Enriching Rehabilitation and Impacting Communities

In Spring 2025, MetroHealth's Old Brooklyn Campus in Cleveland Ohio will open two new and unique food and beverage options for hospital visitors, patients, and employees. What makes these dining locations so special isn’t the food being served or a particular atmosphere—it’s the Metro Café’s role in providing a space for community members with severe traumatic brain injury (TBI) to participate in upcoming research projects while volunteering and rehabilitating. The Metro Café is in partnership with Giant Eagle, a popular grocery chain in the Midwest that is known as a strong supporter of the disability community.

To bring this project to life, Cole Galloway, PT, PhD, FAPTA, Clinical Professor in Baylor University’s Department of Physical Therapy, has partnered with James Sulzer, PhD, Staff Scientist in the Department of Physical Medicine and Rehabilitation (PM&R) and Associate Professor of PM&R at Case Western Reserve University, who serves as principal investigator on the pair’s recently awarded two-year $434,438 grant from the National Institutes of Health (NIH). 

According to Galloway, the project was initially inspired by Anne Dunlap, a young woman who was on the road to recovery following a TBI. When Anne expressed interest in a sales job and was met with disbelief due to her disability, Galloway knew they had to make it happen. Together, Dunlap, Galloway and Dr. Devina Kumar, then a doctoral student in Galloway’s University of Delaware lab determined that, rather than focusing on rehabilitation first and career building second, they needed to bring the two together.

“Why wait on perfect walking and standing when we have simple devices—harnesses—that can prevent falling? Let’s work on rehabilitative goals and vocational goals at the same time—right now,” he says. “Your brain is always changing. We need to put you in an enriched environment for your brain, for your body, for your re-entry into your community.”

The body weight support harness that protects the volunteer sales associate staffing the Metro Café is not new technology. Instead, it has traditionally been used to support patients on a treadmill within the confines of a rehabilitation clinic.

“In the clinic you’re literally sequestered. Therapists know, there’s very little ‘real’ about traditional therapies,” he says. “Many therapists want to move beyond isolated practice towards getting people out in the world with dynamic social interactions and dynamic objects—which make up the reality of their new life. The Café has those things.”

Galloway describes the Café as an opportunity to support individuals as they “scaffold” themselves from their pre-TBI time to post-TBI time. The café intervention project funded by NIH consists of a two-hour shift, three times a week for six weeks. During that time, team members (or, subjects) experience a vibrant mixture of social contact, communication, movement, balance, thinking, and memory exercise. Through the “mundane” everyday processes of running a café, the recovery process for TBI patients is enhanced.  

“It’s like a 100-square-foot oasis where the disability community, the science community, the clinical community, and the broader community all come together to support a person’s exploration of their new capacity.”

The community-centered aspect of his research is critical for Galloway, especially when it comes to the disability communities he is serving through his work.

“I currently don’t have a visible disability. I don’t caregive for someone with a TBI. So, what is my role in serving people with TBI? Traditionally, my role as a therapist is as ‘expert.’ They are ‘my patients.’ Baked into these traditional roles is ableism, which places my worth, my power ahead of theirs,” he shares. “Over time, we are working to flip that. In my opinion, people with lived experiences and their caregivers should be directing healthcare and medical research. The café is a small step towards this power reversal.” 

Galloway points to participatory action research (PAR), where the community defines a problem for themselves and then engineers and scientists play support roles in translating those problems into fundable, feasible studies.

“Researchers are less likely to end up studying things just for the sake of science. You’re studying it as a tool to providing community-approved services.” 

The Metro Café project is no exception. The PI for the project, James Sulzer, is also a caregiver for a family member with a TBI. 

“James’ lived experience as a caregiver provides every aspect of this project with a much deeper connection to the disability community,” Galloway shares.

Replication of the Metro Café is the dream for Galloway and his collaborators. He enthusiastically shares the potential benefits of the project—more effective and comprehensive rehabilitation for TBI patients, high impact research opportunities, earlier community engagement, low implementation cost, and more. The most significant barrier to implementation? It’s a change from “business as usual”—a change from the isolated, expert-driven medical model to community-medical partnership with the TBI community at its center.

“It’s not asking for radical changes, but it is new,” Galloway says. “It’s likely more efficient and there’s a big bang for your buck to treat in these kinds of environments, but it’s different.”

In addition to creating more enriched rehabilitative settings like the Café, Galloway is also seeking to move the treatment earlier in the rehabilitation process. His current research funding with Sulzer is focused on TBI patients who have been discharged from outpatient settings, but Galloway hopes to bring the same ideas and strategies to outpatient and inpatient settings.

“I really believe that, as soon as you’re medically stabilized, there’s a space for enrichment as a key focus,” he shares.

Galloway and his collaborators are pioneering the implementation of enriched environment rehabilitation in clinical settings—and doing so with a low-cost, low-tech methodology. The opportunity for impact is off the charts, and Galloway is excited for the future.

“These types of enriched environments are not a ‘just you wait and see’ promise of a high-tech device for the future. This can be implemented this afternoon—okay, maybe tomorrow afternoon,” he says. “We have the technology, we have the know-how, we have the perfect place—it’s called the real world!”