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

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== Objective  ==
== Objective  ==


The MARM is a palpatory procedure based on the examiners interpretation and estimation of motion perceived by their hands at the posterior and lateral lower rib cage. The examiner using the MARM can gauge various aspects of breathing such as rate, regularity, but its particular utility is for assessing breathing pattern and the relative distribution of breathing motion between upper rib cage and lower rib cage and abdomen.<br>  
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  ==


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


== Method of Use ==
== Method  ==


The MARM also takes into account the form of the spinal column, whose extended or flexed form constitutes a third degree of freedom of breathing movement (Smith and Mead 1986). Extension of the spinal column increases the distance between the pubic symphysis and xiphoid process, elevates the ribcage, facilitating upward motion of the sternum/upper thorax (pump-handle motion) as well as abdominal expansion. Thus, it facilitates inhalation in a vertical direction (‘length breathing’). By contrast, a slumped posture inhibits the vertical movement of inhalation, increases pressure of abdominal contents to increase diaphragm length and promotes lateral expansion and sideways elevation of the lower ribs or bucket-handle movement. Thus, it facilitates inhalation in a horizontal direction (‘width breathing’). <br>
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.  


The'''MARM is 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. Such asymmetry adds even more degrees of freedom of breathing movement.<br><br>
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.


An assumption of the MARM procedure is that breathing is a global movement of expansion (inhalation) and contraction (exhalation) of the body. From the manual assessment of motion at the lower ribs the examiner constructs 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. Specific features of the global change in form that can be estimated are: the degree that the sternum and upper thorax are lifted upwards, the degree that the lower ribs lift and expand sideways and the degree that diaphragmatic descent expands the abdomen outwards. The predominance of motion in either the upper rib cage/sternum or the lower rib cage/abdomen determines the direction of the global change with inhalation, as either predominantly in an upward or downward direction and the shape as either elongation or widening. Individuals may differ in their breathing response to postural change. For example when the spine is extended inspiration may result in a general increase in breathing motion with greater involvement of both upper thorax and abdomen or result in upward elevation of the chest with little increase or paradoxical decrease in abdominal motion.<br><br>With the MARM, having the subject intentionally breathe in different ways, the examiner can test the functionality of breathing. <ref>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><br>
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.  


== Reference  ==
== 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>


<ref>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>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<br>  
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" />  


<br>  
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>


== Evidence  ==
== 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" />


=== Reliability&amp; Validity  ===
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" />


The MARM appears 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. Further studies to confirm its clinical utility are warranted.  
== 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>


== References  ==
== References  ==

Revision as of 01:15, 10 May 2023

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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