SCREENING & ASSESSING BREATHING: A
SCREENING & ASSESSING BREATHING:A MULTIDIMENSIONAL APPROACHCopyright 2017 Functional Movement Systems1Version 2
The information contained herein is not intended to be a substitute for professional medical advice, diagnosis ortreatment in any manner. Always seek the advice of your physician or other qualified health provider with any questionsyou may have regarding any medical condition or before engaging in any physical fitness plan. All rights reserved. No partof this manual may be reproduced or transmitted in any form whatsoever without written permission from the author orpublisher, with the exception of the inclusion of brief quotations in articles or reviews.Copyright 2017 Functional Movement Systems .and Rosalba Courtney.2Copyright 2017 Functional Movement Systems
Table Of ContentsIntroduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Functional vs Dysfunctional . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Functions of Breathing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Multidimensional Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Biochemical Dimension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7Biomechanical Dimension. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Psychophysiological Dimension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Breathing Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12Hi-Lo Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16MARM Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Recording MARM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18The Nijmegen Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19The SEBQ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Breathing Screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21Application of Exercise. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Entry Point . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26Supine FRC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28Supported Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28Quadruped FRC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31Suspended Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32Kneeling FRC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34Stacked Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35Standing FRC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39Standing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42Copyright 2017 Functional Movement Systems1
Copyright 2017 Functional Movement Systems2
IntroductionThe presence of dysfunctional breathing affects overall health and musculoskeletal system performance. Itcontributes to many symptoms and functional disturbances, including those affecting the musculoskeletalsystem. It can contribute to decreased pain thresholds, impaired motor control and balance, andsubsequent movement dysfunction. Each of these impairments adversely affects performance in fitness andrehabilitation. Recent research has exposed that breathing dysfunction is multi-dimensional in nature andincludes three (3) primary categories or dimensions of dysfunction, which are the biochemical dimension, thebiomechanical dimension, and the psychophysiological / symptomatic dimension.Due to the complex and multi-dimensional nature of dysfunctional breathing, no single test or screening toolcan reliably stand alone to identify the client or patient with dysfunctional breathing. Proper evaluation ofdysfunctional breathing needs to be comprehensive and consider all 3 key dimensions and consider causesand contributing factors.This course is designed for the fitness and healthcare professional to provide the background and detailsthat support functional and dysfunctional breathing. It introduces Dr. Courtney’s multi-dimensional "EAARS"model of breathing function and a novel "Breathing Screen." Several tools to assess and test for breathingdysfunction are also provided. Additionally, we introduce a breathing re-training exercise approach, groundedin the neurodevelopmental progression that can be applied in the fitness and rehabilitation settings.The course is organized into six (6) learning units subdivided into 33 chapters and includes hands-onassessment and treatment demonstrations in a case-study format.Copyright 2017 Functional Movement Systems3
Functional vs DysfunctionalBreathingThe term "dysfunctional breathing" can be somewhat vague as people have used the term to reference a rangeof breathing behaviors and symptoms, including the following:People may categorize dysfunction as: Hyperventilation and low CO2 Mouth breathing Upper chest breathing Inability to take a deep and satisfying breath Unexplained breathing discomfort Various combinations of these factorsAsk yourself: “What is functional breathing?”"Functional breathing is breathing that efficiently and appropriately performs primary and secondary functions"EAARSFunctional breathing has the following characteristics:1. Efficient2. Adaptive3. Appropriate4. Responsive5. SupportiveCopyright 2017 Functional Movement Systems4
Functions of BreathingPRIMARY FUNCTIONS OF BREATHING1. Biomechanicala. Refers to the actions of the neuromuscular respiratory pumpb. Creates changes in the intra-abdominal and intra-thoracic pressure that drive the movement of air,lymph and blood2. Biochemicala. Refers to its effect on blood gases and body chemistrySECONDARY FUNCTIONS OF BREATHINGBreathing plays a very important role in non-respiratory functions such as the following: Self regulation of mental and emotional states Speech and vocalization Homeostatic rhythms and oscillations Spinal stability, posture and motor controlCopyright 2017 Functional Movement Systems5
Multidimensional ModelRecent research has exposed that breathing dysfunction is multi-dimensional in nature and includes 3primary categories of dysfunction: biochemical ( CO2, pH ), biomechanical (patterns, ribcage movement,respiratory muscles), and the psychophysiological dimension. No single test or screening tool can reliablystand alone to identify the client or patient with dysfunctional breathing. Proper evaluation of dysfunctionalbreathing needs to be comprehensive and consider all 3 key dimensions as well as causes and contributingfactors. Single tests can tend to give information about one dimension while overlooking others.More severe cases of dysfunctional breathing show an overlap of symptoms in each of the 3 domains (seeimage below).Copyright 2017 Functional Movement Systems6
Biochemical DimensionThe biochemical dimension refers to disturbances in oxygen, carbon dioxide and pH. Hyperventilation isthe most common disturbance in the biochemical dimension. Hyperventilation means breathing in excessof metabolic requirements with subsequent depletion of CO2. The presence of hyperventilation occurswhen breathing in excess of metabolic requirements leads to the depletion of CO2. People with chronichyperventilation can have abnormal breathing control and inaccurate breathing perception. They tend toabnormally increase rather than decrease ventilation levels when their carbon dioxide levels decrease. Thiscreates a flywheel effect that perpetuates hyperventilation and hypocapnia. Hyperventilators often feel likethey are not breathing enough even though they are over-breathing which also perpetuates hyperventilation.One common characteristic of hyperventilators is that instead of controlling breathing, they tend to amplifythe symptoms of hyperventilation and over breathe. This effect can alter an individual’s perception of what isnormal breathing.Effects of Hyperventilation:Effects of Dysfunctional Breathing & Motor ControlCopyright 2017 Functional Movement Systems7
Biomechanical DimensionBreathing Pattern Disorders1. Thoracic/upper rib cagea. Vertical upper rib cage, dominant, asynchronous, paradoxical breathing.2. Excessively irregular breathinga. Sighing dyspnea, breath holding3. Inhalation and/or exhalation schemaThoracic Breathing PatternsCharacterized by rate volume, rhythm, regularity, timing and dominanceNormalAbnormalLower Rib CageAbdominalUpper Rib CageThoracicAdapted from Dr. Larissa Lasovetskaya.Direction of movement:1. Normal - Expansion, outwards motion during inhale2. Paradoxical - Contraction, inwards motion during inhaleCopyright 2017 Functional Movement Systems8
THORACIC BREATHINGNormal - Functional Occasional Appropriate situation (activity, posture and pathology) Supports diaphragm function Complex strategyAbnormal - Dysfunctional Habitual / Excessive Present lying or at rest Recruited too early Simplified strategyBREATHING, POSTURE & MOVEMENT SCHEMAInhalation Schema Exhalation restricted Flexion restricted Inhalation position of rib cage Tension patterns - posterior anterior (hamstring)Stereotypical Posture of Inhalation Schema Hyperboloids with rib flaring Tension at TL Junction Diaphragm DysfunctionExhalation Schema Inhalation restricted Extension restricted Exhalation position of rib cage (expect lower) Tension patterns - Anterior Posterior Can include forward head postureCopyright 2017 Functional Movement Systems9
CONSEQUENCES OF BIOMECHANICAL BREATHINGDYSFUNCTIONS1. Reduced ability to dynamically & accurately regulate intra-abdominal pressurea. Poor motor controlb. Poor spinal supportc. Poor stabilization2. Muscle Imbalance - (neck, shoulder, girdle, abdominals, spine and pelvis)a. Neck painb. Back painc. Pelvic paind. IncontinenceCopyright 2017 Functional Movement Systems10
PsychophysiologicalDimensionIt is important to understand that mental and emotional states have a large impact on breathing functionand breathing symptoms. The way a person breathes -- both consciously and unconsciously -- can affect thefunction of the brain and nervous system and mental and emotional states.The psychophysiological dimension influences ventilatory drive and breathing pattern. It impacts breathingcontrol and can perpetuate dysfunction in the biochemical and biomechanical dimensions.Copyright 2017 Functional Movement Systems11
Breathing AssessmentBasic Principles Evaluate biochemical, biomechanical and psychophysiological dimensions. For each domain, evaluate at rest and under challenge. Evaluate breathing in response to and as part of secondary (breathing related function of concern e.gmuscular-skeletal).Breathing Considerations During a Musculo-Skeletal Exam Breath holding during motor tasks can be a sign of motor control dysfunction Clients may breath-hold in anticipation of pain or movement and can be a conditioned response thatpersists even after pain is gone Flexion/Extension restrictions in relation to inhalation/exhalation dysfunctions: Someone with anextension restriction may also have an inhalation restriction. Someone with a flexion restriction mayalso have an exhalation restriction Breathing restrictions/dysfunctions may also cause restrictions in shoulder mobility, dysfunctionalrolling patterns, and balance impairmentsOrder of Assessment1. Perform Top Tier SFMA2. Biochemical Assessmenta. Observation & Testingb. Breath Holds3. Biomechanical Assessmenta. Hi-Lo Assessmentb. MARM Assessment4. Psychophysiological Dimensiona. This is indicated when there are large numbers of symptoms on SEBQ and NQ. Also look for positiveresponse to questions asking about stress, tension and anxiety in these questionnairesCopyright 2017 Functional Movement Systems12
THE SELECTIVE FUNCTIONAL MOVEMENT ASSESSMENTSFMA SCORINGFNFPDPDNCervical FlexionCervical ExtensionCervical RotationUpper Extremity Pattern 1(MRE)Upper Extremity Pattern 2 (LRF)LRLRLRMulti-Segmental FlexionMulti-Segmental ExtensionMulti-Segmental RotationSingle-Leg StanceLRLROverhead Deep SquatCopyright 2017 Functional Movement Systems13
THE SELECTIVE FUNCTIONAL MOVEMENT ASSESSMENTName:Cervical FlexionDate:Total Score: Painful Can’t touch Sternum to Chin Excessive effort and/or lack of motor controlCervical Extension Painful Not within 10 degrees of parallel Excessive effort and/or lack of motor controlCervical Rotation Right Right Left LeftPattern #1 – MRE Right Right Left LeftPattern #2 – LRF Right Right Left Left Painful Right Painful LeftNose not in line with mid-clavicleExcessive effort and/or appreciable asymmetry or lack of motor control Painful Right Painful LeftDoes not reach inferior angle of scapulaExcessive effort and/or appreciable asymmetry or lack of motor control Painful Right Painful LeftDoes not reach spine of scapulaExcessive effort and/or appreciable asymmetry or lack of motor controlMulti-Segmental Flexion PainfulCannot touch toesSacral angle 70 degreesNon-uniform spinal curveLack of posterior weight shiftExcessive effort and/or appreciable asymmetry or lack of motor controlMulti-Segmental Extension Painful UE does not achieve or maintain 170ASIS does not clear toesSpine of scapula does not clear heelsNon-Uniform spinal curveExcessive effort and/or lack motor controlMulti-Segmental Rotation RightRightRightRightRight LeftLeftLeftLeftLeftSingle Leg Stance RightRightRightRight LeftLeftLeftLeftOverhead Deep Squat Painful Right Painful LeftPelvis Rotation 50 degreesShoulders rotation 50 degreesSpine/pelvic deviationExcessive Knee flexionExcessive effort and/or lack of symmetry or motor control Painful Right Painful LeftEyes open 10 secondsEyes closed 10 secondsLoss of HeightExcessive effort or lack of symmetry or motor control PainfulLoss of UE start positionTibia and Torso are not parallel or betterThighs do not break parallelLoss of sagittal plane alignment:Right LeftExcessive effort, weight shift, or motor controlCopyright 2017 Functional Movement Systems14
BIOMECHANICAL TESTING2 stages in testing:1. Observationa. Muscle signs, posture signs, habits and behaviorsb. Look for hypertonicity in scalenes, SCM, traps, thoracolumbar regionc. Look at movement of shoulders, ribcage, umbilicus in 4 positions2. Test/measurementObservation in standing1. Side ona. May see forward head, tension in body front vs back2. Fronta. Signs of hyperactivity in anterior neck, overdeveloped trapezius, dip above clavicle, may see chestheavingAssessment of biomechanical dimension in a seated position1. Observe for muscle hypertonicity and chest or shoulder movement during the breath2. Can also observe while speaking, looking for gasping, choppy sentences, or speeding up and slowingdownBehind1. Look for hypertonicity or over-development of the upper trapsAssessment of biomechanical dimension in a supine position1. Look for direction of umbilicus movement2. Look for rib flaring or hollowing out of the stomach (both dysfunctional if present)3. If you are not sure if this is happening, ask the patient to shallowly breathe gently and slowly into yourhand placed on the stomach to assess for inactivity or hollowing out of the stomach during inhaleAssessment of biomechanical dimension in a prone position1. Look for direction of umbilicus movement2. Look for rib flaring or hollowing out of the stomach (both dysfunctional if present)3. If you are not sure if this is happening, ask the patient to shallowly breathe gently and slowly into yourhand placed on the stomach to assess for inactivity or hollowing out of the stomach during inhaleCopyright 2017 Functional Movement Systems15
Hi-Lo TestThis test is performed in the sitting position. The clinician stands or kneels at the front and slightly to the side ofthe patient and places one hand on their sternum and one hand on their upper abdomen to determine whetherthoracic or abdominal motion is dominant during breathing. The clinician will demonstrate on themselveswhere the palpation points will be, and in the case when a female subject is not comfortable with a maleclinician performing the test, a female clinician will be made available. They will also check for paradoxicalbreathing by seeing if the abdomen moves in a direction opposite to the thorax during breathing; this is evidentduring inhalation if the abdomen moves toward the spine, and during exhalation, if the abdomen moves in anoutward direction. Test will assess for up to five (5) breath cycles.DemonstrationCopyright 2017 Functional Movement SystemsAssessment16
MARM AssessmentThe Manual Assessment of Respiratory Motion (MARM) was originally developed by Dr. Jan van Dixhoorn. Itis used to assess and quantify breathing patterns, and in particular, the distribution of breathing motionbetween the upper and lower parts of the rib cage and abdomen under various conditions. Research hasshown that it is a reliable assessment tool in the hands of trained practitioners (Courtney and Dixhoorn2009). It does require practice, but once the skills of using this technique and recording findings are acquired,it is a practical and quick technique.Hand PositionINSTRUCTIONS1. Sit behind the subject and place both your hands on the lower lateral rib cage so that your whole handrests firmly and comfortably and does not restrict breathing motion.2. Your thumbs should be approximately parallel to the spine, pointing vertically and your handcomfortably open with fingers spread so that the little finger approaches a horizontal orientation.3. Note that the 4th and 5th finger reach below the lower ribs and can feel abdominal expansion.4. You will make an assessment of the extent of how overall vertical motion of your hands feel relative tothe overall lateral motion.5. Also decide if the motion is predominantly upper rib cage, lower rib cage/abdomen correlativelybalanced.Use this information to determine the relative distance from the horizontal line of the upper and lower linesof the MARM diagram. The upper line will be further from the horizontal and closer to the top if there is morevertical and upper ribcage motion. The lower line will be further from the horizontal and closer to the bottom ifthere is more lateral and lower rib cage/abdomen motion.6. Finally get a sense of the overall magnitude and freedom of rib cage motion. Place lines further apart torepresent greater overall motion and closer for less motionCopyright 2017 Functional Movement Systems17
Recording MARM180Draw Upper Line (Line A)Represents upper rib cage and verticalbreathing motion90Draw Lower line (Line B)Represents lower rib cage and lateralbreathing motion90 degree line (Line C)This is a reference line only0180ACalculating MARM Variables Area Angle AB Average A B/2 Balance Angle AC (minus)Angle AB90C % Rib Cage AC/ABx100B0Copyright 2017 Functional Movement Systems18
The Nijmegen QuestionnaireThe Nijmegen Questionnaire (NQ) gives a broad view of symptoms associated with dysfunctional breathingpatterns. The Nijmegen Questionnaire was introduced over 30 years ago as a screening tool to detect patientswith hyperventilation complaints who could benefit from breathing training.Never0Rare1Sometimes2Often3Very Often4Chest PainFeeling TenseBlurred VisionDizzy SpellsFeeling ConfusedFaster & Deeper BreathingShort of BreathTight Feelings in ChestBloated Feeling in StomachTingling FingersUnable to Breathe DeeplyStiff Fingers or ArmsTight Feeling Around MouthCold Hands or FeetPalpitationsFeelings of AnxietyScoring the Nijmegen QuestionnaireAdd all number for a total score.20 indicates Dysfunctional Breathing.Copyright 2017 Functional Movement Systems19
The SEBQThe Self Evaluation Breathing Questionnaire (SEBQ) measures a number of different types or qualities ofbreathing discomfort. It also contains questions about dysfunctional breathing behaviors such as mouthbreathing. It was developed by Dr. Rosalba Courtney (Courtney, Greenwood 2009) to represent the broadrange of symptoms reported to be found in individual with dysfunctional breathing. Research has shown itto be a reliable instrument for testing and retesting. This makes this questionnaire useful for gauging theeffectiveness of breathing training.(2) frequently-mostly true(0) never/not true at all(1) occasionally/a bit true (3) very frequently/very trueThe Self Evaluation Breathing Questionnaire0123I get easily breathless out of proportion to my fitnessI notice myself breathing shallowlyI get short of breath reading and talkingI notice myself sighingI notice myself yawningI feel I cannot take a deep or satisfying breathI notice that I am breathing irregularlyMy breathing feels stuck or restrictedMy ribcage feels tight and can’t expandI notice myself breathing quicklyI get breathless when I am anxiousI find myself holding my breathI feel breathless in association with other physical symptomsI have trouble coordinating my breathing when speakingI can’t catch my breathI feel that the air is stuffy, as if not enough air in the roomI get breathless even when restingMy breath feels like it does not go in all the wayMy breath feels like it does not go out all the wayMy breathing is heavyI feel that I am breathing moreMy breathing requires workMy breathing requires effortI breathe through my mouth during the dayI breathe through my mouth at night while I sleepScoring the SEBQTo Score the SEBQ just add the numbers Individuals with scores 20 on the Nijmegen on average score 11on the SEBQ.Copyright 2017 Functional Movement Systems20
Breathing ScreenThe breathing screen was introduced to help identify if people do/do not have a breathing dysfunction. Frominternal research, we found that breath hold time and 4-Questions have a sensitivity of .89 for ruling outbreathing dysfunction. If you pass the screen, we are 89% sure you don’t have a breathing problem (Kiesel,Rhodes, Mueller, Waninger, Butler, 2016).BREATH HOLD TIMEBreath holding time is shorter in individuals who have increased ventilatory drive or lowered breathlessnessthresholds due to psychophysiological, biomechanical or biochemical factors. Short breath holding time canindicate dysfunction in any of these 3 dimensions.Breath holding time can be tested in 2 ways:1. After a normal exhale (also know as functional residual capacity)2. After a full inhale (also known as total lung capacity)BREATH HOLDING AT FUNCTIONAL RESIDUAL CAPACITY(FRC)FRC refers to the volume of air left in the lungs after a normal, passive exhalation. Breath holding atFRC means holding the breath after a normal relaxed exhalation. Breath holding times help gauge anunderstanding of all dimensions of breathing because the biomechanical and psychophysiologicaldimensions can also affect outcome of breath holding times.Instructions1. Have the individual breathe in, breathe out naturally. At the end of the exhale, ask them to hold theirbreath by plugging their nose.2. Tell them to hold their breath until they feel a clear desire to breathe or experience involuntary muscleactivity from the diaphragm or other breathing muscles.3. Start a timer as soon as the individual holds their breath, and stop when they release their nose or yousee the first sign of muscle activity.Tips for testing Look for the first sign to breathe. (Normally muscle activity in the stomach or neck)InterpretationIf time is less than 25 seconds, suspect possible dysfunctional breathingCopyright 2017 Functional Movement Systems21
Breathing ScreenBREATH HOLDING AT TOTAL LUNG CAPACITY (TLC)TLC refers to the total volume of air in the lungs at maximal inspiration.Instructions1. Have the individual breathe in and then breathe out, then take a deep breath in (maximum inhalation) and holdtheir breath by plugging their nose.2. Total lung capacity is considered at the end of full inhale. Hold as long as possible until the individual’s breakingpoint.3. Start a timer as soon as the individual holds their breath, and stop when the individual breathes.Tips for Testing Muscle activity is allowed during this test. Clearly instruct the individual to hold as long as physically possible.Copyright 2017 Functional Movement Systems22
BREATHING QUESTIONNAIRE1. Do you feel tense?(0) never/not true at all(1) occasionally/a bit true(2) frequently-mostly true(3) very frequently/very true2. Do you feel a cold sensation in your hands or feet?(0) never/not true at all(1) occasionally/a bit true(2) frequently-mostly true(3) very frequently/very true3. Do you notice yourself yawning?(0) never/not true at all(1) occasionally/a bit true(2) frequently-mostly true(3) very frequently/very true4. Do you notice breathing through your mouth at night?(0) never/not true at all(1) occasionally/a bit true(2) frequently-mostly true(3) very frequently/very trueCopyright 2017 Functional Movement Systems23
Breathing Screen InterpretationCATEGORIESRed: Stop. Address breathing dysfunction, prioritize treatment of breathing, and do not load thisgroup with resistance.Yellow: Some deficits, proceed with caution by monitoring and adding breathing retraining toactivity and add some breathing retraining.Green: Breathing is optimal and individual likely moves very well.FUNCTIONAL RESIDUAL CAPACITY (FRC)Red: 25 SecondsYellow: 26 - 35 SecondsGreen: 35 SecondsTOTAL LUNG CAPACITY (TLC)Red: 35 SecondsYellow: 36 - 60 SecondsGreen: 60 SecondsBREATHING QUESTIONNAIRERed: Score 2 or 3Yellow: Score of 1Green: Score of 0Copyright 2017 Functional Movement Systems24
Application of RestorationAddressBreathing reathingTEST, TREAT, AND RE-TESTYou need to have a clear expectation of each breathing drill you apply and how each individual is expectedto respond. DO NOT GUESS whether an exercise worked. Retest it and make the appropriate changes untilyou get the desired outcome in a timely manner. By taking breath hold times at different postures, it allowsyou to see where their worst posture is for breathing. The breathing drills change breathing mechanics andcreate short-term responses which can then add up to a long-term adaptation. Remember, every breathingdrill presents an opportunity to change an individual’s breathing dysfunction. You will either improve thedysfunction or see no change. Retesting is vital in order for you to treat/correct effectively.Continue on the correct path. If numbers are not changing after 2-3 weeks, you may consider a medicalreferral.MOVEMENT INTERPLAY WITH BREATHINGWe acknowledge that breathing is not only an essential function for living, but it is also a gateway intosympathetic vs.
that support functional and dysfunctional breathing. It introduces Dr. Courtney’s multi-dimensional "EAARS" model of breathing function and a novel "Breathing Screen." Several tools to assess and test for breathing dysfunction are also provided. Additionally, we introduce a breathing re-training exercise approach, grounded
4.4 Emerging and re-emerging infections 43 4.5 Clinically insignificant transfusion-transmissible infections 44 5 Blood screening, quarantine and release 45 5.1 Blood screening process 45 5.2 Approaches to blood screening 45 5.3 Pooling for serological assays 47 5.4 Sequential screening 47 5.5 Blood screening and diagnostic testing 48 5.6 Emergency screening 48 5.7 Screening plasma for .
The evaluation of breathing include several signs including breathing rate, breathing effort, motion of the chest and abdomen, breath sounds, and blood oxygenation levels. Normal breathing rates vary by age and are shown in the table. The breathing rate higher or lower than the normal range indicates the need for intervention.
Physiology of Breathing and Teaching Pranayama 5 Breathing Practices in Yoga Proper breathing techniques are an integral part of any yoga program. Proper breathing is essential to the practice of yoga as it improves focus and brings increased oxygen to the system. While doing a yoga practice, it is a general principle to breathe when the
Running a Resume Screen Page 2 of 17 version 1.2 (updated 6/11/21) Note: If there were screening levels before the Resume Screening (Online and/or Manual Screening), all screening must be complete prior to running the Resume Screening. 1. Go to the Applicants tab within the Job Opening. 2. If the Resume Screen is the only screening level,
Yoga Breathing Allowing the diaphragm to expand into the belly as you breath can stimulate the vagus nerve and help reduce stress A large component of every yoga class is controlled breathing One very effective breathing technique is Ocean (Ujjayi) breathing – narrow the back of
breathing instructions. They had participants change their breathing according to those instructions, with no hint that the breathing patterns were connected to specific emotions. The study found that the breathing patterns reliably created the emotions they were associated with, without any other emotion cue or trigger.
disorders [38,42-46]. Slow paced breathing and other pranayamic breathing techniques incorporated in yoga courses such as Sudarshan Kriya Yoga (SKY) modulate the autonomic nervous system through changes in the patterns of breathing [42,47]. Such voluntary changes in breathing have also been correlated with changes in negative
An Introduction to Conditional Random Fields Charles Sutton1 and Andrew McCallum2 1 EdinburghEH8 9AB, UK, csutton@inf.ed.ac.uk 2 Amherst, MA01003, USA, mccallum@cs.umass.edu Abstract Often we wish to predict a large number of variables that depend on each other as well as on other observed variables. Structured predic- tion methods are essentially a combination of classi cation and graph-ical .
