Background: Although it is common for people with intellectual disability (ID) to fall, the reasons for this have not yet been identified. This pilot study aimed to explore the balance capabilities of a sample of adults with profound ID who had experienced a fall, in order to identify possible reasons for falling and to identify potential tests that could be used to quantify balance capabilities in this population group. Methods: The neuromuscular systems and balance capabilities of 20 adults with profound ID were comprehensively assessed with a battery of tests, including computerized posturography. Results: Of the 20 participants, 15 described themselves as frequent fallers, and 10 participants reported serious injuries as a result of falling. Formalized assessment of the neuromuscular and balance capabilities proved to be challenging, with many participants unable to comprehend what was required of them in the performance of a number of the tests. All participants were observed to have an abnormal pattern of walking. Nine participants completed posturography testing, the main finding of which was that low motor control composite scores indicated a slowing of motor responses to postural perturbations. Other potential risk factors identified were concurrent medical problems, medication, the context and environment of falling, movement impulsiveness and distractibility, and visual deficits. Conclusion: The reason why people with ID frequently fall appears complex and multifactorial. Larger studies are required to verify the potential risk factors identified in this pilot study. Many of the standardized outcome measures commonly used in physiotherapy practice to quantify balance capabilities are not suitable for use in this population group, as participants found it difficult to comprehend what was required of them. Allowing the person to become familiarized with both the test and the tester may help to alleviate this problem. Videotaping and quantifying observations of strategies people use to perform common movements such as walking or turning maybe a more appropriate measurement tool of balance capabilities of people with ID than current standardized measures. This method would require rigorous development.