at least two and a half hours a week to slower decline in quality of life and mobility. What you do with it: prescribe LSVT BIG or an equivalent amplitude programme now, add a structured aerobic component at a working intensity, and set the review cadence before balance problems ever appear.

• Falls within the first year, a poor levodopa response or early autonomic symptoms — tell the neurologist; the diagnosis itself needs a second look
• Shoulder pain or a frozen-shoulder picture limiting the amplitude programme — treat it directly rather than working around it

• The pot on the stove — cognition enters the planTier 2
• The freezing doorway — cueing, not a caneTier 2

This page carries the case’s first decision. The full sequence — every decision, the examination by domain, and the debrief that grades you — is in the drill, and the library is included with membership.