Ficha de avaliação Neurologica

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FICHA DE AVALIAÇÃO – PACIENTE NEUROLÓGICO
 
Nome: _________________________________________________ Sexo: ____________
Data de nascimento:________________________ Idade: _______Est. Civil:___________
Telefone: (___)_____________________ Celular: (___)____________________________
Celular Recado (___)_________________Profissão________________________________
Endereço:_________________________________________________________________
Data da avaliação: _________________ Avaliador:_______________________________
Diagnóstico clínico: _______________________________________________________
Queixa Principal_____________________________________________________________
______________________________________________________________________________________________________________________________________________________
HMA: _____________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
HMP: _____________________________________________________________________
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Medicamentos:_________________________________________________________________________________________________________________________________________ 
Inspenção:
Cicatrizes___________________________________________________________________
Edema______________________________________________________________________
Deformidades________________________________________________________________
Escaras_____________________________________________________________________
Órtese/ prótese_______________________________________________________________ 
Sinais vitais
PA: ______________ FR__________________ FC________________
Funções corticais superiores (linguagem, gnosias, praxias): _________________________
______________________________________________________________________________________________________________________________________________________
Marcha: ___________________________________________________________________
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Tônus muscular: ____________________________________________________________
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Força muscular: ____________________________________________________________
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Equilíbrio Estático: Sentado: ( ) presente ( ) ausente ( ) alterado 
Em pé: ( ) presente ( ) ausente ( ) alterado
Romberg ( ) presente ( ) ausente ( ) não testado
Equilíbrio Dinâmico: ( ) presente ( ) ausente ( ) alterado
Manobras deficitárias
Braços estendidos ____________________________________________________________
Raimiste ___________________________________________________________________
Mingazinni _________________________________________________________________
Queda dos MMI em abdução ___________________________________________________
Barré ______________________________________________________________________
Testes específicos para retração
Thomas ____________________________________________________________________
Ely________________________________________________________________________
Ângulo poplíteo _____________________________________________________________
Reflexos Profundos – miotáticos
Bicipital _______________________ Tricipital __________________________
Patelar ________________________ Calcâneo __________________________
Reflexos superficiais 
Cutâneo plantar ________________________ Hoffman ______________________
Oppenheim _____________________Cutâneo abdominal ____________________
Babinsk_________________________
Coordenação 
Index- index ________________________________________________________________
Index-nariz _________________________________________________________________
Index-index examinador ______________________________________________________
Calcanhar joelho ____________________________________________________________
Movimentos rítmicos e alternados ______________________________________________
Avaliação Sensorial: Superficial 
Dolorosa:___________________________________________________________________
Tátil:_______________________________________________________________________
Profunda Segmentar: 
___________________________________________________________________________
(Normoestesia/Hipoestesia/Hiperestesia/Anestesia)
Testes específicos e Escalas___________________________________________________
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Objetivos: __________________________________________________________________
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Condutas: __________________________________________________________________
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