Fall experiences of ambulatory children and adults with cerebral palsy: A qualitative study using thematic content analysis.

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

Method: Ambulatory adults with CP (n = 165; age median [interquartile range], range: 30 years [25-50], 18-76 years); 101 females, 59 males, five non-binary/not specified) and caregivers of ambulatory children with CP (n = 151; age median [interquartile range], range: 10 years [7-14 years], 5-17 years; 64 females, 83 males, four non-binary/not specified) responded to four open-ended prompts regarding falls. Deductive and inductive thematic content analysis was conducted.

Results: Eight themes were identified (psychological, physical, avoidance, adaptation, people, environment, policy, healthcare). Participants elaborated on the causes of falls (aging, physical, mental, environmental, situational), mechanics (most often trips), repercussions (psychological and physical), adaptations, difficulty getting up, and aspirations for themselves and society. Caregivers and adults detailed several 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 (e.g. give autonomy, be patient), healthcare practice, and policy were made.

Interpretation: This study offers deep 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. Participants were offered simple, but impactful, actions that could be taken immediately to support the creation of safer physical and psychological environments. More research and clinical practice guidelines are warranted.