Preventing falls during transfers for people with Spinal Cord Injury
By Kate Harris, Senior Occupational Therapist, estara
This year’s Spinal Cord Injury (SCI) Awareness Week theme is all about fall prevention. We know that falls can lead to SCI, but our team here at estara is really focussed on preventing falls for our clients after SCI. These most often happen during transfers - getting from bed to wheelchair, wheelchair to toilet, in and out of the car, and so on. These are everyday movements, but they’re also some of the most common times when falls can happen.
The good news? With the right setup, habits, and support, many falls can be prevented. Here’s a look at what causes falls and what can be done to reduce the risk.
Why Do Falls Happen?
There’s no single reason. Falls during transfers can happen for a bunch of different reasons, including:
Not setting things up properly (like forgetting to put the brakes on the wheelchair)
Muscle weakness or spasticity that kicks in at the wrong moment
Difficulty with balance or trunk control
Feeling fatigued, especially later in the day
Trying a new transfer without enough practice or support
Environmental issues like slippery or uneven floors
Most people with SCI know that even small changes in routine or environment can throw things off. That’s why a little planning goes a long way.
Getting Your Setup Right
Setting up properly before a transfer is one of the simplest ways to stay safe. Some things to check every time:
Brakes on. Always double-check your wheelchair brakes are locked before starting a transfer.
Hand placement. Keep your hands close to your centre of gravity and near the surface you’re moving to.
Footplates and feet. Move footplates out of the way and check your feet are in a safe position — no surprises mid-transfer.
Seat height. Ideally, your seat, and the surface you’re transferring to, should be close in height, so you’re not lifting or dropping too far.
Minimise the gap. The smaller the space between surfaces, the safer and smoother the transfer. Use a transfer board if needed — it can bridge the gap and give you more control.
Watch your skin. Be mindful of sharp edges or parts of the chair that could cause scrapes or pressure injuries during the move.
What If You Do Fall?
No matter how careful you are, falls can still happen. Having a plan in place can take some of the stress out of the situation.
Use your cushion. If you’re on the floor, sit on your wheelchair cushion while waiting for help — it’ll protect against pressure injuries.
Call your GP. It’s always worth getting checked after a fall, especially if you’ve hit your hips, knees or shoulders — internal injuries or fractures can go unnoticed.
Keep communication close. Make sure phones or smart speakers (like Alexa or Google Home) are within reach from the floor.
Learn recovery techniques. Ask your physio or occupational therapist to show you safe ways to get back into your chair if possible using furniture or low surfaces to help.
Stay strong. Simple exercises like seated push-ups or a tailored strengthening plan can improve your balance and confidence over time.
Your chair needs care too
Wheelchair setup and maintenance isn’t just about comfort, it’s also about safety.
Get the fit right. A properly fitted wheelchair is more stable and easier to transfer in and out of.
Keep it serviced. Make sure brakes, rear wheels, and casters are in good condition — no one wants a wobbly chair during a transfer.
For carers and support workers
If you are helping with transfers, your technique matters just as much.
Build skills gradually. Confidence comes with practice. Support workers should take the time to learn and build their skills safely preferably guided by a therapist (OT or Physio).
Stick to safe handling techniques. There are no shortcuts when it comes to safety.
Regular training. Ongoing learning helps carers stay confident and reduces the risk of injury for both them and the person they’re supporting.
Things change and that’s OK
Over time, your body and your needs might change. That’s totally normal and it’s important to adjust how you do transfers to match.
Consider hoists. Portable or ceiling hoists can take the strain off and make transfers safer, especially if things have become harder over time.
Reassess regularly. It’s worth checking in with your OT or physio routinely to make sure your setup and techniques still suit your needs.
Transfers might be part of everyday life, but that doesn’t mean they have to feel risky, painful or stressful. With the right environmental setup and support, you can reduce the risk of falls and feel more confident.
If you’re not sure where to start, talk to your occupational therapist or physio. Small changes can make a big difference.