Manual Assessment of Respiratory Motion (MARM): Difference between revisions

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<div class="editorbox"> '''Original Editor '''- [[User:Ajay Upadhyay|Ajay Upadhyay]] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>
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== Objective   ==
== Objective<br>  ==


The '''Berg balance scale''' is used to objectively determine a patient's ability (or inability) to safely [[Balance|balance]] during a series of predetermined tasks. It is a 14 item list with each item consisting of a five-point ordinal scale ranging from 0 to 4, with 0 indicating the lowest level of function and 4 the highest level of function and takes approximately 20 minutes to complete. It does not include the assessment of gait.  
The MARM (Manual Assessment of Respiratory Motion) is a palpatory procedure of motion the posterior and lateral lower rib cage. It is used to assess the distribution of breathing motion between the upper and lower parts of the rib cage and abdomen under various conditions.<ref name=":0">Rosalba Courtney, Jan van Dixhoorn,fckLRMarc Cohen; Evaluation of Breathing Pattern: Comparison of a Manual Assessment of Respiratory Motion(MARM) and Respiratory Induction Plethysmography. Appl Psychophysiol Biofeedback (2008) 33:91–100</ref>


== Intended Population<br> ==
It is a practical, quick, inexpensive manual technique for the assessment of [[Breathing Pattern Disorders|breathing pattern disorders.]]<ref name=":0" />  


Elderly population with impairment of balance, patients with acute [[Stroke|stroke]] (Berg et al 1995, Usuda et al 1998).
== Method  ==


== Method of Use  ==
The patient sits comfortably with the therapist sitting behind him. The therapist places both hands on both sides of the lower ribs with the thumbs approximately parallel to the spine, pointing vertically and hand comfortably open with fingers spread so that the little finger approaches a horizontal orientation. The 4<sup>th</sup> and 5<sup>th</sup> fingers should  reach below the lower ribs and can feel abdominal expansion.


==== Equipment required  ====
The therapist feels for sideways and vertical expansions during inhalation, making an assessment of the overall vertical motion relative to the overall lateral motion. Also, the therapist decides if the motion is predominantly upper rib cage, lower rib cage/abdomen or relatively balanced.


{| width="40%" border="0" align="right" cellspacing="1" cellpadding="1" class="FCK__ShowTableBorders"
A MARM diagram is used. In which a mental picture of global breathing motion, represented by an upper line and a lower line, originating from the centre of a circle or ellipse, together creating a slice in a pie chart, which represents the area of expansion.  
|-
| align="right" |
{{#ev:youtube|i_Jlc5kL6KU|350}} <ref>Kembe Frederick. 5253 Assessment Process Berg Balance Scale F.H.F. Available from: http://www.youtube.com/watch?v=i_Jlc5kL6KU[last accessed 08/02/13]</ref>


|}
== Evidence ==
Initial tests in 2004 of inter-examiner reliability indicated that the MARM has potential as a clinical and research tool for evaluating breathing pattern, with a Reliabilities range from 0.75 - 0.98.<ref>van Dixhoorn JJ. A method for assessment of one dimension of dysfunctional breathing: distribution of breathing movement. InBiological Psychology 2004 Nov 1 (Vol. 67, No. 3, pp. 415-416). PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS: ELSEVIER SCIENCE BV.</ref>


*A ruler
Another 2008 study found MARM to be a valid and reliable clinical and research tool for assessing breathing movement with good inter-examiner and a greater ability to distinguish vertical ribcage motion than RIP (Respiratory Induction Plethysmography).<ref name=":0" />
*2 standard chairs (one with arm rests, one without)  
*A footstool or step
*15 ft walkway
*Stopwatch or wristwatch


==== The scale  ====
A 2009 study compared the validity and clinical utility of MARM to [[Hi-Lo Test|Hi-Lo test]]. It found Both the MARM and the Hi-Lo Test appear to accurately assess breathing patterns when used by both experienced clinicians and osteopathic students.<ref>Courtney R, Cohen M, Reece J. Comparison of the Manual Assessment of Respiratory Motion (MARM) and the Hi Lo Breathing Assessment in determining a simulated breathing pattern. International Journal of Osteopathic Medicine. 2009 Sep 1;12(3):86-91.</ref>


Name: __________________________________ Date: ___________________<br>  
== Clinical Notes ==
The MARM takes into the account the shape of the spinal coloumn. Extension of the spinal column facilitates inhalation in a vertical direction,while slumped posture facilitates inhalation in a horizontal direction.<ref name=":0" />


Location: ________________________________ Rater: ___________________<br>  
It  is also able to differentiate between these breathing patterns and assess asymmetry between the two sides of the body. In case of scoliosis or sideways distortion of the spinal column there is a marked difference in breathing movement between the left and right sides of the body and this can be registered clearly by the examiners two hands.<ref name=":0" />


ITEM DESCRIPTION SCORE (0-4)<br>  
== Resources ==
Access a photo of the MARM diagram and hand placement [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8907211/ here].<ref>Dareh-Deh HR, Hadadnezhad M, Letafatkar A, Peolsson A. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8907211/ Therapeutic routine with respiratory exercises improves posture, muscle activity, and respiratory pattern of patients with neck pain: a randomized controlled trial.] Scientific Reports. 2022 Mar 9;12(1):1-1.</ref>  


Sitting to standing ________<br> Standing unsupported ________<br> Sitting unsupported ________<br> Standing to sitting ________<br> Transfers ________<br> Standing with eyes closed ________<br> Standing with feet together ________<br> Reaching forward with outstretched arm ________<br> Retrieving object from floor ________<br> Turning to look behind ________<br> Turning 360 degrees ________<br> Placing alternate foot on stool ________<br> Standing with one foot in front ________<br> Standing on one foot ________<br>
Total ________<br>
<br>
==== General instructions for completing the scale  ====
Please document each task and/or give instructions as written. When scoring, please record the lowest response category that applies for each item.
In most items, the subject is asked to maintain a given position for a specific time. Progressively more points are deducted if:
*the time or distance requirements are not met
*the subject’s performance warrants supervision
*the subject touches an external support or receives assistance from the examiner
The subject should understand that they must maintain their balance while attempting the tasks. The choices of which leg to stand on or how far to reach are left to the subject. Poor judgment will adversely influence the performance and the scoring.
Equipment required for testing is a stopwatch or watch with a second hand, and a ruler or other indicator of 2, 5, and 10 inches. Chairs used during testing should be a reasonable height. Either a step or a stool of average step height may be used for item # 12.
== Reference<br>  ==
Berg K, Wood-Dauphinee S, Williams JI, Gayton D: Measuring balance in the elderly: Preliminary development of an instrument. Physiotherapy Canada, 41:304-311, 1989<ref name="Berg1">Berg K, Wood-Dauphinee S, Williams JI, Gayton D: Measuring balance in the elderly: Preliminary development of an instrument.fckLRPhysiotherapy Canada, 41:304-311, 1989.</ref>.<br>
Berg K, Wood-Dauphinee S, Williams JI, Maki, B: Measuring balance in the elderly: Validation of an instrument. Can. J. Pub. Health, July/August supplement 2:S7-11, 1992.<ref name="Berg2">Berg K, Wood-Dauphinee S, Williams JI, Maki, B: Measuring balance in the elderly: Validation of an instrument. Can. J. Pub. Health, July/August supplement 2:S7-11, 1992.</ref>
== Evidence  ==
=== Reliability  ===
Studies of various elderly populations (N = 31–101, 60–90 + years of age) have shown high intrarater and interrater reliability (ICC =.98,14,15 ratio of variability among subjects to total = .96–1.0,16 rs =.8817). Test-retest reliability in 22 people with hemiparesis is also high (ICC [2,1]=.98).
<br>
Berg K et al (1995) The Balance Scale: reliability assessment for elderly residents and patients with an acute stroke Scandinavian Journal of Rehabilitation Medicine 27, 27-36<br>
=== Validity  ===
Content validity of the BBS was established in a 3-phase development process involving 32 health care professionals who were experts working in geriatric settings. Criterion-related validity has been supported by moderate to high correlations between BBS scores and other functional measurements in a variety of older adults with disability.
Berg K, Wood-Dauphine SL, Williams JL, Gayton D (1992) Measuring balance in the elderly: validation of an instrument Canadian Journal of Public Health S2: s7-s11.
Usuda S, Araya K, Umehara K, Endo M, Shimizu T, Endo F (1998) Construct validity of functional balance scale in stroke inpatients Journal of Physical Therapy Science 10, 53-56.
Whitney, S., D. Wrisley, et al. (2003). Concurrent validity of the Berg Balance Scale and the Dynamic Gait Index in people with vestibular dysfunction. Physiother Res Int 8(4): 178-86. <br>
=== Responsiveness  ===
Increasing age has not been shown to correlate with decreasing BBS scores.
Steffen, T. M., T. A. Hacker, et al. (2002). Age- and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up and Go Test, and gait speeds. Phys Ther 82(2): 128-37.
Mao, H. F., I. P. Hsueh, et al. (2002). Analysis and comparison of the psychometric properties of three balance measures for stroke patients. Stroke 33(4): 1022-7.
Stevenson, T. J. (2001). Detecting change in patients with stroke using the Berg Balance Scale. Aust J Physiother 47(1): 29-38.
Salbach, N. M., N. E. Mayo, et al. (2001). Responsiveness and predictability of gait speed and other disability measures in acute stroke. Arch Phys Med Rehabil 82(9): 1204-12.<br>
=== Miscellaneous<br>  ===
Harada N, Chiu V, Damron-Rodrick J, Fowler E, Siu A, Reuber D (1995) Screening for balance and mobility impairment in elderly individuals living in residential care facilities Physical Therapy 75, 6, 462-469.
Piotrowski A, Cole J (1994) Clinical measures of balance and functional assessment in elderly persons Australian Physiotherapy 40, 3, 183-188.
Russo SG (1997) Clinical balance measures: literature resources Neurology Report 21, 1, 29-36.
Whitney SL, Poole JL, Cass SP (1998) A review of balance instruments for older adults American Journal of Occupational Therapy 52, 8, 666-71.
Thorbahn LD, Newton RA (1996) Use of the Berg Balance Test to predict falls in elderly persons Phys Ther 76, 6, 576-83.
Lajoie, Y. and S. P. Gallagher (2004). Predicting falls within the elderly community: comparison of postural sway, reaction time, the Berg balance scale and the Activities-specific Balance Confidence (ABC) scale for comparing fallers and non-fallers. Arch Gerontol Geriatr 38(1): 11-26.
Wee, J. Y., H. Wong, et al. (2003). Validation of the Berg Balance Scale as a predictor of length of stay and discharge destination in stroke rehabilitation. Arch Phys Med Rehabil 84(5): 731-5.
Chiu, A. Y., S. S. Au-Yeung, et al. (2003). A comparison of four functional tests in discriminating fallers from non-fallers in older people. Disabil Rehabil 25(1): 45-50.
Feld, J. A., M. H. Rabadi, et al. (2001). Berg balance scale and outcome measures in acquired brain injury. Neurorehabil Neural Repair 15(3): 239-44.
Wee, J. Y., S. D. Bagg, et al. (1999). The Berg balance scale as a predictor of length of stay and discharge destination in an acute stroke rehabilitation setting. Arch Phys Med Rehabil 80(4): 448-52.
Whitney, S. L., J. L. Poole, et al. (1998). A review of balance instruments for older adults. Am J Occup Ther 52(8): 666-71.<br>
== Links  ==
*[http://www.strokecenter.org/trials/scales/berg.html http://www.strokecenter.org/trials/scales/berg.html]
*[[Media:Berg.pdf|Berg balance scale]]
*[[Media:Berg_balance_scale_with_instructions.pdf|Berg balance scale with instructions]]
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
<div class="researchbox">
<rss>http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=14_xQ7JEOWXDuoqfM8fnknjm_kLTkFNXzh17vH36R9mIfgiM9W|charset=UTF-8|short|max=10</rss>
</div>
== References  ==
== References  ==
References will automatically be added here, see [[Adding References|adding references tutorial]].


<references />  
<references />  


[[Category:Outcome_Measures]] [[Category:Older_People/Geriatrics|Geriatrics]] [[Category:Open_Physio]]
[[Category:Respiratory]]
[[Category:Outcome_Measures]]  
[[Category:Open_Physio]]
[[Category:Cardiopulmonary]]
[[Category:Respiratory System - Assessment and Examination]]

Latest revision as of 01:17, 10 May 2023

Original Editor - Ajay Upadhyay Top Contributors - Ajay Upadhyay, Kim Jackson, Lilian Ashraf, WikiSysop, Scott Buxton, Lizzie Cotton and Areeba Raja

Objective[edit | edit source]

The MARM (Manual Assessment of Respiratory Motion) is a palpatory procedure of motion the posterior and lateral lower rib cage. It is used to assess the distribution of breathing motion between the upper and lower parts of the rib cage and abdomen under various conditions.[1]

It is a practical, quick, inexpensive manual technique for the assessment of breathing pattern disorders.[1]

Method[edit | edit source]

The patient sits comfortably with the therapist sitting behind him. The therapist places both hands on both sides of the lower ribs with the thumbs approximately parallel to the spine, pointing vertically and hand comfortably open with fingers spread so that the little finger approaches a horizontal orientation. The 4th and 5th fingers should  reach below the lower ribs and can feel abdominal expansion.

The therapist feels for sideways and vertical expansions during inhalation, making an assessment of the overall vertical motion relative to the overall lateral motion. Also, the therapist decides if the motion is predominantly upper rib cage, lower rib cage/abdomen or relatively balanced.

A MARM diagram is used. In which a mental picture of global breathing motion, represented by an upper line and a lower line, originating from the centre of a circle or ellipse, together creating a slice in a pie chart, which represents the area of expansion.

Evidence[edit | edit source]

Initial tests in 2004 of inter-examiner reliability indicated that the MARM has potential as a clinical and research tool for evaluating breathing pattern, with a Reliabilities range from 0.75 - 0.98.[2]

Another 2008 study found MARM to be a valid and reliable clinical and research tool for assessing breathing movement with good inter-examiner and a greater ability to distinguish vertical ribcage motion than RIP (Respiratory Induction Plethysmography).[1]

A 2009 study compared the validity and clinical utility of MARM to Hi-Lo test. It found Both the MARM and the Hi-Lo Test appear to accurately assess breathing patterns when used by both experienced clinicians and osteopathic students.[3]

Clinical Notes[edit | edit source]

The MARM takes into the account the shape of the spinal coloumn. Extension of the spinal column facilitates inhalation in a vertical direction,while slumped posture facilitates inhalation in a horizontal direction.[1]

It is also able to differentiate between these breathing patterns and assess asymmetry between the two sides of the body. In case of scoliosis or sideways distortion of the spinal column there is a marked difference in breathing movement between the left and right sides of the body and this can be registered clearly by the examiners two hands.[1]

Resources[edit | edit source]

Access a photo of the MARM diagram and hand placement here.[4]

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 1.4 Rosalba Courtney, Jan van Dixhoorn,fckLRMarc Cohen; Evaluation of Breathing Pattern: Comparison of a Manual Assessment of Respiratory Motion(MARM) and Respiratory Induction Plethysmography. Appl Psychophysiol Biofeedback (2008) 33:91–100
  2. ↑ van Dixhoorn JJ. A method for assessment of one dimension of dysfunctional breathing: distribution of breathing movement. InBiological Psychology 2004 Nov 1 (Vol. 67, No. 3, pp. 415-416). PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS: ELSEVIER SCIENCE BV.
  3. ↑ Courtney R, Cohen M, Reece J. Comparison of the Manual Assessment of Respiratory Motion (MARM) and the Hi Lo Breathing Assessment in determining a simulated breathing pattern. International Journal of Osteopathic Medicine. 2009 Sep 1;12(3):86-91.
  4. ↑ Dareh-Deh HR, Hadadnezhad M, Letafatkar A, Peolsson A. Therapeutic routine with respiratory exercises improves posture, muscle activity, and respiratory pattern of patients with neck pain: a randomized controlled trial. Scientific Reports. 2022 Mar 9;12(1):1-1.
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