1. Potential benefits of IEPR application for Parkinson Disease in Italy COMOESTAS – Meeting Buenos Aires November 26 th, 2010 Silvano CRISTINA, MD Neurorehabilitation Unit PAVIA - ITALY

2. Research and communication Information and Communication Technology (ICT) Information and Communication Technology (ICT) –general term that stresses the role of communications (telephone lines and wireless signals) in modern information technology –technical means used to handle information and aid communication, including both computer and network hardware as well as necessary software –merge the telephone network with the computer network system Interactive Electronic Patient Record (IEPR) – for monitoring medication overuse in headache –developed by the COMOESTAS Project for monitoring medication overuse in headache

3. Epidemiology of Parkinson’s Disease in Latin America and in Italy Junin (Argentina) 1997 Junin (Argentina) 1997 –6,57‰ subjects > 40 years Habana (Cuba) 2000 Habana (Cuba) 2000 –1,35 ‰ 1/3 patients undiagnosed Medellin (Colombia) 2004 Medellin (Colombia) 2004 –0,31 ‰ Sicily (Italy) 1992 Sicily (Italy) 1992 –2,57 ‰ Arcisate- S. Giovanni Rotondo (Italy) 1994 Arcisate- S. Giovanni Rotondo (Italy) 1994 –1,85 ‰ L’Aquila (Italy) 2005 L’Aquila (Italy) 2005 –2,29 ‰ Latin America Italy

4. Our former experience on Parkinson’s Disease

5. Unified Parkinson Disease Rating Scale (UPDRS) evaluation

6. Staging of patient and monitoring of complication

7. Patient visits and therapy management

8. The Network in Lombardia

9. Minimum Data Set for Parkinsonism

10. Ongoing Italian Projects on ICT in Parkinson’s Disease Goals Toscana - Siena

11. United Kingdom 2003 Tele Rehabilitation

12. Telerehabilitation tools in Italy

14. The term Telerehabilitation indicate a communication/information system with different complexity levels (from phone to advanced remote exercices control) which allows to provide a remote medical-rehabilitative assistance: Teleconference Virtual 3D high interactive settings Sensorized systems The association with ICT technology (wireless, pocket-pc,mobile-phones) allows interactive networks Virtual Reality Rehabilitation System (VRRS) by our Institute and others Institution with this technology and by the patient residence (Home version) will be usefull in different neurological disorders with high social impact, like Parkinson’s Disease

15. AIMS OF STAR PROJECT To increase intensity and frequency od Rehabilitation sessions To increase intensity and frequency od Rehabilitation sessions To reduce displacement of patients into the territory To reduce displacement of patients into the territory To reduce the costs of assistance To reduce the costs of assistance To propel to do rehabilitation treatment To propel to do rehabilitation treatment To assure continuity on the assistance To assure continuity on the assistance To evaluate and to prove the cheapness and effectiveness of telerehabilitation To evaluate and to prove the cheapness and effectiveness of telerehabilitation

16. New Horizons Use IEPR in management of Parkinson’s Disease Patients Use IEPR in management of Parkinson’s Disease Patients –Advanced alert system usefull for the physician in decision making –Therapy and treatment management and medical supervision Replacing paper on-off chart in computerized one Replacing paper on-off chart in computerized one U Using electronic monitoring bottles (Aardex1) to control patient’s therapeutic compliance

17. Computerizable charts for IEPR