Manual Assessment of Respiratory Motion (MARM)
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.
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.
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).
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.
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.
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.
Resources[edit | edit source]
References[edit | edit source]
- 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
- 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.
- 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.
- 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.