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

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== Objective ==
== Objective ==


The MARM is a palpatory procedurebased on the examiners interpretation and estimationof motion被他们的手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 utilityisfor assessing breathing pattern andtherelativedistribution of breathing motion between upperrib cageand 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.Itisused to assessthe distribution of breathing motion betweentheupper and lowerparts of therib cage and abdomenunder 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>
== Intended Population ==


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


== Methodof Use==
== Method ==


TheMARM also takes into accounttheform of the spinal column, whose extended or flexed form constitutes a third degree of freedom of breathing movement (Smith and Mead 1986).Extensionof thespinal column increasesthedistance betweenthepubic symphysisandxiphoid process, elevates the ribcage, facilitating upward motion ofthesternum/upper thorax (pump-handle motion) as well as abdominal expansion. Thus, it facilitates inhalation inavertical direction (‘length breathing’).By contrast, a slumped posture inhibits the vertical movement of inhalation, increases pressure of abdominal contents to increase diaphragm lengthandpromotes lateral expansion and sideways elevation ofthe lower ribsor bucket-handle movement. Thus, it facilitates inhalation in a horizontal direction (‘width breathing’).
Thepatient sits comfortably withthetherapist sitting behind him.The therapist places both hands on both sidesof thelower ribs withthethumbs approximately parallel tothespine, pointing verticallyandhand comfortably open with fingers spread so thatthelittle finger approachesahorizontal orientation.The 4thand5th fingers should reach belowthe lower ribsand can feel abdominal expansion.


The'''MARM is able to differentiate between these breathing patternsandassess asymmetry betweenthetwo sides ofthebody.''' In case of scoliosis or sideways distortion ofthespinal column thereisa 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.

Thetherapist feels for sidewaysandvertical expansions during inhalation, making an assessment oftheoverall vertical motion relative totheoverall lateral motion.Also, the therapist decides ifthemotionispredominantly upper rib cage, lower rib cage/abdomen or relatively balanced.


An assumption of theMARMprocedure is that breathingisa global movement of expansion (inhalation) and contraction (exhalation) of the body.From the manual assessment of motion at the lower ribs the examiner constructsa 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.那特定特性的全球变化形式t 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.

With the MARM, having the subject intentionally breathe in different ways, the examiner can test the functionality of breathing. 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
AMARMdiagramisused.In whicha 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.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.


Rosalba Courtney, Jan van Dixhoorn,fckLRMarc Cohen; Evaluation of Breathing Pattern: Comparison ofaManual Assessment of Respiratory Motion(MARM) andRespiratory 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>
另一个2008年的研究发现小姐是一个有效的和再保险liable clinical and research tool for assessing breathing movement with good inter-examiner andagreater ability to distinguish vertical ribcage motion than RIP(Respiratory Induction Plethysmography).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.>


==Evidence==
==Clinical Notes==
小姐需要进入账户的形状pinal coloumn. Extension of the spinal column facilitates inhalation in a vertical direction,while slumped posture facilitates inhalation in a horizontal direction.


=== Reliability& 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.=":0" />


TheMARMappears to be a validandreliable clinicalandresearch tool for assessing breathing movementwithgood inter-examiner andagreater ability to distinguish vertical ribcage motion.Further studies to confirm its clinical utility are warranted.
== Resources ==
Access a photo of theMARMdiagramandhand placement [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8907211/ here].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,andrespiratory pattern of patientswithneck pain:arandomized controlled trial.] Scientific Reports.2022 Mar 9;12(1):1-1.


== References ==
== References ==

Revision as of 01:15, 10 May 2023

Top Contributors-Ajay Upadhyay,Kim Jackson,Lilian Ashraf,WikiSysop,Lizzie Cotton,Areeba RajaandScott Buxton

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 ofbreathing 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 4thand 5thfingers 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]

另一个2008年的研究发现小姐是一个有效的和再保险liable 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 toHi-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]

小姐需要进入账户的形状pinal 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 placementhere.[4]

References[edit|edit source]

  1. 1.01.11.21.31.4Rosalba 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.