Evaluation of Breathing Pattern: Comparison of a Manual Assessment of Respiratory Motion (MARM) and Respiratory Induction Plethysmography

Abstract

Altered breathing pattern is an aspect of dysfunctional breathing but few standardised techniques exist to evaluate it. This study investigates a technique for evaluating and quantifying breathing pattern, called the Manual Assessment of Respiratory Motion (MARM) and compares it to measures performed with Respiratory Induction Plethysmography (RIP). About 12 subjects altered their breathing and posture while 2 examiners assessed their breathing using the MARM. Simultaneous measurements with RIP were taken. Inter-examiner agreement and agreement between MARM and RIP were assessed. The ability of the measurement methods to differentiate between diverse breathing and postural patterns was compared. High levels of agreement between examiners were found with the MARM for measures of the upper rib cage relative to lower rib cage/abdomen motion during breathing but not for measures of volume. The measures of upper rib cage dominance during breathing correlated with similar measures obtained from RIP. Both RIP and MARM measures methods were able to differentiate between abdominal and thoracic breathing patterns, but only MARM was able to differentiate between breathing changes occurring as result of slumped versus erect sitting posture. This study suggests that the MARM is a reliable clinical tool for assessing breathing pattern.

Dysfunctional breathing: a review of the literature and proposal for classification

“…It has been shown to have good inter-examiner reliability and is consistent with older and more complex methods such as respiratory induction plethysmography (RIP), which has limitations when posture is slumped [29]. In this method the user wears a series of bands across the chest to measure change in dimensions of the chest and abdomen; to distinguish between abdominal and thoracic breathing; and to determine a "phase angle" as a measurement of asynchrony [27]. Patients with both elevated Nijmegen questionnaire scores and abnormal breathing patterns as assessed by MARM may benefit from breathing retraining to produce more efficient breathing patterns [34].…”

“…Other suggested methods of diagnosis include other questionnaires such as the Self Evaluation of Breathing Questionnaire (SEBQ), end-tidal carbon dioxide measurement (measured using capnography with an expected low end-tidal carbon dioxide in hyperventilation), breath holding time (where a short breath holding time after normal expiration at functional residual capacity is considered an indicator of dysfunctional breathing) and manual assessment of respiratory motion (MARM) [27][28][29][30]. It is important to note that, other than MARM and the Nijmegen questionnaire (which correlate weakly), these methods have yet to been shown to correlate with one another [31].…”

Relationships between measures of dysfunctional breathing in a population with concerns about their breathing

“…One component of breathing pattern that is considered dysfunctional is chronic thoracic dominant breathing at rest. Recently a technique called the Manual Assessment of Respiratory Motion (MARM), which can quantify extent of thoracic dominant breathing as well as other aspects of breathing pattern, has been found to have high levels of interexaminer reliability and to agree with measures made simultaneously with Respiratory Induction Plethysmography (Courtney, van Dixhoorn et al, 2008). Normal healthy individuals appear to have balanced breathing with relatively equal motion of upper rib cage to lower rib cage abdominal motion.…”

“…Normal values for the MARM in this study of 12 yoga teachers and breathing therapy practitioners were around 6. MARM values above 30 can be considered dysfunctional, as they are at least 2 standard deviations above the mean values found in normal healthy individuals (Courtney, van Dixhoorn et al, 2008). Another aspect of breathing pattern considered dysfunctional is the presence of paradoxical or asynchronous breathing (Prys-Picard, Kellett et al, 2004).…”

“…The Manual Assessment of Respiratory Motion (MARM) is a clinical tool used to assess breathing pattern that has been shown to have clinical utility and validity (Courtney, van Dixhoorn et al, 2008;Courtney and Reece, 2009). This palpatory technique permits the examiner to assess the relative contribution of upper thoracic to lower thoracic and abdominal compartments during breathing and calculate quantitative measures of the balance between these two compartments in breathing.…”