modelo de ficha de Avaliação fisioterapêutica Neurologica adulto

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 UNIC - UNIVERSIDADE DE CUIABÁ 
 FACULDADE DE FISIOTERAPIA 
 FICHA DE AVALIAÇÃO NEUROLOGICA 
 
 
1 - IDENTIFICAÇÃO DO PACIENTE: 
 
NOME: ________________________________________IDADE:_____SEXO:___RAÇA:_______ 
ESTADO CIVIL:___________________________________________________________________ 
PROFISSÃO:______________________________________________________________________ 
ENDEREÇO:______________________________________________________________________ 
TELEFONE: _____________________________________________________________________ 
ESTAGIARIO:_____________________________________________________________________ 
DATA:___________________________________________________________________________ 
 
2 - AVALIAÇÃO DA DISFUNÇÕES: 
 
QUEIXA PRINCIPAL (Q.P: )__________________________________________________________________ 
___________________________________________________________________________________________ 
 
H.M.P. e H.M. A:_________________________________________________________________________ 
__________________________________________________________________________
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3 – DADOS CLINICOS: 
 
 SINAIS VITAIS: P.A.S : _________________FC :___________________ FR :_________________ 
 
DIAGNOSTICO CLINICO:_________________________________________________________ 
 
 EXAMES COMPLEMENTARES:_____________________________________________________ 
 
ANTECEDENTES CIRÚRGICOS: ___________________________________________________ 
 
PATOLOGIA ASSOCIADA: ________________________________________________________ 
 
MEDICAMENTOS:________________________________________________________________ 
 
 4- EXAMES NEURO- FUNCIONAIS : 
 
INSPEÇÃO: ________________________________________________________________ 
__________________________________________________________________________ 
 __________________________________________________________________________ 
 
 PALPAÇÃO: ______________________________________________________________________ 
 __________________________________________________________________________________ 
 ___________________________________________________________________________ 
 
REFLEXO : _______________________________________________________________ 
 __________________________________________________________________________ 
 __________________________________________________________________________ 
 
TONOS MUSCULAR :_____________________________________________________________ 
________________________________________________________________________________ 
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TROFISMO :_____________________________________________________________________ 
________________________________________________________________________________ 
 
MOTRICIDADE:___________________________________________________________________
________________________________________________________________________________ 
 
 5- TESTES ESPECIAIS: 
 
 CORDENAÇÃO ESTATICA: 
 
 Teste para MMII: 
 
• Teste de Mingazzini: 
• Teste de queda dos membros inferiores em Abdução: 
• Teste de Barré: 
 
 Teste para MMSS: 
 
• Teste de Mingazzini: 
• Teste de queda dos membros superiores em Adução: 
• Teste de Raimiste: 
 
 CORDENAÇÃO DINAMICA: 
 
• MMSS: 
• MSD: 
• MSE: 
• MMII: 
• MID: 
• MIE: 
 
MARCHA:________________________________________________________________________
_________________________________________________________________________________ 
 
FORÇA MUSCULAR: 
• MMSS: _______________________________________________________________________ 
 _____________________________________________________________________________ 
 _____________________________________________________________________________ 
 
• MMII: _______________________________________________________________________ 
_____________________________________________________________________________ 
_____________________________________________________________________________ 
 
6- DIAGNOSTICO FISIOTERAPÊUTICO: 
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OBJETIVO DE TRATAMENTO: 
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PLANO DE TRATAMENTO: 
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EDUCAÇÃO E SAÚDE: 
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	FICHA DE AVALIAÇÃO NEUROLOGICA
	REFLEXO : _______________________________________________________________