Preventing Falls Following Brain Injury

      People who are older, have had a brain injury (including stroke), or have other disabilities have a significant risk for falling. This tip card will help you decide if you are at risk and provide suggestions on how to increase your safety and prevent falls.

      How common is falling for the elderly and following brain injury?

      Falling is a very common problem.
      • One out of 3 adults age 65 and older falls each year.
      • Fifty percent of the people who experience stroke are at risk for falling.
      • Although there are no national statistics on the rate of falls for people who have had a traumatic brain injury, many of the symptoms associated with TBI are known causes of falls.

      Am I at increased risk for falling?

      If you check one or more of the following boxes, you are at increased risk to have a fall:
      Tabled 1
      □ fallen in past year□ need help getting dressed
      □ afraid of falling□ need help with bathing
      □ take many different medications□ difficulty paying attention
      □ dizziness□ do risky things
      □ poor balance□ use a wheelchair, walker, or cane
      □ difficulty walking□ feel unsteady getting out of bed or chair
      □ feel depressed□ feel unsteady sitting or standing

      What can be done about falling following brain injury?

      You can reduce the risk of falling by taking 1 or more of these steps.

        See your doctor:

      • Your doctor can examine your vision, strength, walking, and balance and refer you for therapies that can improve your functioning.
      • Let your doctor know if you are having problems with sadness, anger, and poor attention and memory.
      • If possible, it is best to seek treatment from a doctor or therapist associated with a rehabilitation program who can address all aspects of recovery.
      • Ask your doctor for a home safety evaluation to help determine how to make your home a safer place.
      • Inform each of your doctors about all of the medications you take, including over-the-counter medications. Your doctor needs to know this so he/she does not prescribe something that will make you dizzy, drowsy, or weak, which will increase the risk of falling and possible injury.
      • If you take blood thinners, a fall can be particularly dangerous because of the increased likelihood of bleeding.

        Use good judgment:

      • Use things as they are intended. For example, use a step stool and not a chair if you need to reach for something. Better yet, ask for help!
      • Concentrate on one task at a time and be sure to walk slowly.
      • Don’t attempt things you know you shouldn’t do.
      • Follow basic safety precautions: clean up spills, remove clutter, etc.
      • Over-the-counter medications, specifically cold and flu remedies, can increase dizziness and fall risk. Use them only after consulting with your doctor!
      • Consider getting a Medic Alert System if you live alone or are alone for extended periods of time.

        Use assistive devices:

      • Wear your prescription glasses, if you have them.
      • Be sure to use walkers or other assistive devices if you need them.
      • Use assistive devices correctly. For example, lock the wheelchair before standing or transferring. Don’t try to go down stairs with a walker.
      • Use reachers, transfer devices, and bath aids as instructed by your therapist. If you have never talked with a therapist about these devices, ask your doctor for a referral.

        Make your home safer:

      • Proper lighting is important. If it is dark, turn on a light. Don’t try to find what you need, such as your robe or the way to the bathroom, in the dark.
      • Remove throw rugs, extension cords, furniture, or other obstacles that may make you trip from hallways and other much-used pathways.
      • Be aware of surface changes, such as going from the carpet to a hardwood floor or tile, or from pavement to grass, and try to avoid them if possible.
      • Use slip-resistant strips on bathroom and kitchen floors or slippery hardwood floors.
      • Be aware that having a pet such as a dog or cat under foot increases the likelihood of falling.

      Where can I find additional information?

      If you would like more information on the references we used for this tip card, please go to the ACRM BI-ISIG website ( or view the supplemental online-only material at
      We also recommend the following websites:
      American Physical Therapy Association ( When you get to the home page, click on the section for “Practice and Patient Care,” and under the options for this section, you will find some more good advice on fall prevention.
      Brain injury support groups are another source of information and help. Your local chapter of the Brain Injury Association of America ( might help you find such a group.


      This information is not meant to replace the advice from a medical professional. You should consult your health care provider regarding specific medical concerns or treatment.


      This Tip Card was prepared by the American Congress of Rehabilitation Brain Injury Interdisciplinary Special Interest Group; Taskforce on Long-Term Issues. This Information/Education Page may be reproduced for noncommercial use for health care professionals to share with patients and their caregivers. Any other reproduction is subject to approval by the Publisher.
      Special thanks to David Krych, MS-CCC-SLP for leading the effort and other ReMed Recovery Care Centers contributors: Helen Carmine, MSN, CRNP, CRRN and Mary Pat Murphy, MSN, CRRN. Also, special thanks to Tom Felicetti, PhD, Beechwood Rehabilitation Services, for his contributions.

      Bibliography for “Preventing Falls Following Brain Injury” Information/Education Page

        • Connell B.
        • Wolf S.
        Environmental and behavioral circumstances associated with falls at home among healthy elderly individuals.
        Arch Phys Med Rehabil. 1997; 78: 179-186
        • Di Fabio R.
        • Greany J.
        • Emasithi A.
        • Wyman J.
        Eye-head coordination during postural perturbation as a predictor of falls in community-dwelling elderly women.
        Arch Phys Med Rehabil. 2002; 83: 942-951
        • Gill T.
        • Williams C.
        • Robinson J.
        • Tinetti M.
        A population-based study of environmental hazards in the homes of older persons.
        Am J Pub Health. 1999; 89: 553-556
        • Hausdorff J.
        • Rios D.
        • Edelberg H.
        Gait variability and fall risk in community-living older adults: a 1-year prospective study.
        Arch Phys Med Rehabil. 2001; 82: 1050-1056
        • Holtzer R.
        • Verghese J.
        • Xue X.
        • Lipton R.
        Cognitive processes related to gait velocity: results from the einstein aging study.
        Neuropsychology. 2006; 20: 215-223
        • Kallin K.
        • Jensen J.
        • Lundin-Olsson L.
        • Nyberg L.
        • Gustafson Y.
        Why the elderly fall in residential care facilities, and suggested remedies.
        J Fam Prac. 2004; 53: 41-52
        • Kallin K.
        • Lundin-Olsson L.
        • Jenson J.
        • Nyberg L.
        • Gustafson Y.
        Predisposing and precipitating factors for falls among older people in residential care.
        Public Health. 2002; 116: 263-271
        • Kenny R.
        • Rubenstein L.
        • Martin F.
        • Tinetti M.
        Guideline for the prevention of falls in older persons.
        Am Ger Soc. 2001; 49: 664-672
        • Lord S.
        Visual risk factors for falls in older people.
        Age and Ageing. 2006; 35: ii42-ii45
        • Lord S.
        • Menz H.
        • Sherrington C.
        Home environment risk factors for falls in older people and the efficacy of home modifications.
        Age and Ageing. 2006; 35: ii55-ii59
        • Moylan K.
        • Binder E.
        Falls in older adults: risk assessment, management and prevention.
        Am J Med. 2007; 120: 493.e1-493.e6
        • O'Mahony D.
        • Foote C.
        Prospective evaluation of unexplained syncope, dizziness, and falls among community-dwelling elderly adults.
        J Gerontol (A Biol Sci Med Sci). 1998; 53A: M435-M440
        • Peel N.
        • McClure R.
        • Hendrikz J.
        Psychosocial factors associated with fall-related hip fractures.
        Age and Ageing. 2007; 34: 145-151
        • Pluijm S.
        • Smit J.
        • Tromp E.
        • et al.
        A risk profile for identifying community-dwelling elderly with a high risk of recurrent falling: results of a 3-year prospective study.
        Osteoporos Int. 2006; 17: 417-425
        • Rubenstein L.
        Falls in older people: epidemiology, risk factors and strategies for prevention.
        Age and Ageing. 2006; 35: ii37-ii41
        • Sattin R.
        • Rodriguez J.
        • DeVito C.
        • Wingo P.
        Home environmental hazards and the risk of fall injury events among community dwelling older persons. Study to assess falls among the elderly (SAFE) group.
        J Am Geriatr Soc. 1998; 46: 669-676
        • Thurman D.
        • Stevens J.
        • Rao J.
        Practice parameter: assessing patients in a neurology practice for risk of falls (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology.
        Am Acad Neurol. 2008; 70: 473
        • Tinetti M.
        • Speechley M.
        • Ginter S.
        Risk factors for falls among elderly persons living in the community.
        N Eng J Med. 1988; 319: 1701-1707
        • Van Iersel M.
        • Ribbers H.
        • Munneke M.
        • Borm G.
        • Olde Rikkert M.
        The effect of cognitive dual tasks on balance during walking in physically fit elderly people.
        Arch Phys Med Rehabil. 2007; 88: 187-191
        • Vellas B.
        • Wayne S.
        • Garry P.
        • Baumgartner R.
        A two-year longitudinal study of falls in 482 community-dwelling elderly adults.
        J Gerontol (A Biol Sci Med Sci). 1998; 53A: M265-M274
        • Verghese J.
        • Buschke H.
        • Viola L.
        • et al.
        Validity of divided attention tasks in predicting falls in older individuals: a preliminary study.
        J Am Geriatr Soc. 2002; 50: 1572-1576
        • Verghese J.
        • Kuslansky G.
        • Holtzer R.
        • et al.
        Walking while talking: effect of task prioritization in the elderly.
        Arch Phys Med Rehabil. 2007; 88: 50-53
        • Whooley M.
        • Kip K.
        • Cauley J.
        • Ensrud K.
        • Nevitt M.
        • Browner W.
        Depression, falls, and risk of fracture in older women.
        Arch Intern Med. 1999; 159: 484-490