Preventing Falls at Home After Stroke or Traumatic Brain Injury: The Role of Occupational Therapy

When a loved one experiences a stroke or traumatic brain injury (TBI), the recovery journey often feels overwhelming. Everyday activities—walking to the kitchen, stepping into the shower, or getting dressed—can suddenly feel much harder. One of the most common concerns families share during this time is the risk of falling.

This concern is very real. Falls are more likely after a stroke or TBI because of changes in balance, strength, coordination, vision, and even attention. But the good news is that falls can often be prevented. Families do not have to face this challenge alone—this is exactly where occupational therapy (OT) can make a difference.

Occupational therapists look at both the person and their environment, making recommendations that allow individuals to safely participate in the activities that matter most. Fall prevention isn’t about taking away independence—it’s about building safety and confidence so people can continue to live life on their own terms.

Seeing the Home with New Eyes

One of the first steps OTs often take with families is a home walk-through. The environment plays a huge role in safety, and sometimes hazards are easy to overlook until they cause problems. After a stroke or TBI, something as simple as a loose rug, a dimly lit hallway, or an electrical cord across the floor can increase the chance of a fall.

With the guidance of an OT, families can make meaningful changes such as:

Clearing walkways of clutter and cords.
Adding lighting in hallways, stairways, and bathrooms.
Installing grab bars and using non-slip mats in the bathroom.

Families often share that after these changes, their loved one feels more confident moving through the home—and more willing to engage in daily routines.

Resource: The CDC Home Fall Prevention Checklist is a helpful tool that OTs often use with families to identify hazards together.

Supporting Safe Movement

Mobility is often affected after a stroke or TBI. Weakness on one side, poor balance, or visual changes can make daily movement more challenging. OTs help families look at how these changes affect meaningful routines—like getting to the bathroom on time, carrying groceries, or moving safely between rooms.

Safe movement strategies may include:

Using a cane, walker, or wheelchair when recommended and practicing how to use these tools during everyday activities.
Encouraging a slower pace, especially during busy times of day.
Wearing supportive shoes indoors and outdoors.
Adding railings to both sides of stairways for extra security.

What makes OT unique is that we don’t just teach “safe walking”—we integrate safe movement into the routines that matter most to the individual.

Rebuilding Strength and Balance

Fall prevention also depends on the body itself. After stroke or TBI, rebuilding strength and balance is critical. While physical therapists may focus on specific exercises, occupational therapists emphasize recovery through meaningful activity.

This might include:

Practicing sit-to-stand movements while completing meal preparation.
Using cooking or gardening tasks to safely challenge balance.
Designing simple routines at home that keep movement consistent and achievable.

By embedding therapy into daily life, OTs help individuals strengthen their bodies while also practicing the activities that bring them purpose and independence.

Resource: The National Institute on Aging offers simple exercise ideas that OTs often adapt into home programs.

Rethinking Daily Routines

Perhaps the most powerful way OT supports fall prevention is by adapting daily routines. After a stroke or TBI, familiar tasks often need to be restructured. For example, reaching for dishes on a high shelf, hurrying to the bathroom at night, or managing multiple steps in the morning may all carry higher risks.

Occupational therapists help families make practical changes, such as:

Rearranging storage so frequently used items are easy to reach.
Building in rest breaks during chores to prevent fatigue.
Creating simple checklists or visual reminders for routines when memory or attention is affected.
Establishing consistent morning and evening rhythms to reduce stress and rushing.

The goal is not to remove activities, but to adapt them in ways that keep people safe, confident, and engaged.

When to Call in Extra Support

Fall prevention works best as a team approach. Occupational therapists often serve as a bridge between the individual, their family, and other providers. In addition to OT, families may benefit from support from:

Physical therapists, for targeted strengthening and gait training.
Primary care providers, for reviewing medications that may cause dizziness or drowsiness.
Community fall prevention programs, which often involve OTs in teaching strategies and practicing skills.

Resource: The National Council on Aging lists evidence-based fall prevention programs across the country.

Final Thoughts

Falls after a stroke or TBI can feel frightening—but they do not have to define recovery. Occupational therapy provides families with a holistic approach to fall prevention by looking at the person, their routines, and their environment. With thoughtful adjustments, safe movement strategies, and support from professionals, it is possible to reduce risks and restore confidence.

At Moxie OT, we believe fall prevention is not about limiting independence—it is about creating opportunities. When individuals feel safe in their homes, they can focus less on fear and more on living a meaningful, empowered life.