Identifying central elements of the therapeutic alliance in the setting of telerehabilitation: A qualitative study.

INTRODUCTION: Therapeutic alliance is a relevant aspect of healthcare and may influence patient outcomes. So far, little is known about the therapeutic alliance in telerehabilitation. PURPOSE: To identify and describe central elements of therapeutic alliance in the setting of telerehabilitation and compare it to those in conventional rehabilitation. METHODS: In this qualitative study, a literature search and in-depth semi-structured interviews with rehabilitation and telerehabilitation experts were conducted from 15.5.-10.8.2020 on elements influencing the therapeutic alliance in rehabilitation and telerehabilitation. Using a combined deductive and inductive approach, qualitative content analysis was used to identify categories and derive central themes. RESULTS: The elements bond, communication, agreement on goals and tasks and external factors were identified in the literature search and informed the development of the interview guide. Twelve purposively sampled experts from the fields of physiotherapy, occupational therapy, speech and language therapy, psychology, general medicine, sports science and telerehabilitation software development participated in the interviews. We identified three central themes: building effective communication; nurturing a mutual relationship of trust and respect; and agreement on goals and tasks and drivers of motivation. CONCLUSIONS: In this qualitative study, key elements of therapeutic alliance in rehabilitation confirmed those reported in the literature, with additional elements in telerehabilitation comprising support from others for ensuring physical safety and technical connectedness, caregivers acting as co-therapists and applying professional touch, and promoting patient autonomy and motivation using specific strategies.

[Scale for the assessment and rating of ataxia (SARA): translation and cultural adaptation to German-speaking areas]. / Scale for the assessment and rating of ataxia (SARA): Übersetzung und kulturelle Anpassung an den deutschsprachigen Raum.

BACKGROUND/OBJECTIVE: The scale for the assessment and rating of ataxia (SARA) is a feasible assessment for the classification and evaluation of therapeutic interventions. In order to provide access to the SARA in German, the aim of this work was to translate the SARA into German and to adapt it according to international guidelines for German-speaking countries. METHOD: The process involved six steps. The comprehensibility of the scale was assessed using interviews with potential users. RESULTS: A total of nine physiotherapists and six physicians working in various clinical settings were interviewed, seven of them worked in Germany and four each in Austria and Switzerland. The interviews led to a refined version of the translation. The comprehensibility testing revealed no country-specific differences. CONCLUSION: A German version of the SARA authorized by the co-author of the original publication, is now available. The results provide methodological insights into the translation process of observation-based standardized assessments.

Factors influencing the willingness to adopt telerehabilitation among rehabilitation professionals in Austria and Germany: a survey comparing data before and during COVID-19.

PURPOSE: To investigate determinants of willingness to adopt telerehabilitation, willingness of technology use, core affect regarding using telerehabilitation, and digital competencies in rehabilitation professionals in Austria and Germany before and during the COVID-19 pandemic. MATERIALS AND METHODS: A cross-sectional paper-based and online survey was conducted before and during COVID-19, respectively, with three cohorts of rehabilitation professionals. Outcomes were the willingness to adopt telerehabilitation evaluated using the extended Unified Theory of Acceptance and Use of Technology; willingness of technology use using the short scale for assessing the willingness of technology use; digital competencies and core affect using the Digital Competence Framework and semantic differential, respectively. Multivariate ordinal regression analysis was performed to determine predictors. RESULTS: Included were 603 rehabilitation professionals. Analysis revealed differences between Austria and Germany and before and during the pandemic for most outcomes. German residency, the pandemic, and a higher educational level were most important predictors of higher willingness to adopt telerehabilitation, willingness of technology use, digital competencies, and positive core affect.The pandemic increased most aspects of willingness to adopt telerehabilitation, willingness of technology use, digital competencies, and positive core affect. Results confirm that rehabilitation professionals with higher degrees are more prone to adopt innovations in healthcare.Registration: German Clinical Trials Register (DRKS00021464)IMPLICATIONS FOR REHABILITATIONThe willingness to adopt telerehabilitation is associated with external factors increasing the need for alternative rehabilitation delivery, such as COVID-19, and with financial facilitators, such as reimbursement.As the willingness to adopt telerehabilitation is higher among speech and language therapists and dietitians, efforts are necessary to enhance its use in physiotherapists and occupational therapists.As a higher willingness to adopt telerehabilitation was observed in younger rehabilitation professionals and those with higher education, increasing the importance of telerehabilitation in education curricula and further knowledge transfer into practice for those already working in the field seems necessary.

Group-based circuit training to improve mobility after stroke: a cross-sectional survey of German and Austrian physical therapists in outpatient settings.

BACKGROUND: A contextual transferability analysis identified group-based circuit training (GCT) as an optimal intervention in German and Austrian outpatient physical therapy to improve mobility post-stroke. GCT incorporates task-oriented, high-repetitive, balance, aerobic and strength training and allows for increased therapy time without increasing personnel. OBJECTIVE: To determine the extent to which German and Austrian physical therapists (PTs) use GCT and its components in the outpatient treatment of stroke-related mobility deficits and to identify factors associated with using GCT components. METHODS: A cross-sectional online survey was conducted. Data were analyzed descriptively and using ordinal regression. RESULTS: Ninety-three PTs participated. None reported using GCT moderately to frequently (4-10/10 patients). The percentage of PTs reporting frequent use (7-10/10 patients) of task-oriented, balance, strength, aerobic, and high-repetitive training was 45.2%, 43.0%, 26.9%, 19.4%, and 8.6%, respectively. Teaching or supervising students, time for evidence-based practice activities at work, and working in Austria was associated with using GCT components frequently. CONCLUSION: German and Austrian PTs do not yet use GCT in outpatient physical therapy for stroke. Almost half of PTs, however, employ task-oriented training as recommended across guidelines. A detailed, theory-driven and country-specific evaluation of barriers to GCT uptake is necessary to inform implementation.

Standardized tools for assessing balance and mobility in stroke clinical practice guidelines worldwide: A scoping review.

Background: Use of standardized tools to assess balance and mobility limitations is a recommended practice in stroke rehabilitation. The extent to which clinical practice guidelines (CPGs) for stroke rehabilitation recommend specific tools and provide resources to support their implementation is unknown. Purpose: To identify and describe standardized, performance-based tools for assessing balance and/or mobility and describe postural control components challenged, the approach used to select tools, and resources provided for clinical implementation, in CPGs for stroke. Methods: A scoping review was conducted. We included CPGs with recommendations on the delivery of stroke rehabilitation to address balance and mobility limitations. We searched seven electronic databases and grey literature. Pairs of reviewers reviewed abstracts and full texts in duplicate. We abstracted data about CPGs, standardized assessment tools, the approach for tool selection, and resources. Experts identified postural control components challenged by each tool. Results: Of the 19 CPGs included in the review, 7 (37%) and 12 (63%) were from middle- and high-income countries, respectively. Ten CPGs (53%) recommended or suggested 27 unique tools. Across 10 CPGs, the most commonly cited tools were the Berg Balance Scale (BBS) (90%), 6-Minute Walk Test (6MWT) (80%), Timed Up and Go Test (80%) and 10-Meter Walk Test (70%). The tool most frequently cited in middle- and high-income countries was the BBS (3/3 CPGs), and 6MWT (7/7 CPGs), respectively. Across 27 tools, the three components of postural control most frequently challenged were underlying motor systems (100%), anticipatory postural control (96%), and dynamic stability (85%). Five CPGs provided information in varying detail on how tools were selected; only 1 CPG provided a level of recommendation. Seven CPGs provided resources to support clinical implementation; one CPG from a middle-income country included a resource available in a CPG from a high-income country. Conclusion: CPGs for stroke rehabilitation do not consistently provide recommendations for standardized tools to assess balance and mobility or resources to facilitate clinical application. Reporting of processes for tool selection and recommendation is inadequate. Review findings can be used to inform global efforts to develop and translate recommendations and resources for using standardized tools to assess balance and mobility post-stroke. Systematic Review Registration: https://osf.io/, identifier: 10.17605/OSF.IO/6RBDV.

[Balance Evaluation Systems Test: German translation, cultural adaptation and preliminary results on psychometric properties]. / Balance Evaluation Systems Test: deutsche Übersetzung, kulturelle Anpassung und erste Ergebnisse zu Gütekriterien.

BACKGROUND: The Balance Evaluation Systems Test (BESTest) evaluates balance ability and identifies affected systems associated with balance deficits. OBJECTIVE: The primary objective was the translation and cultural adaptation of the BESTest into German. Secondary objective was the preliminary evaluation of psychometric properties of the BESTest. METHOD: In accordance with international guidelines, the BESTest was translated and adapted by a 7-step process. To test the psychometric properties, persons with subjective or objective balance deficits were included. Internal consistency was evaluated by means of Cronbach's alpha. The criterion validity was tested by measuring the correlation with the Berg Balance Scale (BBS). Construct validity was examined using the Activities-Specific Balance Confidence (ABC-D) scale and the known groups methods (fallers versus non-fallers). RESULTS: A total of 27 subjects were included in the testing of the psychometric properties. Cronbach's alpha was 0.95 for the total scale. The correlation of BESTest scores with those of the BBS revealed a Spearmen's ρ of 0.84 (p < 0.001) and 0.61 (p < 0.001) with those of the ABC­D scale. Fallers and non-fallers showed a trend towards different BESTest scores (p = 0.057). DISCUSSION: This paper provides a German translation of the BESTest authorized by the developer. Our preliminary results confirm reliability and validity.

Task-Oriented Circuit Training for Mobility in Outpatient Stroke Rehabilitation in Germany and Austria: A Contextual Transferability Analysis.

People with stroke cite mobility deficits as one of the most burdensome limitations. National and international stroke guidelines recommend physical therapy based on task-oriented practice, with high numbers of repetitions to improve mobility. In the outpatient setting in Germany and Austria, these principles have not yet been established. The purpose of this study was to identify an evidence-based intervention that could help reduce this research-practice gap. A stepwise approach proposed by Voigt-Radloff and colleagues and Cochrane Germany was used. First, the specific health service problem in the German and Austrian physical therapy outpatient context was identified. Second, a promising intervention was identified using a systematic search in the Cochrane Library and by grading the quality of the evidence using the Grading of Recommendations Assessment, Development and Evaluation. Finally, the transferability of the promising intervention into the local context was evaluated using predefined questions from the Cochrane guide and reports from health insurances, professional organizations, and national stroke guidelines. Task-oriented circuit training reviewed by English and colleagues was chosen. The review showed clinically important improvements in walking distance and speed. The quality of the evidence was graded high for these 2 outcomes. We identified contextual challenges for implementation at the setting level (eg, insufficient reimbursement for group therapy by insurance companies), the participant and therapist level (eg, unknown motivation for group therapy due to the established 1:1 patient-therapist ratio), and the outcome measure level (eg, lack of standardized, cross-culturally translated manuals). Although task-oriented circuit training is scientifically well established, barriers to implementation into routine care in Germany and Austria can be expected. In a next step, research using knowledge translation methodology will focus on the detailed evaluation of barriers and facilitators with relevant stakeholders.

[Translation of the evidence-based practice confidence (EPIC) scale into German and its cross-cultural adaption for Switzerland, Austria and Germany]. / EPIC-Skala ­ Übersetzung und interkulturelle Adaptation für die Schweiz, Österreich und Deutschland.

BACKGROUND: The Evidence-based Practice Confidence (EPIC) scale is a self-report questionnaire for health professionals. The EPIC scale was developed in Canada and is based on Bandura's self-efficacy theory. It comprises 11 statements on the organization and implementation of evidence-based practice (EBP) steps. The aim of the study was to translate the EPIC scale into German, to test its comprehensibility in German-speaking countries and to interculturally adapt the scale. METHODS: The translation process followed international guidelines. After two independent translations into German and two independent back translations had been conducted, an expert committee discussed discrepancies in view of intercultural comprehensibility and agreed on a preliminary German version. The comprehensibility of this version was evaluated with physical therapists from Switzerland, Austria and Germany. They were recruited using purposeful sampling and interviewed via telephone using a semi-structured questionnaire (cognitive interviewing). The interviews were recorded and analyzed independently by two authors using a structured evaluation scheme. Based on these results, the final version was created. All changes were discussed with the author of the EPIC scale. RESULTS: Sixteen physical therapists of the three German-speaking countries were interviewed. Demographic data showed a balanced distribution of country of origin, age group, qualification and years of work experience. In general, participants reported a good overall comprehensibility. However, they reported that (too) many scientific terms caused comprehension problems and that some of these terms were unknown to participants. During the intercultural adaptation attention was paid to simplify and shorten sentences and to paraphrase terms that were difficult to understand. Moreover, the instructions were expanded to address partial lack of knowledge of scientific terms. CONCLUSION: The EPIC scale was successfully translated and interculturally adapted to the German language. The scale evaluates self-efficacy in EBP activities and could potentially be used to assess courses or be integrated into surveys. In the next step, the validity and reliability of the German scale should be established involving other health care professionals in this process.

The Embodied Self in Parkinson's Disease: Feasibility of a Single Tango Intervention for Assessing Changes in Psychological Health Outcomes and Aesthetic Experience.

BACKGROUND: Dance is an embodied activity with benefits for mobility, balance, and quality of life (QoL) of persons affected by Parkinson's Disease (PD). It is enjoyable and likely to support adherence to movement prescriptions. The objective of this study was to assess the feasibility of measuring changes in psychological outcomes, specifically well-being, body self-efficacy, outcome expectations, and experienced beauty after a single Argentine Tango intervention in a workshop format. To anchor experienced beauty in a theory, the article introduces a model of embodied aesthetics featuring active art-making as a central aspect of healing in arts-based interventions. METHODS: In a single-group pre-post design, we tested the feasibility of measuring psychological changes of 34 PD patients from Southern Germany after an introductory workshop in Argentine Tango. They participated in a 90 min Tango for PD intervention and completed the Heidelberg State Inventory (HSI-24; (Koch et al., 2007)), the Body Self-Efficacy Scale (BSE; (Fuchs and Koch, 2014)) with a sub-dimension on aesthetic experience, and the Credibility-Expectancy Questionnaire (CEQ; (Devilly and Borkovec, 2000)) before and after the intervention. A subgroup completed the therapeutic factors of arts therapies-scale, a new measure to elaborate on the aesthetic experience. We analyzed pre-post-differences with a t-test for paired samples. RESULTS AND DISCUSSION: The study supports the feasibility of measuring health-related psychological changes from a single Argentine Tango intervention for PD patients, as well as acceptance and appropriateness of the intervention for the patient group. After the tango intervention, well-being, body self-efficacy, and outcome expectancies increased. Participants also experienced an increase in beauty of their movements and other aesthetic aspects. We suspect that, in addition to the functional and psychological factors identified so far, the aesthetic experience in dance may be an important therapeutic factor mediating several outcomes of dance and other arts-based interventions. A controlled study for evidence-based testing of targeted variables can now follow to examine the new hypotheses.

Clinical relevance of the effects of reach-to-grasp training using trunk restraint in individuals with hemiparesis poststroke: A systematic review.

OBJECTIVE: To evaluate the evidence for, and clinical relevance of, immediate and long-term effects of trunk restraint during reach-to-grasp training poststroke on movement patterns and functional abilities within the framework of the International Classification of Functioning, Disability and Health. DATA SOURCES: PubMed, Web of Science, CINAHL, Embase, PEDro, Cochrane Library (publication dates January 1985 to March 2015). STUDY SELECTION: Randomized controlled trials comparing training using trunk restraint with any other exercise training. DATA EXTRACTION: Data were extracted by one researcher and checked by two other researchers. The Cochrane Collaboration's tool for assessing risk of bias and the Physiotherapy Evidence Database scale were used by two researchers to assess study quality and risk of bias. DATA SYNTHESIS: Eight studies met the inclusion criteria. Five studies found better recovery of movement patterns (trunk displacement, elbow extension, and/or shoulder flexion - body function/structure) at post-test in the experimental compared with the control groups. Functional abilities (activity/participation) improved more in the experimental groups in 3 studies at post-test. Long-term effects were found in one study after 4 weeks. CONCLUSION: Trunk restraint has immediate and some long-term effects in adults with chronic stroke. However, these effects are not consistently clinically relevant when referring to minimal detectable change or minimal clinically important difference values.

Evidence-based practice in physical therapy in Austria: current state and factors associated with EBP engagement.

RATIONALE, AIMS AND OBJECTIVES: Research examining the use of evidence-based practice (EBP) in physical therapy in many countries has revealed positive attitudes, varying degrees of EBP use and barriers at practitioner, patient and organizational levels. In contrast to these countries, Austria does not have an academic or research tradition in physical therapy. Engagement in EBP in countries such as Austria is unknown. The objectives of the study were to describe the current state of EBP engagement and identify factors associated with EBP engagement among Austrian physical therapists (PTs). METHODS: A cross-sectional online survey was conducted. Existing questionnaires and the theory of planned behaviour guided questionnaire development. Face and content validity and ease of use of the questionnaire were evaluated in pilot tests. Item-level response frequencies and percentages were determined. Simple and multiple regressions were used to identify factors associated with EBP engagement. RESULTS: The final sample size was 588 (response rate: 17.5%). Ten percent of participants fully agreed that they regularly use guidelines and standardized assessment tools in clinical practice. While 49.9% reported not using electronic databases for literature searching, 41.9% reported reading research articles 2-5 times per month. Most frequently cited barriers to EBP engagement were lack of scientific skills, lack of time and insufficient organizational support. Research awareness, attitude, behavioural control, involvement in research and degree level were final correlates of EBP engagement. CONCLUSION: Austrian PTs show a low level of engagement in EBP. Initiatives to advance EBP in Austria and other countries with no academic or research tradition should primarily target practitioner-level factors.

Benefits of inpatient multidisciplinary rehabilitation in multiple sclerosis.

BACKGROUND: Rehabilitation is often recommended to MS-patients but data on its efficacy is limited. OBJECTIVE: To evaluate the benefit of inpatient multidisciplinary rehabilitation. METHODS: A rater-blinded, randomized, waiting list controlled exploratory study. 19 participants completed the study with ten allocated to the intervention and nine to the waiting list group. Assessment of outcome-parameters was done at baseline and after 3 months. Time Walking Tests (TWTs) and 9 Hole Peg Test were used to objectively assess the level of activity, Functional-Assessment-in-MS and MS-Self Efficacy-Scale to assess participation and quality of life and Expanded Disability Status Scale (EDSS) to assess bodily function. Additionally Rivermead Mobility Index, Berg Balance Scale, Tinetti-Test, MS-Functional Composite and a rater-blinded evaluation of a video-analysis on walking performance was done. RESULTS: Mean change scores of Timed 50 meter Walk (p = 0.014), walking speed (p = 0.034), 2- (p = 0.204) and 6-Minute Walk (p = 0.027) indicated an improvement favoring inpatient multidisciplinary rehabilitation. We could not demonstrate a benefit for upper limb function and some improvement was seen in other outcome-parameters without reaching statistical significance. EDSS remained unchanged. CONCLUSION: Inpatient multidisciplinary rehabilitation is effective in MS patients with positive impact on the level of activity as measured by TWTs covering both short and long distance ambulation.

Impaired anticipatory control of grasp during obstacle crossing in Parkinson's disease.

During self-paced walking, people with Parkinson's disease maintain anticipatory control during object grasping. However, common functional tasks often include carrying an object while changing step patterns mid-path and maneuvering over obstacles, increasing task complexity and attentional demands. Thus, the present study investigated the effect of Parkinson's disease on the modulation of grasping force changes as a function of gait-related inertial forces. Subjects with Parkinson's disease maintained the ability to scale and to couple over time their grip and inertial forces while walking at irregular step lengths, but were unable to maintain the temporal coupling of grasping forces compared to controls during obstacle crossing. We suggest that this deterioration in anticipatory control is associated with the increased demands of task complexity and attention during obstacle crossing.

Aging effects on object transport during gait.

The ability to manipulate objects deteriorates with increasing age. In the coordination of fingertip forces underlying object manipulation, older adults use excessive grip (normal) forces but maintain anticipatory force control during simple manipulations. Daily activities are often more complex and involve grasp manipulations while simultaneously performing other activities. When walking while carrying an object, young adults couple grip forces to gait-induced inertial force changes (anticipatory control). It is unclear if anticipatory control is preserved in older adults during demanding tasks. The purpose of this study was therefore to investigate aging effects on grasp control when walking and transporting an object. We included gait perturbations to vary task difficulty and step regularity associated with walking. Twelve healthy older (65-84 years) and young (20-30 years) adults transported a hand-held object during unperturbed walking, obstacle crossing and step-length changes. While older subjects employed higher grip-inertial force ratios, they showed a strong force coupling comparable to that of the young during unperturbed walking and step-length changes. During obstacle crossing the forces in the older group were less tightly coupled (grip force delays). Gait patterns were similar between groups. Our findings indicate that older adults maintain anticipatory control during regular and irregular walking. Grasp control changes in older adults only during obstacle crossing suggest that overall task demands (balance requirements, attention demands) may contribute to declines of manual dexterity in functional tasks. This highlights the need to investigate grasp control within complex tasks when aiming to understand impairments of older adults encountered in daily life.

Finger force coordination underlying object manipulation in the elderly - a mini-review.

BACKGROUND: A decline in manual dexterity is a common phenomenon in elderly individuals. Often, simple daily activities such as handling coins and preparing meals become challenging. A substantial decline in manual dexterity may impact one's ability to live independently. Thus, understanding the underlying causes of these impairments is essential. Considerable attention has been given to the regulation of fingertip forces during object grasp, lift and transport in the elderly. OBJECTIVE: Here we review studies on fingertip force coordination in the elderly, with an emphasis on the relationship between the degree of change in elderly grip force control and the nature of the tasks performed. METHODS: A literature search was performed using Medline, Pubmed, and Web of Science electronic databases covering studies from 1985 to 2009, inputting combinations of the following key words: grip force, grasp force, fingertip forces, precision grip, aging, elderly, and hand motor control. RESULTS: Studies show a consistent elevation in grip force magnitudes that may easily lead to fatigue. These force increases may represent a compensation for increased skin slipperiness or a reduction in tactile information. In contrast, anticipatory grip force control (planning) remains relatively intact. Age-related changes in anticipatory control seem to emerge only during more complex tasks. CONCLUSION: The relationship between task complexity and degree of age-related changes suggests that results from simple, laboratory-based tasks may only partially explain impairments observed during the performance of activities of daily living, since the latter ones are typically more complex. A better understanding of impaired manual dexterity experienced by elderly individuals could be achieved by expanding experimental paradigms so that they more closely resemble the complexities encountered in functional daily tasks. Subsequently, these findings could be used in clinical settings to develop treatment approaches that consider grasp control in the context of behaviorally meaningful tasks.

Coordination of grasping and walking in Parkinson's disease.

Studies on grasp control underlying manual dexterity in people with Parkinson disease (PD) suggest that anticipatory grasp control is mainly unaffected during discrete tasks using simple two-digit grasp. Nevertheless, impaired hand function during daily activities is one of the most disabling symptoms of PD. As many daily grasping activities occur during functional movements involving the whole body, impairments in anticipatory grasp control might emerge during a continuous dynamic task such as object transport during walking. In this case, grasp control must be coordinated along with multiple body segments. The present study investigated the effect of PD on anticipatory grasp control and intersegmental coordination during walking with a hand-held object. Nine individuals with idiopathic PD (tested OFF and ON medication) and nine healthy age-matched controls carried a grip instrument between their right thumb and index finger during self-paced and fast walking. Although the amplitude of grip forces was higher in standing and walking for subjects with PD, both subjects with PD and control subjects coupled grip and inertial force changes in an anticipatory fashion while walking. However, gait-induced motions of the object relative to that of the trunk (i.e., dampening) was reduced in subjects with PD. Medication increased the dampening in all subjects with PD. We suggest that these differences are associated with impairments in intersegmental coordination.

Grip force control during gait initiation with a hand-held object.

When walking with a hand-held object, grip force is coupled in an anticipatory manner to changes in inertial force resulting from the accelerations and decelerations of gait. However, it is not known how grip and inertial forces are organized at the onset of gait, and if the two forces are coupled in the early phases of gait initiation. Moreover, initiating walking with an object involves the coordination of anticipatory postural (e.g., ground reaction force changes) and grasping adjustments. The aim of this study was to investigate the relationship of ground reaction, grip, and inertial force onsets, and the subsequent development of the coupling of grip and inertial forces during gait initiation with a hand-held object. Ten subjects performed gait initiation with a hand-held object following predictable and unpredictable start signals. We found that ground reaction and grip force onsets were closely linked in time regardless of the predictability of the start signal. In the early period of gait initiation, the grip force started to increase prior to inertial force changes. While the strength of the coupling of grip and inertial forces was moderate in this early phase, it increased to values observed during steady-state gait after the swing foot left the ground. The early grip force increase and the coupling of grip and inertial forces represent an anticipatory control process. This process establishes an appropriate grip-inertial force ratio to ensure object stability during acceleration after foot-off and maintains this increased ratio thereafter. The results suggest that grasping and whole body movements are governed by a common internal representation.