Rachel E. Cowan, Ph.D.
Research Assistant Professor, Department of Neurological Surgery
In in March of 1996, approximately 12 weeks before graduating from high school, I broke my neck in a car accident while driving to my first class of the day (Bummer). Seven months later, in January 1997, unable to walk or stand, I moved 200 miles away from home to start college at the University of North Carolina Wilmington. I figured there was no reason to stay at home and I had been accepted to UNCW before my accident. I wasn’t sure what I wanted to study or what I wanted to do with my new life as someone with SCI, but I knew staying home was not the answer. So I left.
I earned my B.A. in Physical Education with a minor in computer science from UNCW in December 2000, managing to acquire University and Departmental Honors. While working on my major I fell in love with Biomechanics. Human movement had always fascinated me and biomechanics was just the coolest. thing. ever. My minor gave me the opportunity to learn how to program in C/C++. I wasn’t sure how that skill would ever be useful to me, but turns out knowing how to program came in handy during my doctorate studies (Life Lesson: learn useful stuff and trust it will come in handy). During my final year, I completed a research project of my own design to earn Departmental Honors. About a year before graduation, I began trying to figure out what was next. . . I had zero interest in teaching Physical Education. My disability wouldn’t allow me to be an athletic trainer (my concentration in my major). So I began researching graduate schools. I applied to exercise focused graduate programs at UNC-Chapel Hill and Wake Forest University, was accepted to both, and decided to attend Wake Forest.
As a graduate student at Wake Forest University in Health and Exercise Science, I was an intern in the Cardiac Rehabilitation Program (now the Healthy Exercise & Lifestyle Programs (WFU HELPS)), and picked up my ACSM Clinical Exercise Specialist Certification. I met so many interesting people via patient contact at Cardiac Rehab and got used to getting up at 5am in the morning. By the end, when I was finishing my thesis, I was at the lab everyday by 6am. Getting in early was a habit that stuck with me for many years and occasionally still happens. During my second year at Wake, I worked with Steve Messier on a low intensity exercise intervention for very old adults. The average age of my participants was over 80 years (crazy). While at Wake, I learned about how to use exercise to prevent or delay the onset of functional decline secondary to chronic health conditions, how to perform peak exercise tests, and how to assess functional independence (All stuff I use in my current research). During my second year of studies at WFU, I began to again wonder, “what next”? I knew from my involvement with Cardiac Rehab that I would not be happy doing that as a career and I knew from my thesis research that I really did not like research (go figure). But I also had the opportunity to teach and I really enjoyed that… Well apparently you needed a PhD to teach at the college level, so that’s what I decided to do next. (Note the absence of any big plan for my life, just decisions as needed.)
Since I knew I was not a fan of research, but research was required to earn a PhD, I figured I might as well pick a place that studied something I thought was interesting. A pubmed search led me to Mike Boninger and the University of Pittsburgh. Mike studied wheelchair propulsion mechanics, which I thought sounded super interesting (imagine being a runner or biker and studying that for your PhD… so cool). Fortunate for me, Mike and Pitt accepted me to the Rehabilitation Science PhD Program in 2003. At Pitt, at the Human Engineering Research Laboratories, I worked with a cadre of graduate students with engineering degrees, clinical degrees, and allied health degrees. It was a powerful lesson on the importance of transdisciplinary work and the benefit of being able to walk down the hall to ask a clinician or engineer a question. I’m a firm believer in working with people who know their stuff vs. trying to hack out a solution by myself. At Pitt I learned the ins and outs of the SmartWheel (a love-hate relationship to this day), learned how to program in matlab (way easier than C/C++), played a role in developing the Smart Wheel Clinical protocol, and learned than I needed way more sunshine in my life. (you would think with all those engineers at Pitt & CMU they’d figure out how to pipe in sunshine….apparently not) Along the way I picked up a NIH F31 grant, a PVA Quality of Life Grant, and internal funding from Pitt’s Pepper Center. (3 for 3 on grant applications….). My dissertation (F31 & internal pepper funding) fell under my wheelchair propulsion research focus.
And once again as I approached the end of my studies, I began to wonder “what next”…. (Have you noticed a theme yet…) Funny enough, although I started the PhD with the intent to teach, I finished it wanting to continue the research path. I learned I liked research when I could design it. Approximately 9 months before I graduated in December 2007, I began to reach out to research groups who knew something I wanted to learn and to whom I could add value with my skill set. I ended up getting an opportunity to post-doc at the Miami Project to Cure Paralysis with Mark Nash in the Applied Physiology Laboratory after cold-calling him and asking for a job. (True story)
During my post-doc, I applied my Wake Forest experiences with ambulatory adults (exercise testing and functional assessments) to people with spinal cord injury. Mark pretty much gave me free reign to do whatever I wanted and so I began my fitness-function theme. I submitted my first fellowship grant in August 2008 (NIH F32), the second in December 2008 (Neilsen), the third in August 2009 (NIH F32) and the fourth in August 2009 (PVA). The fourth submission was funded, with a start date of January 1st 2010, two years after I started my post-doc. (WHEW! .. persistence is important). My post-doc project fell under my fitness-function research focus. My entire post-doc was 4.5 years (Mom wanted to know if I was ever gonna get a real job…). Well worth it for the knowledge I gained and the opportunities it created. As for the inevitable “what next” question…. I consider myself incredibly lucky to have been given the opportunity to stay at the Miami Project as a faculty member.
Today I’m a research assistant professor at the Miami Project working hard to earn my keep. I started this position in June 2012 and it took four grant submissions and two years to secure my first funding as a faculty member. (you gotta be persistent…) I LOVE my job and quite possibly work in the best place in the world. Everyone is incredibly supportive and I have all the resources I need to pursue my goals and make an impact.
People often assume that I’m at the Miami Project today because of my spinal cord injury, that working here was a goal I set for myself after incurring my SCI. If pay attention to my narrative, you’ll not there was never a grand plan, just hard work to open doors and moving towards more of what I wanted whenever faced with a major life decision. I study what I study because of my SCI. I have the opportunity to do it at the Miami Project because of my hard work and previous successes. I choose to stay here because it is a positive, supportive, resource rich environment filled with people committed to excellence.
Enhancement and preservation of maximal transfer and wheelchair propulsion ability
I generally classify my research into two broad categories, wheelchair propulsion and fitness-function. But overall you could say my focus is maximizing mobility in non-ambulatory people with SCI. As someone living with SCI, I draw heavily on my daily experiences for research inspiration.
In less elegant terms, my research generally tries to define how we can reduce what I affectionately call the ‘suck factor’. As I go through my day, I inevitably have moments when the physical demand of transferring, dressing, cooking, cleaning, or pushing my chair is just too much… At those moments the internal dialogue goes something like this ‘man this is hard’, ‘actually, this sucks’, ‘why does this suck so much?’, ‘do other feel this way?’, “how can I make this easier?’, “Can I research this?”
Turns out, it isn’t just me….. The physical demands of living with SCI are high. Many people have to work hard just to get through basic daily activities. That has the unfortunate effect of influencing the activities you choose to participate in on a daily basis. When the basics are too hard, you choose to do less, and slowly, but surely you become isolated. My objective is find ways to make the basics easier and to get them into your life ASAP so you choose to do more. Nothing more, nothing less.
Wheelchair Propulsion: Let’s face it, for most people, wheelchairs represent disability. And truthfully, for many people with SCI, the wheelchair represents everything they’ve lost about themselves. Wheelchairs are stigmatizing. BUT the wheelchair is also an enabler. For without a wheelchair, you are stuck in bed forever.
In this arena, my focus is on generating the evidence a) that you and your clinician need to choose the best wheelchair for your needs AND b) enables you to justify that selection to insurance companies and government funding agencies. I’m also working on defining how what I can change about YOU to make propulsion easier (e.g. weight loss, improving fitness, and improving skills). More than just WHAT, specifically how much of a change needs to happen to meaningfully decrease the effort of propulsion.
My career goals here include revolutionizing the process of selecting and configuring wheelchairs and impacting policy on wheelchair classifications and funding. (go big or go home).
Fitness-Function: Let’s replace the term ‘function’ with independence. One of the most emotionally and mentally challenging aspects of living with an SCI is the loss of autonomy, of not being able to do the basics like dress yourself, bath yourself, get in & out of your wheelchair/car/shower by yourself, or push yourself.
In this arena, my focus is teasing apart the things that work together to make you independent. Yes, motor impairment is one (and very important), but fitness is a big player, as is ‘skill’, technique, motivation, pain, spasticity, and sensation. I’m working to understand how all these work together so we can a) identify the best one to focus on to improve YOUR independence, b) how much must these change to meaningfully improve your independence, and c) what interventions are most effective at improving these factors.
Right now, my focus is on the ‘fitness’ aspect. I want to define how much fitness must change to meaningfully improve independence. The follow-up to this is to test out exercise programs to see if improving fitness is sufficient to improve independence or if we need to add in skills training.
My career goals here are pretty simple… to get intensive strength training re-incorporated into rehabilitation and everyone’s weekly life so that lack of fitness stops being a barrier to maximal independence.
Research Design Philosophy: When designing a research project, my goal is to create a project that generates knowledge that can be immediately applied in clinical practice. This is why, although I fell in love with biomechanics, I intentionally moved away from it as a research focus. I just did not see an immediate application that would benefit people.
Rachel E. Cowan, Ph.D.
- The Miami Project to Cure Paralysis
1095 NW 14th Terrace (R-48)
Miami, FL 33136
- (305) 243-1949
- (305) 243-3914
Effectiveness of Group Wheelchair Skills Training (11/09/2017)
American Spinal Injury Association
American Congress of Rehabilitation Medicine
American College of Sports Medicine
Department of Physical Medicine and Rehabilitation
MedStar National Rehabilitation Hospital & MedStar Health Research Institute, Washington, D.C.
George Mason University, Fairfax, VA
University of Pittsburgh, Department of Physical Medicine and Rehabilitation
Human Engineering Research Laboratories, Pittsburgh, PA
Kessler Institute for Rehabilitation, West Orange, NJ
Rehabilitation Institute of Chicago, Chicago, IL
University of British Columbia, Vancouver, BC