Three weeks after DBS — exercise in the “on” window

Bilateral STN-DBS converts a fluctuating disease into a scheduled one: the randomized trial evidence established the motor benefit over medication alone in advanced Parkinson’s, and the rehabilitation literature says structured exercise alongside programming is safe and wanted. Two rules come with the hardware and do not expire — diathermy in any form is contraindicated because the energy can be conducted along the electrodes, and the extension cables at the neck are not stretched or loaded until the system has settled. What you do with it: timetable the sessions into the “on” window with the programming team, strike the heat modalities from the list, and tell the family that more walking is a settings problem, not an effort problem.

• New confusion, worsening speech or a change in stimulation effect — call the programming team before the next session
• Any sign of wound breakdown or infection along the scalp, chest or cable track
• A fall onto the hardware side — same-day review of the incisions and the settings

• The dyskinetic hour — exercise against the diaryTier 3
• The bent spine — camptocormia and the honest ceilingTier 4

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.