Aim To qualitatively assess causes, adaptations, and psychosocial impact of falls, and solutions for safer environments as shared by persons diagnosed with cerebral palsy (CP).

Method Ambulatory adults with CP (n=165) and caregivers of ambulatory children with CP (n=151) responded to four open-ended falls questions. Deductive and inductive content analysis was conducted. Results: Eight themes emerged (psychological, physical, avoid, adapt, people, environment, policy, healthcare). Participants elaborated on fall causes (aging, physical, mental, environmental, and situational), mechanics (most often trips), repercussions (psychological and physical), adaptations, difficulty getting up, and aspirations for themselves and society. Caregivers and adults detailed various adaptations to or deliberate avoidance of high-risk situations (e.g. uneven surfaces, crowds). Specific suggestions for environmental accessibility (e.g. more handrails), societal behavioral responses (give autonomy, be patient), healthcare practice, and policy were made.

Interpretation This study offers profound insights into how individuals with CP navigate the challenges of falls and how people and surroundings both positively and negatively affect their fall-related experiences. Many issues identified were multifactorial, requiring multidimensional, non-ableist solutions. Thus, the onus to address these issues is shared. Participants offered simple, but impactful, actions that could be taken immediately to support the creation of safer physical and psychological environments.

WHAT THIS PAPER ADDS 1. People should ask if and how to help when someone falls.

2. Falls trigger anxiety, embarrassment, and avoidance, often outweighing physical injuries’ impact.

3. Participation can be enhanced through more inclusive activities and environments.

4. Safe falling strategies should be taught at all ages.

5. Multifaceted solutions include conversations regarding falls with clinicians and addressing policy shortcomings.

The authors have declared no competing interest.

Endowed Fund for Cerebral Palsy Treatment at Gillette Childrens

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Institutional Review Board of the University of Minnesota gave ethical approval for this work.

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All data produced in the present study are available upon reasonable request to the authors.