As a rehabilitation engineer, James Sulzer, PhD, Staff Scientist at MetroHealth Rehabilitation Institute and Associate Professor at Case Western Reserve University, Department of Physical Medicine and Rehabilitation (PM&R), has devoted years to creating devices that help patients recover from serious brain trauma, such as strokes. For him, the potential of rehab technology to improve the lives of those with traumatic brain injuries (TBI) has been a career driver.
Today, though, Dr. Sulzer looks at his research through a different lens: as a caregiver of someone with a disability.
In 2020, a tragic family accident changed his life—and how he approached his work. His then four-year-old daughter sustained a severe TBI when a tree branch fell on her head in the backyard. As Dr. Sulzer and his wife pursued various treatments to help their daughter recover, it became apparent to him that rehabilitation engineering research lacked a key element: an awareness of what families face as they cope with a neurological injury.
“I realized we were missing input from those on whose behalf we’re working,” he explains. “With these technologies, we need more input to understand better the problems faced by those with the disability.”
At the time of the accident, Dr. Sulzer—the founder of the University of Texas Cellular to Clinically Applied Rehabilitation Research and Engineering Initiative—leveraged his experience as a rehabilitation engineer to help her once she left the hospital. He discovered that some devices from his lab were too hard to set up, didn’t engage his daughter enough, or failed to fit into her schedule.
“I was so frustrated that the solutions I was coming up with were mostly solid in theory but lacked an understanding of the practical hurdles that make or break an intervention,” he says. “Our family’s personal experience showed me that we were missing the essence of the lived experience in our research. This includes both the person with the disability as well as the caregivers.”
Today’s Special: Rehabilitation
Today, his research at the MetroHealth Rehabilitation Institute focuses on the lived experience of patients and caregivers. One notable research initiative is the Metro Café, a functional café for community-based rehabilitation of people with TBI. Dr. Sulzer and his research partner, Cole Galloway, PT, PhD, Professor in the Department of Physical Therapy at Baylor University and an adjunct professor at Case Western Reserve University, secured a two-year, $434,438 grant from the National Institutes of Health to study if real-world work experience improves cognitive and motor function. (While at the University of Delaware, Dr. Galloway launched a smaller, similar initiative, which showed improvements in hand function, socialization and mobility.)
“We want to provide a more enriching rehabilitation environment,” Dr. Sulzer says. “One that improves certain abilities and gives people with TBI an opportunity to contribute and be productive—all in an environment designed with their safety in mind.”
Individuals with TBI discharged from rehabilitative therapy (physical, occupational, and speech therapy) will participate in Metro Café—two-hour shifts, three times a week, for six weeks. Participants will use an overhead harness system that allows someone with limited mobility to move in all directions while performing tasks at the Metro Café. There will be two café locations: a freestanding version in the atrium and another in the Old Brooklyn Center cafeteria.
Community Collaboration
One of the unique aspects of the Metro Café is that it’s been a true collaboration—between researchers and participants, between research and non-research disciplines, and between MetroHealth and another community staple: Giant Eagle.
“To do this well, we had to tap into a team outside of research,” Dr. Sulzer explains. “When we proposed it to different groups like Food Services, they were immediately interested in how to support the initiative.”
Giant Eagle was an ideal community partner, too. The supermarket chain will provide the food to sell, plus one employee to work alongside the research participant. Giant Eagle is well known throughout the community for hiring people with disabilities. If the research project is successful, a longer-term goal would be for participants to transition to employment at Giant Eagle if desired.
Making Moves
Initially, Drs. Sulzer and Galloway will assess whether the Metro Café environment improves cognitive and motor outcomes in people with TBI compared to other community dwellers. In addition to mobility and cognition, the team is evaluating clinical measures like community participation, anxiety, speech and other factors that affect quality of life.
“We think that this holistic, engaging approach can be used with patients early in the recovery process through vocational rehabilitation,” Dr. Sulzer says. “Research into complex problems like neurological rehabilitation needs to focus more on real-world interventions like the Metro Café.”
