Comparison of the manual assessment of respiratory motion (MARM) and the hi lo breathing assessment in determining a simulated breathing pattern

by Dr Marc | May 24, 2017

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, 12(3) 86-91

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.

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

by Dr Marc | May 18, 2017

Courtney, R., Greenwood, K.M., Cohen M., (2011) “Relationship between measures of dysfunctional breathing in a population with concerns about their breathing” Journal of Bodywork and Movement Therapies 15(1) 24-34. doi:10.1016/j.jbmt.2010.06.004

Abstract

Background: Dysfunctional breathing (DB) is implicated in physical and psychological
health, however evaluation is hampered by lack of rigorous definition and clearly defined measures. Screening tools for DB include biochemical measures such as end-tidal CO2, biomechanical measures such assessments of breathing pattern, breathing symptom questionnaires
and tests of breathing function such as breath holding time.
Aim: This study investigates whether screening tools for dysfunctional breathing measure distinct or associated aspects of breathing functionality.
Method: 84 self-referred or practitioner-referred individuals with concerns about their breathing were assessed using screening tools proposed to identify DB. Correlations between these measures were determined.
Results: Significant correlations where found within categories of measures however ccorrelations between variables in different categories were generally not significant. No measures were found to correlate with carbon dioxide levels.
Conclusion: DB cannot be simply defined. For practical purposes DB is probably best characterised as a multi-dimensional construct with at least 3 dimensions, biochemical, biomechanical and breathing related symptoms. Comprehensive evaluation of breathing dysfunction
should include measures of breathing symptoms, breathing pattern, resting CO2 and also include functional measures such a breath holding time and response of breathing to physical and psychological challenges including stress testing with CO2 monitoring.

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The sustainable training, treatment, employment program model: effects of manual therapy on musculoskeletal pain and limitation in a Filipino squatter community

by Dr Marc | May 18, 2017

Vindigni, D, Polus, van Rotterdam, J, Da Costa, C, Edgecombe, G, Walsh, M, Howard, M, Browell, T, Biasbas, A, Cohen, M, Paterson, C. (2011) The Sustainable Training, Treatment, Employment Program Model: Effects Of Manual Therapy On Musculoskeletal Pain And Limitation In A Filipino Squatter Community, Journal of Manipulative and Physiological Therapeutics 34(6) 381-387

Abstract

OBJECTIVE:
The purpose of this study is to describe the musculoskeletal conditions and associated pain and limitation and the effects of massage treatment in a Filipino squatter community.
METHODS:
The study was conducted at the Hands On Philippines Education (HOPE) clinic in Bagong Barrio, Caloocan, Philippines. Baseline data were collected before the first treatment, and follow-up data were collected immediately after the second treatment. Treatment was delivered by massage students who were trained in massage by a chiropractic program faculty member through the Project HOPE charitable community-based initiative. A prospective pretest-posttest observational research design was used. The sample consisted of 290 subjects aged 16 years and older visiting the Project HOPE clinic. One hundred ninety-two subjects completed the follow-up surveys. The outcome measures were sites of pain, self-reported levels of pain, and limitation to activities of daily living at baseline and after the second massage therapy treatment.
RESULTS:
Three self-reported anatomical locations were identified by each subject. The most frequently reported painful sites over the last 7 days among the 166 respondents were the upper back (36.7%), lower back (18.7%), and shoulders (16.3%). The pre-post treatment analyses of pain and disability was restricted to 66 participants who provided completed outcome measures. After 2 massage therapy treatments, all pain and limitation scores decreased. A comparison of mean self-reported levels of pain and disability at baseline and immediately after the second consultation showed statistically significant decreases of pain (t65 = 16.97, P < .001) and disability (t65 = 12.4, P < .001).
CONCLUSION:
This study suggests that participants who visited the Filipino squatter community clinic experience a high prevalence of musculoskeletal conditions located primarily within the axial skeleton, and that, in the short term, massage therapy delivered on-site by trained therapists was helpful in reducing self-reported levels of pain and limitation to activities of daily living

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Relationship between dysfunctional breathing patterns and ability to achieve target heart rate variability with features of “coherence” during biofeedback.

by Dr Marc | May 18, 2017

Courtney, R., Cohen, M., van Dixhoorn J., Relationship between dysfunctional breathing patterns and ability to achieve target heart rate variability with features of “coherence” during biofeedback. Altern Ther Health Med. 2011 May-Jun;17(3):38-44.

Abstract

BACKGROUND:
Heart rate variability (HRV) biofeedback is a self-regulation strategy used to improve conditions including asthma, stress, hypertension, and chronic obstructive pulmonary disease. Respiratory muscle function affects hemodynamic influences on respiratory sinus arrhythmia (RSA), and HRV and HRV-biofeedback protocols often include slow abdominal breathing to achieve physiologically optimal patterns of HRV with power spectral distribution concentrated around the 0.1-Hz frequency and large amplitude. It is likely that optimal balanced breathing patterns and ability to entrain heart rhythms to breathing reflect physiological efficiency and resilience and that individuals with dysfunctional breathing patterns may have difficulty voluntarily modulating HRV and RSA. The relationship between breathing movement patterns and HRV, however, has not been investigated. This study examines how individuals’ habitual breathing patterns correspond with their ability to optimize HRV and RSA.
METHOD:
Breathing pattern was assessed using the Manual Assessment of Respiratory Motion (MARM) and the Hi Lo manual palpation techniques in 83 people with possible dysfunctional breathing before they attempted HRV biofeedback. Mean respiratory rate was also assessed. Subsequently, participants applied a brief 5-minute biofeedback protocol, involving breathing and positive emotional focus, to achieve HRV patterns proposed to reflect physiological “coherence” and entrainment of heart rhythm oscillations to other oscillating body systems.
RESULTS:
Thoracic-dominant breathing was associated with decreased coherence of HRV (r = -.463, P = .0001). Individuals with paradoxical breathing had the lowest HRV coherence (t(8) = 10.7, P = .001), and the negative relationship between coherence of HRV and extent of thoracic breathing was strongest in this group (r = -.768, P = .03).
CONCLUSION:
Dysfunctional breathing patterns are associated with decreased ability to achieve HRV patterns that reflect cardiorespiratory efficiency and autonomic nervous system balance. This suggests that dysfunctional breathing patterns are not only biomechanically inefficient but also reflect decreased physiological resilience. Breathing assessment using simple manual techniques such as the MARM and Hi Lo may be useful in HRV biofeedback to identify if poor responders require more emphasis on correction of dysfunctional breathing.

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Yoga in Australia: results of a national survey

by Dr Marc | May 18, 2017

Cohen, M. Wolfe, R. Mai, T. Lewis, D. A Randomised, Double-blind, Placebo-controlled Trial of a Topical Cream containing Glucosamine Sulfate Chondroitin Sulfate and Camphor for Osteoarthritis of the Knee. Journal of Rheumatology, 30 (3):523-8, 2003 [PubMed] [PDF – see above]

Abstract

INTRODUCTION:
The therapeutic benefits of yoga and meditation are well documented, yet little is known about the practice of yoga in Australia or elsewhere, whether as a physical activity, a form of therapy, a spiritual path or a lifestyle.
MATERIALS AND METHODS:
To investigate the practice of yoga in Australia, a national survey of yoga practitioners was conducted utilizing a comprehensive web-based questionnaire. Respondents were self-selecting to participate. A total of 3,892 respondents completed the survey. Sixty overseas respondents and 1265 yoga teachers (to be reported separately) were excluded, leaving 2,567 yoga practitioner respondents.
RESULTS:
The typical yoga survey respondent was a 41-year-old, tertiary educated, employed, health-conscious female (85% women). Asana (postures) and vinyasa (sequences of postures) represented 61% of the time spent practicing, with the other 39% devoted to the gentler practices of relaxation, pranayama (breathing techniques), meditation and instruction. Respondents commonly started practicing yoga for health and fitness but often continued practicing for stress management. One in five respondents practiced yoga for a specific health or medical reason which was seen to be improved by yoga practice. Of these, more people used yoga for stress management and anxiety than back, neck or shoulder problems, suggesting that mental health may be the primary health-related motivation for practicing yoga. Healthy lifestyle choices were seen to be more prevalent in respondents with more years of practice. Yoga-related injuries occurring under supervision in the previous 12 months were low at 2.4% of respondents.
CONCLUSIONS:
Yoga practice was seen to assist in the management of specific health issues and medical conditions. Regular yoga practice may also exert a healthy lifestyle effect including vegetarianism, non-smoking, reduced alcohol consumption, increased exercise and reduced stress with resulting cost benefits to the community.

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