Fall experiences of ambulatory children and adults with cerebral palsy: A qualitative study using thematic content analysis
Prepared by: AACPDM Digest reviewer/ Christa Weigel PT, DPT, PCS
Keywords:
- Cerebral palsy
- Falls
Study Type: Qualitative descriptive study
Summary: This study explored fall experiences among individuals with cerebral palsy (CP) across the lifespan (ages 5–76 years, GMFCS levels I–III) using responses from 316 participants (children, caregivers, and adults) to an electronic survey that included open-ended questions on causes and impacts of falls. Thematic analysis identified two central themes—internal and external—with eight subthemes (internal: mental, physical, avoidance, adaptation; external: people, environment, policy, healthcare) and further subthemes within avoidance (public, physical exertion, terrain) and adaptation (physical behaviors, mental). Participants expanded on factors contributing to falls, resulting consequences, and the changes they hoped to see for themselves and society.
Internal factors: Psychological contributors to falls included mental fatigue, distraction, and overthinking, while consequences involved embarrassment, anxiety, panic, and insecurity. Physical contributors included fatigue, weakness, tight muscles, low tone, poor balance, and age-related changes, with tripping due to poor foot clearance commonly reported. Emotional states (excitement, nervousness) and comorbidities (visual impairments, seizures) also influenced falls. Participants described physical and mental adaptations (sitting or crawling during activities, using orthotics or assistive devices, strength and balance training, and careful planning) as well as avoidance behaviors in which fear of falling reduced their participation.
External factors: Social and environmental influences shaped fall experiences. Companions could enhance safety, whereas crowds, rushing, or unwanted attention after falling increased distress. Participants desired better education on fall prevention and response. Environmental risks included trip hazards, unfamiliar settings, and poor accessibility. Individuals advocated for improved accessibility (ramps, elevators, handrails, seating) and stronger enforcement of accessibility laws. Healthcare-related needs included better access to therapy, including fall-prevention education and treatment in realistic environments, with adults emphasizing the lasting benefits of physical therapy.
Understanding falls from the perspectives of individuals with CP provides critical insight into causes, consequences, and opportunities to create safer, more accessible environments and support participation, physical safety, and mental well-being across the lifespan.