Ficha de evaluación neurokinésica

Daniela Navarrete H. Kinesióloga Ficha Neurokinésica Pediátrica FECHA EVALUACIÓN: ______ / _____ /_______ ANTECEDENTES GENERALES: Nombre: _________________________ _____________________________________ __________________________ ________________________ _________________________ _______________________ ________ Edad: ______ años

Fecha de nacimiento: ______/ ______ / ____ RUT: ___________________________ _______________________________ ____

Diagnóstico Médico: __________________________ ______________________________________ _________________________ ___________________________ ________________________ __________ Quién lo acompaña: _______________________Con quién vive: __________________________ ______________________________________ _____________ _ Ayudas técnicas/ Prótesis / Silla de ruedas: _________________________________ ____________________________________________ _______________________ ____________ Escolaridad: __________________________ _______________________________________ _________________________ _________________________ ____________________________ _________________ __ Motivo de consulta: _______________________ _____________________________________ __________________________ _________________________ __________________________ _____________  ____________________________________ _________________________ __________________________ _________________________ ___________________ _____ ANAMNESIS __________________________  ________________________  ______________________________________ __________________________ _________________________ _________________________ __________________________ _________________ ___  ________________________  ______________________________________ __________________________ _________________________ _________________________ ___________________________ _________________ __  ________________________  ______________________________________ __________________________ _________________________ _________________________ __________________________ _________________ ___  ________________________  ______________________________________ __________________________ _________________________ _________________________ __________________________ _________________ ___  ________________________  ______________________________________ ___________________________ _________________________ __________________________ __________________________ _______________ ___

ANAMNESIS REMOTA o

Antecedentes relevantes del embarazo y parto: ________________________ ____________________________________ _____________________ _________

 ________________________  ______________________________________ __________________________ _________________________ _________________________ __________________________ _________________ ___  ________________________  ______________________________________ __________________________ _________________________ ___________________________ ___________________________ _______________ __ o

Cirugías: __________________________ _______________________________________ __________________________ __________________________ _________________________ ____________

 ________________________  ______________________________________ __________________________ _________________________ _________________________ __________________________ _________________ ___ o

Tratamientos invasivos: _________________________ _______________________________________ ________________________ _________________________ ________________ _

 ________________________  ______________________________________ __________________________ _________________________ _________________________ __________________________ _________________ ___ o

Medicamentos de uso habitual: _________________________ _____________________________________ __________________________ ______________________ ________

 ________________________  ______________________________________ __________________________ _________________________ _________________________ ___________________________ _________________ __ o

Otros medicamentos usados: _________________________ _______________________________________ ____________________________ ______________________ ________

 ________________________  ______________________________________ __________________________ _________________________ ___________________________ ___________________________ _______________ __ o

Tratamientos Kinésicos anteriores: _________________________ _____________________________________ __________________________ ___________________ _____

 ________________________  ______________________________________ __________________________ _________________________ ___________________________ ___________________________ _______________ __  ________________________  ______________________________________ __________________________ _________________________ ___________________________ ___________________________ _______________ __ o

ANTECEDENTES FAMILIARES RELEVANTES: ________________________ _______________________________________ __________________________ ___________

 ________________________  ______________________________________ __________________________ _________________________ _________________________ __________________________ _________________ ___  ________________________  ______________________________________ __________________________ _________________________ _________________________ __________________________ _________________ ___

EXAMEN FÍSICO Impresión general : ____________________________________________________________________________

 ____________________________________________________________________________________________  ____________________________________________________________________________________________ Piel y fanéreos: _______________________________________________________________________________ Tono: _______________________________________________________________________________________ MMSS: _______________________________________ MMII: _________________________________________ Reflejos:_____________________________________________________________________________________  ____________________________________________________________________________________________ Acortamientos: _______________________________________________________________________________  ____________________________________________________________________________________________  ____________________________________________________________________________________________ Habilidades sociales  Comportamiento: __________________________________________________________________________  Comunicación: _____________________________________________________________________________  Comprensión: _____________________________________________________________________________ Capacidades: ______________________________________________________________________________

Deformidades:  ____________________________________________________________________________________________  ____________________________________________________________________________________________

CAMBIOS DE POSICIÓN: Salida de su silla : _____________________________________________________________________________

 ____________________________________________________________________________________________  ____________________________________________________________________________________________ Decúbito supino : ______________________________________________________________________________

 ____________________________________________________________________________________________  ____________________________________________________________________________________________ Decúbito lateral : ______________________________________________________________________________

 ____________________________________________________________________________________________  ____________________________________________________________________________________________ Decúbito prono: ______________________________________________________________________________

 ____________________________________________________________________________________________  ____________________________________________________________________________________________ Sedestación : _________________________________________________________________________________

 ____________________________________________________________________________________________  ____________________________________________________________________________________________ Bipedestación : : ______________________________________________________________________________

 ____________________________________________________________________________________________  ____________________________________________________________________________________________ Marcha: ____________________________________________________________________________________

 ____________________________________________________________________________________________  ____________________________________________________________________________________________

Reacciones de protección: Anterior: ___________Posterior: __________Lateral derecha: __________Lateral izquierda: ____________ Destrezas funcionales , AVD: _____________________________________________________________________

 ____________________________________________________________________________________________  ____________________________________________________________________________________________ Función respiratoria: __________________________________________________________________________  ____________________________________________________________________________________________  ____________________________________________________________________________________________  ____________________________________________________________________________________________ OBJETIVOS ¿Qué espero yo de mi terapia?/ ¿Qué logros espera Ud. de la terapia de su hijo (a)?  ____________________________________________________________________________________________  ____________________________________________________________________________________________ Objetivo General:  ____________________________________________________________________________________________  ____________________________________________________________________________________________ Objetivos Específicos: 1.  _____________________________________________________________________________________  _____________________________________________________________________________________ 2.  _____________________________________________________________________________________  _____________________________________________________________________________________ 3.  _____________________________________________________________________________________  _____________________________________________________________________________________ 4.  _____________________________________________________________________________________  _____________________________________________________________________________________ 5.  _____________________________________________________________________________________  _____________________________________________________________________________________ PLAN DE TRATAMIENTO:  ____________________________________________________________________________________________  ____________________________________________________________________________________________  ____________________________________________________________________________________________  ____________________________________________________________________________________________  ____________________________________________________________________________________________  ____________________________________________________________________________________________