Introduction: Spinal cord injury (SCI) can cause changes to motor and sensory functioning increasing the risk of falls. Falls have economic and personal costs and therefore, this program of research aimed to develop an understanding of falls and fall management after SCI and determine methods to enhance clinical falls practice. Methods: The research used multiple methods to sequentially build an understanding and basis for practice change. It included a scoping review, qualitative exploration of the perspectives of falls and fall prevention, and co-design with consumers and clinicians to explore enhancement in falls practice. Results: Results of the scoping review (n = 35 articles) provided evidence on the incidence, consequences and contributing factors to falls although gaps indicated a need to address falls in the inpatient setting and build an understanding of the patients perspective The perspectives of 15 people with SCI were organised into three themes including expectation of falling, learning from my own experience and the experience of others’ and how to prevent falls. Finally, the co-design study included six consumers and eight clinicians and built on the perspectives in the qualitative study and generated approaches for enhancement of practice including getting everyone on the same page, supporting moving safely through experience-based learning, understanding it requires more than just a focus on falls and, the need for personalised approaches. Practical strategies for implementation were developed. Contribution to the occupational therapy profession: This research has collaboratively developed innovative approaches for occupational therapists and teams to implement within falls management with people with SCI.