The dyskinetic hour — exercise against the diary
| Patient | 69M, moderate stage |
|---|---|
| ConditionIdiopathic Parkinson’s disease, H&Y III, with peak-dose dyskinesia | |
| Severity | UPDRS-III 36 |
| Days since diagnosis | 2920 |
| Before the diagnosisIndependent. Retired bus inspector; swam twice weekly until the fluctuations. | |
| PrecautionsPeak-dose dyskinesia — sessions scheduled from the diary, off the peak hour; Fall risk during dyskinesia — seated or supported work with protection | |
Test yourself
When in his day should the exercise sessions sit?
The teaching
Peak-dose dyskinesia is a scheduling problem with a pharmacological clock, and the therapy answer is to read the clock: the on/off diary picks the hour, moderate intensity fills it, and seated or supported alternatives carry the session through the chorea when it arrives. Medication manipulation to tidy the gym is outside the physiotherapy remit and inside the “off”-state trap. What you do with it: teach him to plan sessions from the diary, build the supported alternatives before they are needed, and send worsening choreography back to the movement-disorders team.
- Dyskinesia spreading into the “off” periods or becoming violent — movement-disorders review this month
- Any fall during a dyskinetic window — re-map the session plan before the next one
Read next
The full sequence
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.
Sources on this page: Olanow CW et al. An algorithm (decision tree) for the management of Parkinson’s disease: treatment guidelines. Neurology. 2001. NICE. Parkinson’s disease in adults. NICE guideline NG71. 2017. Osborne JA et al. Physical therapist management of Parkinson disease: a clinical practice guideline from the American Physical Therapy Association. Phys Ther. 2022 · Goetz CG et al. Mov Disord. 2005. Osborne JA et al. Physical therapist management of Parkinson disease: a clinical practice guideline from the American Physical Therapy Association. Phys Ther. 2022