Bridging the digital divide: Co-designing communication tools for people with brain injury

In today’s world, so much of our communication happens online – through emails, texts, video calls, and social media. But for people with TBI, cognitive-communication challenges can make these everyday interactions difficult, even impossible.

'Technology is embedded in day-to-day life,' says Lu, a PhD candidate in the Faculty of Health at UTS. 'But many people with TBI are being left behind.'

This digital exclusion isn’t just inconvenient, it’s unjust. Without the ability to communicate online, people with TBI face barriers to employment, education, healthcare, and social connection. Yet, there are few clinical tools to assess or support their use of technology. 

Lu’s project, supported by a UTS Social Impact Grant, set out to change that. 

A new kind of assessment 

The project’s goal was to lay the groundwork for a new kind of clinical tool: a dynamic assessment for technology-mediated communication. Unlike traditional assessments, which often rely on outdated tasks like using a landline or reading a paper map, this tool would reflect the real-world digital environments people navigate every day. 

'Assessments are so old now,' said one participant. 'They’re not relevant anymore.' 

To ensure the tool would be meaningful and accessible, Lu formed an advisory committee that included speech pathologists and people with lived experience of TBI. Their involvement was central to the project. 

'We used aphasia-friendly communication, sent materials in advance, and adapted our meeting formats,' says Lu. 'It was about making sure everyone could contribute meaningfully.' 

Listening, learning, adapting 

The project included 2 research studies: a scoping review of the literature and a Delphi study involving interviews and surveys with clinicians, people with TBI, and their supporters. 

Recruitment wasn’t easy. While speech pathologists were relatively easy to engage, it took multiple rounds of outreach to connect with people with TBI and their support networks. But the effort paid off. 

'Having something like that – where you could get their baseline and then see their learning capacity – would be incredibly valuable,' said one clinician. 

Another participant reflected on how the research had already changed their practice: 'You asking me that question – I will change the way I conduct my initial assessments now.' 

Co-design in action 

One of the most significant changes came from piloting the interview protocol with the advisory committee. Their feedback led to major improvements: combining questions, adding visual supports, and sending materials in advance. 

'If I could have it in front of me… having it typed behind you,' one member suggested. That simple change made a big difference. 

These adaptations didn’t just improve the research – they modelled what inclusive, equitable research can look like. 

'People with disabilities are often excluded from research. But they have the expertise we need. This project showed how we can include them meaningfully.' – Sheree Lu

Looking ahead 

The project is ongoing, with 2 more studies planned and a pilot version of the assessment tool in development. Lu and her team are also presenting their findings at national and international conferences, helping to shift clinical practice and raise awareness. 

'We’re pretty good at making it up as we go along,' said one clinician. 'But that’s not sustainable. We need tools that reflect the world we live in.' 

Thanks to this project, those tools are one step closer.