"MEASUREMENT OF CHEST WALL EXPANSION FOR HEALTHY INDIVIDUAL IN TWO DIFFRENT ARM POSITION"

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2 "MEASUREMENT OF CHEST WALL EXPANSION FOR HEALTHY INDIVIDUAL IN TWO DIFFRENT ARM POSITION" Submitted by: KIRAN GEHLOT (12sptpt11029) FORAM GOHEL (12sptpt11030) 6 th semester, July-2015 Guided by: Dr. Namrata Chandrala MPT in Musculoskeletal and Sports Science Assistant Professor School of Physiotherapy, RK University ii

3 CERTIFICATE This is to certify that the project work entitled MEASUREMENT OF CHEST WALL EXPANSION FOR HEALTHY INDIVIDUAL IN TWO DIFFRENT ARM POSITION has been undertaken and written under my supervision and it describes the original research work carried out by Mr. Kiran Gehlot & Miss Foram Gohel registered at RK University in 6 th semester Bachelors of Physiotherapy. Signature of Guide: Dr Namrata Chandrala MPT in Musculoskeletal and sports science, Assistant Professor School of Physiotherapy, RK University iii

4 DECLARATION We hereby certify that we are the authors of this project work. We certify to the best of our knowledge, our project does not infringe upon anyone s copyright nor violate any proprietary rights and that any ideas, techniques, quotations, or any other material from the work of other people included in our project published or otherwise, are fully acknowledged in accordance with the standard referencing practices. We declare that this is a true copy of our project, including any final revisions, as approved by my project review committee. Signature of candidate KIRAN GEHLOT Enrolment no.:12sptpt11029 Date: Place: Rajkot Signature of candidate FORAM GOHEL Enrolment no.:12sptpt11030 Date: Place: Rajkot iv

5 ACKNOWLEGEMENT First and foremost we would like to thank our parents Gehlot Ishvarbhai & Shitaben & Gohel Mukeshbhai & Vilasben who our living Gods and our sisters Prisha for their valuable support and encouragement, blessing and love which has always been a source of inspiration and strength in accomplishing this academic task. Our heartfelt gratitude to almighty God who has guided us this far and to whom goes all the honour and glory for the successful completion of this study. We wish to express our regards to our Director Dr. Priyanshu Rathod School of Physiotherapy, R.K. University for his whole hearted guidance and meticulous suggestions in the completion of this work and for all the facilities and support extended to us during this study. We are extremely thankful for his constant encouragement and inspiration during the course of this study. With due respect, we would like to express our sincere thanks to our guide Dr. Namrta Chandrala Assistant lecturer of School of Physiotherapy, R.K. University, for his judicious information, expert suggestions, valuable guidance, continuous support, incessant reassurance during every stage of this work and interest shown in this dissertation without which this work would not have been possible. We would like to extend our heartfelt thanks to assistant lecture Dr. Vaibhavi Ved & Dr. Shewta Rakholia for their valuable guidance, constant help and support throughout this v

6 study and all the lecturers of our college who have taught us and gave their valuable suggestions during the course of the study. Our sincere thanks to Dr. Khyati kamdar for taking keen interest in our study, guiding us through the path, giving us support and motivation during the course of study. We wish to express our thanks to Mr. Harshal our librarian for their timely help in lending us books and journals for our reference all the time. We shall fail our duties if we don t acknowledge our Colleagues and Friends for their suggestions and criticism while assisting us in this study. Last but not the least we would like to thanks all the Individuals in our study without whom this task would not have been possible. Our sincere thanks to all the contributors whose names we might have missed but who truly deserve our gratitude. We would like to thank once again to all who have helped us all the while. Signature Name: Miss Foram Gohel Signature Name: Mr. Kiran Gehlot vi

7 LIST OF ABBREVIATIONS 1. HBS: HAND BY SIDE 2. HOH: HAND ON HEAD vii

8 ABSTRACT BACKGROUND: Chest wall excursion measurements give us a measure of chest wall mobility, chest wall expansion measurement is one such outcome measurement which forms an integral part of cardiopulmonary assessment for assisting in diagnosis and prognosis of conditions. Chest wall mobility is affected in many obstructive pulmonary diseases. Further the usefulness of a measurement is dictated by how much confidence we have that the measurement is true and also by its ability to reflect deviations from the normal AIM: To find the normative values of chest wall expansion measurements in healthy adults in two different arm positions namely- arms by the side and hands on the head. METHODOLOGY: Study Design: Observational study Study Setting: RKU campus, Young individual Sampling Technique: Convenient sample technique Study Population: Male and female both Study Duration: Training duration 2 months Total Study duration - 6 months RESULTS: In our study we found that there is no significant difference between Nipple level and Xiphi sternum level, but in Axilla level significant difference. CONCLUSION: On the basis of present study it can be concluded that we concluded that there is significant difference at Axilla level but there is no significant difference at Nipple level and Xiphi sternum level. KEY WORDS: Chest expansion measurement viii

9 TABLE OF CONTENTS Sr. No. TITLE Page No. 1. INTRODUCTION 1 2. NEED OF STUDY 3 3. AIMS & OBJECTIVES 5 4. REVIEW OF LITERATURE 9 5. METHODOLOGY RESULTS DISCUSSION CONCLUSION SUMMARY BIBLIOGRAPHY ANNEXURES 37 ix

10 LIST OF TABLES Sr. NO. TABLES Page No. 6.1 TABLE NO : 1. Shows Mean and standard deviation 18 of Axilla level in two Different arm position 6.2 TABLE NO: 2 Shows Mean and standard deviation of Nipple level in two Different arm position. 6.3 TABLE NO: 3 Shows Mean and standard deviation of Xiphi sternum level in two different arm position x

11 LIST OF GRAPHS SR. NO. GRAPHS PAGE NO. 6.1 Shows Mean and standard deviation of Axilla level in two Different arm position 6.2 Shows Mean and standard deviation of Nipple level in two Different arm position 6.3 Shows Mean and standard deviation of Xiphi sternum level in two different arm position xi

12 INTRODUCTION 1

13 INTRODUCTION Chest wall excursion measurements give us a measure of chest wall mobility. Chest wall expansion measurement is one such outcome measurement which forms an integral part of cardiopulmonary assessment for assisting in diagnosis and prognosis of any pulmonary conditions. Chest wall mobility is affected in many obstructive pulmonary diseases like COPD, Asthma, bronchitis etc. Clinically, chest wall excursion measurements are taken with the subject s arms by the side. However in a study of chest expansion, they 1 suggested that the hands on head position would be a better one since it would clear the breasts and the scapula from the site of measurement. In another study 7 used both the above mentioned arm positions during the measurement of chest girth. This study however, was done only to find out the reliability of chest wall excursion measurements,in clinical practice, it has been observed that chest expansion can be improved if the patient voluntarily activates the muscles of the rib cage during measurement of thoracic excursion, An additional instruction actively to increase or decrease the volume of the thorax, over and above the ordinary instruction to breathe in and out maximally, could possibly optimize measurement of chest expansion. this study is intended to find out the normative values of chest wall excursion measurements in normal healthy adults in two arm positions viz. arms by the side and hands on the head at three measuring sites (axilla, nipple and xiphi sternum) Measurement of chest wall can be measured with the use of measure tap which is Universally approved which gives true measurement of chest wall Normally, a 2-5" of chest expansion can be observed. Any lung or pleural disease can give rise to a decrease in overall chest expansion. 2

14 NEED OF THE STUDY 3

15 NEED OF THE STUDY To know the normative chest expansion value of an individual. To prevent the cardiopulmonary complications like COPD, Asthma, Bronchitis etc in future. 4

16 AIM AND OBJECTIV 5

17 AIM & OBJECTIVES To find the normative values of chest wall expansion Measurements in 100 healthy adults in two different arm positions (sitting) namely... (1) Arms by the side (2) Hands on the head. 6

18 HYPOTHESIS 7

19 HYPOTHESIS NULL HYPOTHESIS:- There is No significant difference of chest expansion in between two different arm position. ALTERNETIVE HYPOTHESIS:- There is significant difference of chest expansion in between two different arm position. 8

20 REVIEW OF LITERATURE 9

21 REVIEW OF LITERATURE 1. J Sharma, H Senjyu, L Williams and C White in their study in 2004 on clients with AS found that chest expansion measurements using a tape measure has a high intertester and intratester reliability. These measurements were carried out in two positions: Arms by the side and hands on the head. 2. Stackowicz D, Frownfelter D and Rheault W in their study in 2003 suggested that chest wall expansion measurements may be more reliable for subjects without than with a diagnosed pulmonary disease or disorder. 3. TK LaPier, Cook Adrian, Droege Karoline, Oliverson Rachelle et al in 2000 studied the reliability of chest expansion measurements and found that it provided a highly reliable index of chest wall mobility in subjects without impairment. 4. Further, Viitanen JV, Heikkila S, Koko ML, Kautianen H in their study in 2000 on AS patients concluded that the chest expansion together with cervical rotation, extension and/or lateral flexion comprised the set of mobility tests for the follow up and assessment of disease progression in ankylosing spondylitis. 10

22 METHODOLOGY 11

23 METHODOLOGY Study Design: Observational study Study Setting: RK University campus, Young individual Sampling Technique: Convenient sample technique Study Population: Male and Female both Study Sample: 100 Healthy subjects Study Duration: Total Study duration -16 Weeks 12

24 CRITERIA FOR SELECTION INCLUSION CRITERIA Medically fit healthy individuals Inclusive age group 20-30yrs. Individuals of both genders. EXCLUSION CRITERIA History of diagnosed pulmonary disease History of injury, trauma or surgery in the thoracic region. History of injury, trauma or surgery in the upper abdominal region. History of Smoking. 13

25 MATERIALS USED IN THE STUDY Measure tape Page Writing pad Pen 14

26 METHOD 100 subjects will be taken from RKU campus. Chest expansion is measured with the use of measure tap. Consent form will be taken from all the subject, chest expansion will be measure in sitting with two different Arm position at 3 different level (1) axilla level (2) nipple level (3) xiphi sternum during inspiratory phase of respiration Chest wall measurement HBS position 15

27 Chest wall Measurement in HOH position 16

28 RESULTS 17

29 RESULT TABLE NO: 6.1 Shows Mean and standard deviation of Axilla level in Two Different arm position MEAN Standard Deviation Hand on the head Hand by the side Unpaired t-test P value t Value Are variances significantly different? Yes 18

30 Graph: 6.1 Shows Mean and standard deviation of Axilla level in Two Different arm position y=value of chest expantion [cm] Mean Standerd deviation HOH HBS x 19

31 TABLE NO: 6.2 Shows Mean and standard deviation of Nipple level in Two Different arm position. MEAN Standard Deviation Hand on the head Hand by the side Unpaired t-test P value t Value Are variances significantly different? No 20

32 Graph: 6.2 Shows Mean and standard deviation of Nipple level in two Different arm position. 21

33 TABLE NO: 6.3 Shows Mean and standard deviation of Xiphi sternum level in Two different arm position MEAN Standard Deviation Hand on the head Hand by the side Unpaired t-test P value t Value Are variances significantly different? No 22

34 Graph 6.3: Shows Mean and standard deviation of Xiphi sternum level in two different arm position 23

35 DISCUSSION 24

36 DISCUSSION The aim of study to find the normative values of chest wall expansion measurements in healthy adults in two different arm positions namely- arms by the side and hands on the head. The need of normative value of chest expansion is important in clinical practice to evaluation of patient treatment intervention. Chest wall expansion measurement gives as chest wall mobility. Chest wall mobility evaluation is important to know in many condition like myasthenia gravis, fibromyalgia, and pulmonary disease. T.K.lapier established the normative value of chest expansion supine and standing but again the arm poisons were not considered. In our study we took chest expansion measurement on three anatomical levels in two different arm positions 1. Hands on head 2. Hands by side Chest expansion measurement taken on axilla level, nipple level and Xiphi sternum level. In our study there is no significant difference between nipple level and Xiphi sternum level, but at axilla level significant difference. A study by Roberts et al. investigated that chest expansion measured at Xiphi sternum level hands on head position found reliable. The previous studies were to find out reliability of chest expansion measurement. Jagannath Sharma et al. studied that chest expansion measurement is not high reliable outcome measurement. Previous studies while measuring chest expansion few investigator have used armpits, xiphoid and fourth intercostal space as the landmark to place the measure taps but this study used to axilla, nipple and xiphi sternum level. 25

37 LIMITATIONS OF THE STUDY Limited age group - 20 to 30 years Used only sitting position FURTHER RECOMMENDATIONS Wide age group can be selected. Chest wall can be measured in other position. 26

38 CONCLUSION 27

39 CONCLUSION On the basis of present study it can be concluded that we concluded that there is significant difference at Axilla level but there is no significant difference at nipple level and Xiphi sternum level. 28

40 SUMMARY 29

41 SUMMARY Chest wall excursion measurements give us a measure of chest wall mobility chest wall expansion measurement is one such outcome measurement which forms an integral part of cardiopulmonary assessment for assisting in diagnosis and prognosis of condition, To find the normative values of chest wall expansion measurements in healthy adults in two different arm positions namely- arms by the side and hands on the head, 100 subjects were taken from RKU campus. Chest expansion was measured in sitting position at 3 different level-axilla level, nipple level and xiphi sternum level in two different arm position, 1. Hands on the head 2. Hands by sides during inspiratory phase of respiration. Chest expansion measurement taken on axilla level, nipple level and xiphi sternum level. In our study there is no significant difference... -between nipple level and xiphi sternum level, but in axilla level significant difference. 30

42 BIBLIOGRAPHY 31

43 BIBLIOGRAPHY 1) Moll JMH, Wright V. An objective study of chest expansion. Ann Rheum Dis. 1972;31:1-8 2) Stackowicz D, Frownfelter D, Rheault W. Intertester reliability of the measurement of chest wall expansion. Cardiopulm Phys Ther Dec 3) LaPier TK, Cook A, Droege K, Oliverson R et al. Intertester and intratester reliability of chest excursion measurements in subjects without impairment. Cardiopulm Phys Ther Sep 4) Rajiv Gandhi University of Health Sciences, Karnataka,Bangalore 32

44 ANNEXURES 33

45 ANNEXURE 10.1 ETHICAL INFORMED CONSENT FORM Study title: Measurement of chest wall expansion for healthy individual in two different arm positions Subject s Name: Age : Years Sex: Address of the Subject I have been explained in details about the various questions/tests that will be asked/performed is to assess my functional capacity & health status etc. I have also been explained that all the tests are non-invasive and without any side effect. I understand that my participation in the study is voluntary and that I am free to withdraw at any time, without giving any reason, without my medical care or legal right being affected. I understand that the data obtained through the study may be used for research paper publication and I also understand that my identity will not be revealed at any cost. I agree to give my consent for taking my photograph and have no objection against it. I agree to take part in the above study Signature / Thumb impression of the subject Date: Name of Witness: Signature of the Witness: Signature of Investigator: Date: 34

46 ANNEXURE 10.2 DATACOLLECTION FORM Name: Age: Gender: Occupation: Address: Height: Weight: Date of assessment: On Examination: Chest Expansion Value Hand on Head Sr. No Axilla level Nipple level Xiphi sternum level 1 Chest Expansion Value Hand by side Sr. No Axilla level Nipple level Xiphi sternum level 1 35

47 ANNEXURE 10.3 MEASUREMENT TOOL Measure tap 36

48 ANNEXURE 10.5 MASTER CHART Sr. no AGE GENDER CHEST EX. VALUE CHEST EX. VALUE Hand on head Hand by side Axilla level (cm) Nipple Level (cm) Xiphi sternum level (cm) Axilla level (cm) Nipple Level (cm) Xiphi sternum level (cm) 1 21 Female Female Female Female Female Female Female Female Female o Female Female Female Female Female Female Female

49 17 20 Female Female Female Female Female Female Female Female Female Female Female Female Female Female Female Female Female Female Female Female Female Female Female Female

50 42 21 Female Female Female Female Female Female Female Female Female

51 Sr.no AGE GENDER CHEST EX. VALUE CHEST EX. VALUE Hand on head Hand by side Axilla level (cm) Nipple level (cm) Xiphi sternum level (cm) Axilla level (cm) Nipple Level (cm) Xiphi sternum level (cm) Male Male Male Male Male Male Male Male Male o 24 Male Male Male Male Male Male Male Male Male

52 69 24 Male Male Male Male Male Male Male Male Male Male Male Male Male Male Male Male Male Male Male Male Male Male Male Male Male

53 94 20 Male Male Male Male Male Male Male