Professional Documents
Culture Documents
Antecedentes Personales
Anamnesis Remota
Nombre:
Edad:
Fecha Nacimiento:
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Direccin:
Ocupacin:
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Telfono:
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Estado
civil:
Dominancia:
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Previsin:
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Diagnostico:
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Red de Apoyo:
________________________________________________________________________________
Antecedentes;
Mrbidos:_______________________________________________________________________
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Impresin
General del Paciente
__
Acompaado: No
Si
con quin?
Quirrgicos: Si
No
cules?
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____________________________________________________________________
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Uso de ayuda tcnica:
Familiares:______________________________________________________________________
Silla de __
ruedas
Andador:
No usa
otra:
Sociales:________________________________________________________________________
Elementos
__ ortopedia:
________________________________________________________________________________________
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Hbitos:
Alcohol
Tabaco clave, bsd,Drogas
Observacin
en sedente: (punto
punto de apoyo)
Plano Fontal
otro___________________________________________________________________________________
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Frmacos:
Cules? Hace cuanto?
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Plano sagital:
_________________________________________________________________________________
Exmenes
Complementarios:
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_______________________________________________________________________________________
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_______________________________________________________________________________________
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_______________________________________________________________________________________
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Plano transversal:
_________________________________________________________________________________
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Anamnesis
Prxima
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Evaluacin Neurocognitiva
Estado de conciencia:
Consiente__ Inconsciente__
Vigil __ Orientado __Obnubilado__ Somnoliento__ Sopor__
Orientacin temporal:
Si___
No___
Orientacin espacial:
Si___
No___
Orientacin personal:
Si___
No___
Memoria:
Alterada___
No Alterada___
Gnosias
Apraxias:
SI___
NO___
Si___
No___
Evaluacin Neurosensitiva
Sensibilidad superficial:
T: Alterada__ Conservada__
Dnde?
Sensibilidad profunda:
Derecho
Izquierdo
Alterada__ Funcional__
Campo visual: Derecho
Izquierdo
Alterada__ Funcional__
Vestibular:
Audicin:
Dolor:
Localizacin
Tipo dolor
Dolor reposo (EVA)
Dolor en mov. (EVA)
Agravante
Atenuante
Duracin
Alterada___
Alterada___ Funcional___
Alterada___ Funcional___
No Alterada____
Alterada__ Funcional__
Anlisis Motor
Extremidades Superiores
ROM activo
________________________________________________________________________________
________________________________________________________________________________
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___
ROM pasivo
________________________________________________________________________________
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Disquinesia escapular
________________________________________________________________________________
_
Extremidades Inferiores
ROM activo
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
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ROM pasivo
________________________________________________________________________________
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Acortamiento Muscular
Isquiotibiales:
Test Thomas:
Tricep /gastrocnemio
Extensores Cd:
Reacciones de Enderezamiento
Reacciones de Apoyo
Supino a prono
Lado indemne
Lado afectado
Prono a Supino
Lado Indemne
Lado afectado
Transferencias
No logrado___
Marcha
Logrado____
Velocidad:
Longitud:
Cadencia:
Fase de Oscilacin
No logrado_____
Pronstico
Tabla CIF
ESTRUCTURA
FUNCIN
DIAGNOSTICO KINSICO
ACTIVIDAD
PARTICIPACIN
Objetivo General
Objetivos Especficos
Objetivos Teraputicos