FISIOTERAPIA 2019

Ficha de Avaliação Fisioterapêutica

Identificação:
Nome: ____________________________________________________________
Data de Nascimento: ____/____/____ Idade: ___________________________
Estado Civil: _______________________ Sexo: ___________________________
Endereço: __________________________________________________________
Cidade: _________________________ Telefone:____ ______________________
Profissão: __________________________________________________________
Anamnese:
Data da Avaliação: ____/_____/______ Início do tratamento:____/_____/______
Diagnóstico Médico: _________________________________________________
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Diagnóstico Fisioterapêutico: ___________________________________________
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Queixa Principal:____________________________________________________
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História:____________________________________________________________
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Medicamentos:_______________________________________________________
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Exame Físico:
Inspeção Estática: ____________________________________________________
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Inspeção dinâmica:___________________________________________________
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Palpação:___________________________________________________________
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Sensibilidade:______________________________________________________
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Goniometria: _______________________________________________________
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Perimetria: _________________________________________________________
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Grau de força muscular:
MMSS: _____________________________________________________________
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MMII:_______________________________________________________________
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Cirurgias: ____________________________________________________
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Alterações da Marcha:________________________________________________
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Testes Especiais: _____________________________________________________

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Exames Complementares: _____________________________________________
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FLEXIBILIDADE:
 FISIOTERAPIA 2019

Dor Em Alguma Parte Do Corpo? SIM______ NÃO _____

E.V.A:____________________________________________________________

AVALIAÇÃO POSTURAL:

Vista anterior

Cabeça: ( ) Linha Média ( ) Rodada p/ D ( ) Rodada p/ E

( ) Fletida p/ D ( ) Fletida p/ E

Ombros: ( ) ( ) Alinhado ( ) ( ) Elevado ( ) ( ) Deprimido ( ) ( ) Alinhada

Clavículas: ( ) ( ) Verticalizada ( ) ( ) Horizontalizada ( ) Normal

Tórax: ( ) Peito de Pombo ( ) Em Tonel ( ) ( ) Neutro

Braços: ( ) ( ) Pronado ( ) ( ) Supinado ( ) Simétrico

Triângulo de Tales: ( ) Diminuído à D ( ) Diminuído á E ( ) Alinhada

Pelve: ( ) Rodada anterior ( ) Alinhadas

 FISIOTERAPIA 2019

EIAS: ( ) Elevada a D ( ) Elevada a E

Massa do Quadríceps: ( ) Simétrico ( ) Assimétrico ( )

Patelas: ( ) Simétrica ( ) ( ) Elevada ( ) ( ) Lateralizada ( ) ( ) Normal

Joelhos: ( ) ( ) Valgo ( ) ( ) Varo ( ) ( ) Normal

Hálux: ( ) ( ) Valgo ( ) ( ) Varo ( ) ( ) Normal

Pés: ( ) ( ) Pronado ( ) ( ) Supinado ( ) ( ) Arco Normal ( ) ( ) Arco Cavo ( ) ( )

Arco Plano ( ) ( ) Antepé Valgo ( ) ( ) Antepé Varo

Vista Lateral

Cabeça: ( ) Alinhada ( ) Protrusa ( ) Retraída

Cervical: ( ) Hiperlordose ( ) Retificada ( ) Normal

Ombros: ( ) ( ) Protuso ( ) ( ) Retruso ( ) ( ) Normal

Torácica: ( ) Hipercifose ( ) Retificada ( ) Normal

Lombar : ( ) Hiperlordose ( ) Retificada ( ) Normal

Pelve: ( ) Anteversão ( ) Retroversão ( ) Neutro (30°)

Joelhos: ( ) ( ) Normal ( ) ( ) Hiperextensão ( ) ( ) Genuflexo

Vista Posterior:

Escápulas : ( ) ( ) Normal ( ) ( ) Aduzida ( ) ( ) Abduzida

( ) ( ) Alada ( ) ( ) Elevada ( ) ( ) Deprimida

Processos Espinhosos: ( ) Alinhados ( ) ( ) Desvio

EIPS: ( ) Elevada a D ( ) Elevada a E ( ) Alinhadas

Pregadas Glúteas: ( ) Simétrico ( ) ( ) Assimétrico

Massa do Tríceps: ( ) Simétrico ( ) ( ) Hipotrófica ( ) ( ) Hipertrófica

Tendão do Calcâneo: ( ) ( ) Normal ( ) ( ) Valgo ( ) ( ) Varo

 FISIOTERAPIA 2019

AVALIAÇÃO NEUROLÓGICA:
Reflexos Superficiais ou Proprioceptivos ( patológicos ):
Cutâneo Plantar: Cutâneo Abdominal:

Reflexos Profundos ou Exteroceptivos:

Bicipital Tricipital Braquiorradial
Patelar Aquileu Adutor

Sensibilidade
Superficial (Exteroceptiva) Profunda (Proprioceptiva)
Tátil: Cinestésica:
Dolorosa: Barognosia (peso)
Térmica: Barestésica (pressão)
Grafestesia
Estereognóstica (Objetos)

Coordenação e Equilíbrio
Índex-índex: Índex-nariz:
Índex-Orelha Romberg:
Diadococinesia: Calcanhar-joelho:
Grafia ( figura ): Batida do Pé:

Manobras Deficitárias da Motricidade:

Braços Estend.: Barré: Mingazzini:
Raimiste: Prova da queda do membro
inferior em abdução:

CONDUTA:

Objetivo do(a) paciente: ( ) Melhora Postural ( ) Alívio do Stress ()

Alongamento ( ) Alívio da Dor ( ) Melhora do Condicionamento Físico ( )
Fortalecimento Muscular ( ) Outros

Objetivos:__________________________________________________________
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Plano de Tratamento:______________________________________
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Assinatura
 FISIOTERAPIA 2019

Evolução
Paciente: ____________________________________________________________

DATA
 FISIOTERAPIA 2019

Relatório Fisioterapêutico

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Assinatura