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Manrui Zhang, MPH, MSW, PhD, is driven by a simple but often overlooked question in rehabilitation care: how do we accurately recognize cognitive impairment in people who are already navigating complex physical disabilities? Her work sits at the intersection of measurement science, clinical implementation and health equity, with a particular focus on improving cognitive assessment for individuals with spinal cord injury.
Zhang earned her PhD at Northwestern University through the Integrated Health Sciences Program, where her research focused on cognitive function and the measurement of cognitive impairment. During her doctoral training, she worked on multiple projects examining the feasibility, reliability, and validity of cognitive measures for use in clinical care. “My research has always been very measurement-focused,” Zhang said. “I’m interested in how we can detect cognitive impairment accurately without placing unnecessary burden on patients or clinicians.”
Following her PhD, Zhang completed a Health Services and Outcomes Research postdoctoral fellowship supported by an Advanced Rehabilitation Research Training (ARRT) grant (funded by the National Institute on Disability, Independent Living and Rehabilitation Research). While much of her earlier work focused on aging populations, the fellowship provided an opportunity to broaden her research to people with disabilities receiving rehabilitation services. “That training period really allowed me to evolve my focus,” she explained. “I started thinking more about people in rehabilitation settings and how cognitive impairment is often under detected, even though it can strongly influence rehabilitation outcomes.”
As she refined her research direction, Zhang was introduced to Alex Wong, PhD, DPhil, assistant director of the Center for Rehabilitation Outcomes Research at Shirley Ryan AbilityLab through the center’s director, her mentor, Allen Heinemann, PhD. Zhang connected with Wong to gain a stronger clinical and implementation perspective. “I knew what I was interested in scientifically,” she said, “but I needed guidance on population needs and how measurement tools actually work in real clinical environments.” Wong now serves as a primary mentor on two of Zhang’s current research grants, both centered on cognitive assessment in people with spinal cord injury.
The first project, funded by a $110,374 grant from Paralyzed Veterans of America, focuses on developing accommodation guidelines for the NIH Toolbox cognitive measures for individuals with spinal cord injury. While the NIH Toolbox uses computer adaptive testing to reduce testing time and burden, physical limitations can still affect access and usability. “People with spinal cord injury have very diverse clinical profiles,” Zhang said. “We want to understand what accommodation solutions are available, how people experience them, and what barriers clinicians face when trying to use these tools in practice.” The project includes field testing with users as well as input from clinicians in the VA system to better understand implementation challenges and opportunities.
Zhang’s second major award is a two-year, $192,000 grant from the Craig H. Neilsen Foundation, which takes a broader approach to cognitive assessment in spinal cord injury. The project will systematically review all cognitive tests used in this population, documenting their psychometric properties, validity, reliability, and any deviations from standardized administration, such as accommodations or modified scoring. “We’re trying to summarize both the scientific accuracy and the practical realities,” Zhang said. “Some tools are being used, but that information isn’t always widely known.”
In addition to the literature review, the Neilsen-funded project includes surveys and focus groups across five major rehabilitation institutions nationwide. Zhang and her team will gather perspectives from a range of professionals involved in rehabilitation care, including psychologists, neuropsychologists, occupational therapists, nurses, and social workers. “Guidelines tell us that cognitive testing is important, but implementation looks very different across organizations,” she explained. “Professional roles, institutional structures, and organizational culture all shape how cognitive assessment actually happens.”
Zhang’s interest in cognitive measurement began well before her doctoral training. Prior to her PhD, she worked as a research assistant at the Rush Institute for Healthy Aging, contributing to epidemiological studies of older Chinese adults living in the United States. Through extensive field-based data collection, she became acutely aware of how language, culture, and education influence cognitive and emotional assessments. “As a data collector, I saw how cultural context could change how people interpret questions,” she said. “That’s especially true for language-based cognitive tests, where differences can mask someone’s true cognitive ability.”
She also observed the burden that lengthy assessments place on participants. “Some interviews lasted two hours, and then participants were asked to complete cognitive testing on top of that,” Zhang recalled. “That experience really shaped my interest in reducing testing burden and making assessments more accessible.”
Zhang’s academic path reflects her interdisciplinary perspective. She completed her undergraduate training in informatics at Beijing Language and Culture University, where she developed technical and analytical skills, before earning graduate degrees in social work and public health at Washington University in St. Louis. “I was learning tools like coding and data mining,” she said, “but I wanted to apply those tools to population health and social equity, to solve problems that actually matter to people.”