School of Health Professions

PT professor’s research aims to determine whether a combination of exercise and virtual reality games can reduce fall risk among people with Parkinson’s disease

PT Assistant Professor Anjali Sivaramakrishnan


People with Parkinson’s disease face a greater risk of falls because the progressive neurological disorder impairs their balance as their levels of dopamine decrease. The resulting fear of falling can lead to reduced activity and isolation.

Anjali Sivaramakrishnan, PhD, PT, an assistant professor in the Department of Physical Therapy in the School of Health Professions at The University of Texas Health Science Center at San Antonio, sees an opportunity to develop interventions to help people with Parkinson’s disease improve their balance and, as a result, decrease their risk of falls. She has undertaken research projects seeking to determine how to do that and more.

“My long-term goal is to develop something that is effective and that can slow the progression” of Parkinson’s disease, she said. “That’s my vision.”

Sivaramakrishnan studies whether exercise can be used to prime virtual reality (VR)-based rehabilitation to potentially improve balance and neuroplasticity among people with Parkinson’s disease. 

Sivaramakrishnan was recently awarded a K12 Mentored Career Development grant for her study titled “High-intensity endurance exercise as a primer to virtual reality for optimizing cortical excitability and neuroplasticity in Parkinson’s disease.” Funded by the National Center for Advancing Translational Sciences (NCATS), the grant is administered under the Institute for Integration of Medicine and Science (IIMS) under principal investigator Joel Tsevat, MD, MPH. Sivaramakrishnan's grant mentor is Daniel M. Corcos, an expert on Parkinson’s disease and professor of physical therapy and human movement sciences at Northwestern University. Associate Professor of Neurology Okeanis Vaou, MD, FAAN, a specialist on movement disorders, serves as a consultant on the grant. 

The study will be eight weeks long and involve 16 subjects who will be screened to ensure they have balance problems and are at risk of falling, Sivaramakrishnan said. The participants will be divided into an exercise group and a control group.

“The exercise group gets exercise and VR and the control group does stretching and VR,” she said. “The hypothesis is the exercise group will do better than the group that is doing stretching.”

The study’s outcomes will include measures of the connectivity between the brain and leg muscles, levels of circulating proteins related to brain health and balance outcomes, Sivaramakrishnan explained.

The study builds on data Sivaramakrishnan and colleagues  gathered in an earlier research study funded by the Texas Physical Therapy Foundation that seeks to determine whether virtual reality-assisted exercise can improve balance in people with Parkinson’s disease. In that study, over a period of three weeks, eight participants performed moderate exercise for about 30 minutes and then played virtual reality games that simulated real-life activities, such as unloading a dishwasher. The study began in 2021 and will end in December. Sivaramakrishnan presented preliminary findings in August at the International Congress of Parkinson’s Disease and Movement Disorders 2023 Conference in Copenhagen, Denmark. 

“Preliminary findings suggest that a combination of exercise and virtual-reality-based games seems to induce changes in neuroplasticity as well as improve balance,” Sivaramakrishnan said.

Other researchers have found that exercise makes the brain more responsive. In a published systematic review of 16 studies, Sivaramakrishnan and Assistant Professor Sandeep Subramanian, PhD, PT, reported that when people with stroke exercised at moderate to vigorous intensity for just one session, the brain was primed to be more responsive to whatever activity followed the exercise. 

Sivaramakrishnan recently earned first place in T1–T4 in 3, a cross-collaborative activity of the IIMS Community Health Advisory Board, Office of Research Education and Mentoring and Community Engagement. In the virtual challenge, presenters share their translational science research in three minutes — using just one slide — with an audience made up of students, faculty and community members. 

In her presentation, Sivaramakrishnan highlighted the potential of brain-changing effects of exercise.

“Ultimately, we expect that the intervention could slow the progression of Parkinson's and reduce risk of fall, thereby improving lives of patients and their caregivers," she told her audience.

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