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FICHA CLNICADatos personales: Nombre: _________________________________________________________________________________ Edad: ___________________________________________________________________________________ Hijos: ___________________________________________________________________________________ Direccin: ________________________________________________________________________________ Fono: ___________________________________________________________________________________ Profesin: ________________________________________________________________________________ Diag Mdico: _____________________________________________________________________________ Fecha de ingreso: __________________________________________________________________________ Fecha de Alta: ____________________________________________________________________________ Exmenes: _______________________________________________________________________________ ________________________________________________________________________________________ Medicamentos: ___________________________________________________________________________ ________________________________________________________________________________________ Anamnesis Remota: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Anamnesis Prxima: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin Fsica: Dolor: ___________________________________________________________________________________ Observacin: ________________________________________________________________________________________ ________________________________________________________________________________________ ______________________________ __________________________________________________________ Inspeccin: Piel: ____________________________________________________________________________________ Edema: __________________________________________________________________________________ Hematoma: ______________________________________________________________________________1
Vendaje: ________________________________________________________________________________ Cicatriz: _________________________________________________________________________________ lceras: _________________________________________________________________________________ Va externa: ______________________________________________________________________________ Palpacin: T corporal: ______________________________________________________________________________ Puntos dolorosos: _________________________________________________________________________ Contracturas: _____________________________________________________________________________ Acortamientos musculares: _________________________________________________________________ Tono muscular: ___________________________________________________________________________ Trofismo muscular: ________________________________________________________________________ Sensibilidad profunda (presin o dolor): _______________________________________________________ Sensibilidad superficial (tacto): _______________________________________________________________ Sensibilidad a temperaturas (fro-calor): _______________________________________________________ Movimientos de fasias: _____________________________________________________________________ Test de rasguo: __________________________________________________________________________ Movimientos vertebrales: ___________________________________________________________________ Trax (rgido-flexible): ______________________________________________________________________ Evaluacin postural: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Pruebas especiales pertinentes: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de rangos articulares:
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________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de fuerza muscular: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de funcionalidad: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Problema kinsico: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Objetivos kinsico: General: _________________________________________________________________________________ ________________________________________________________________________________________ Especficos: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Tratamiento kinsico: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________
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Datos personales: Nombre: _________________________________________________________________________________ Edad: ___________________________________________________________________________________ Hijos: ___________________________________________________________________________________ Direccin: ________________________________________________________________________________ Fono: ___________________________________________________________________________________ Profesin: ________________________________________________________________________________ Diag Mdico: _____________________________________________________________________________ Fecha de ingreso: __________________________________________________________________________ Fecha de Alta: ____________________________________________________________________________ Exmenes: _______________________________________________________________________________ ________________________________________________________________________________________ Medicamentos: ___________________________________________________________________________ ________________________________________________________________________________________
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Anamnesis Remota: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Anamnesis Prxima: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin Fsica: Dolor: ___________________________________________________________________________________ Observacin: ________________________________________________________________________________________ ________________________________________________________________________________________ ______________________________ __________________________________________________________ Inspeccin: Piel: ____________________________________________________________________________________ Edema: __________________________________________________________________________________ Hematoma: ______________________________________________________________________________ Vendaje: ________________________________________________________________________________ Cicatriz: _________________________________________________________________________________ lceras: _________________________________________________________________________________ Va externa: ______________________________________________________________________________ Palpacin: T corporal: ______________________________________________________________________________ Puntos dolorosos: _________________________________________________________________________ Contracturas: _____________________________________________________________________________ Acortamientos musculares: _________________________________________________________________ Tono muscular: ___________________________________________________________________________ Trofismo muscular: ________________________________________________________________________ Sensibilidad profunda (presin o dolor): _______________________________________________________ Sensibilidad superficial (tacto): _______________________________________________________________
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Sensibilidad a temperaturas (fro-calor): _______________________________________________________ Movimientos de fasias: _____________________________________________________________________ Test de rasguo: __________________________________________________________________________ Movimientos vertebrales: ___________________________________________________________________ Trax (rgido-flexible): ______________________________________________________________________ Evaluacin postural: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Pruebas especiales pertinentes: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de rangos articulares: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de fuerza muscular: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de funcionalidad: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Problema kinsico: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________6
________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Objetivos kinsico: General: _________________________________________________________________________________ ________________________________________________________________________________________ Especficos: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Tratamiento kinsico: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________
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Datos personales: Nombre: _________________________________________________________________________________ Edad: ___________________________________________________________________________________ Hijos: ___________________________________________________________________________________ Direccin: ________________________________________________________________________________ Fono: ___________________________________________________________________________________ Profesin: ________________________________________________________________________________ Diag Mdico: _____________________________________________________________________________ Fecha de ingreso: __________________________________________________________________________ Fecha de Alta: ____________________________________________________________________________ Exmenes: _______________________________________________________________________________ ________________________________________________________________________________________ Medicamentos: ___________________________________________________________________________ ________________________________________________________________________________________ Anamnesis Remota: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Anamnesis Prxima: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin Fsica: Dolor: ___________________________________________________________________________________ Observacin: ________________________________________________________________________________________ ________________________________________________________________________________________ ______________________________ __________________________________________________________ Inspeccin: Piel: ____________________________________________________________________________________ Edema: __________________________________________________________________________________8
Hematoma: ______________________________________________________________________________ Vendaje: ________________________________________________________________________________ Cicatriz: _________________________________________________________________________________ Ulceras: _________________________________________________________________________________ Va externa: ______________________________________________________________________________ Palpacin: T corporal: ______________________________________________________________________________ Puntos dolorosos: _________________________________________________________________________ Contracturas: _____________________________________________________________________________ Acortamientos musculares: _________________________________________________________________ Tono muscular: ___________________________________________________________________________ Trofismo muscular: ________________________________________________________________________ Sensibilidad profunda (presin o dolor): _______________________________________________________ Sensibilidad superficial (tacto): _______________________________________________________________ Sensibilidad a temperaturas (fro-calor): _______________________________________________________ Movimientos de fasias: _____________________________________________________________________ Test de rasguo: __________________________________________________________________________ Movimientos vertebrales: ___________________________________________________________________ Trax (rgido-flexible): ______________________________________________________________________ Evaluacin postural: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Pruebas especiales pertinentes: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________
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Evaluacin de rangos articulares: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de fuerza muscular: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de funcionalidad: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Problema kinesico: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Objetivos kinesico: General: _________________________________________________________________________________ ________________________________________________________________________________________ Especificos: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Tratamiento kinesico: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________
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Datos personales: Nombre: _________________________________________________________________________________ Edad: ___________________________________________________________________________________ Hijos: ___________________________________________________________________________________ Direccin: ________________________________________________________________________________ Fono: ___________________________________________________________________________________ Profesin: ________________________________________________________________________________ Diag Medico: _____________________________________________________________________________ Fecha de ingreso: __________________________________________________________________________ Fecha de Alta: ____________________________________________________________________________ Exmenes: _______________________________________________________________________________ ________________________________________________________________________________________ Medicamentos: ___________________________________________________________________________11
________________________________________________________________________________________ Anamnesis Remota: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Anamnesis Prxima: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin Fsica: Dolor: ___________________________________________________________________________________ Observacin: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Inspeccin: Piel: ____________________________________________________________________________________ Edema: __________________________________________________________________________________ Hematoma: ______________________________________________________________________________ Vendaje: ________________________________________________________________________________ Cicatriz: _________________________________________________________________________________ Ulceras: _________________________________________________________________________________ Va externa: ______________________________________________________________________________ Palpacin: T corporal: ______________________________________________________________________________ Puntos dolorosos: _________________________________________________________________________ Contracturas: _____________________________________________________________________________ Acortamientos musculares: _________________________________________________________________ Tono muscular: ___________________________________________________________________________ Trofismo muscular: ________________________________________________________________________ Sensibilidad profunda (presin o dolor): _______________________________________________________ Sensibilidad superficial (tacto): _______________________________________________________________12
Sensibilidad a temperaturas (fro-calor): _______________________________________________________ Movimientos de fasias: _____________________________________________________________________ Test de rasguo: __________________________________________________________________________ Movimientos vertebrales: ___________________________________________________________________ Trax (rgido-flexible): ______________________________________________________________________ Evaluacin postural: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Pruebas especiales pertinentes: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de rangos articulares: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de fuerza muscular: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de funcionalidad: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Problema kinesico: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________13
________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Objetivos kinesico: General: _________________________________________________________________________________ ________________________________________________________________________________________ Especificos: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Tratamiento kinesico: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________
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Datos personales: Nombre: _________________________________________________________________________________ Edad: ___________________________________________________________________________________ Hijos: ___________________________________________________________________________________ Direccin: ________________________________________________________________________________ Fono: ___________________________________________________________________________________ Profesin: ________________________________________________________________________________ Diag Medico: _____________________________________________________________________________ Fecha de ingreso: __________________________________________________________________________ Fecha de Alta: ____________________________________________________________________________ Exmenes: _______________________________________________________________________________ ________________________________________________________________________________________ Medicamentos: ___________________________________________________________________________ ________________________________________________________________________________________ Anamnesis Remota: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Anamnesis Prxima: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin Fsica: Dolor: ___________________________________________________________________________________ Observacin: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Inspeccin: Piel: ____________________________________________________________________________________ Edema: __________________________________________________________________________________
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Hematoma: ______________________________________________________________________________ Vendaje: ________________________________________________________________________________ Cicatriz: _________________________________________________________________________________ Ulceras: _________________________________________________________________________________ Va externa: ______________________________________________________________________________ Palpacin: T corporal: ______________________________________________________________________________ Puntos dolorosos: _________________________________________________________________________ Contracturas: _____________________________________________________________________________ Acortamientos musculares: _________________________________________________________________ Tono muscular: ___________________________________________________________________________ Trofismo muscular: ________________________________________________________________________ Sensibilidad profunda (presin o dolor): _______________________________________________________ Sensibilidad superficial (tacto): _______________________________________________________________ Sensibilidad a temperaturas (fro-calor): _______________________________________________________ Movimientos de fasias: _____________________________________________________________________ Test de rasguo: __________________________________________________________________________ Movimientos vertebrales: ___________________________________________________________________ Trax (rgido-flexible): ______________________________________________________________________ Evaluacin postural: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Pruebas especiales pertinentes: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________
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Evaluacin de rangos articulares: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de fuerza muscular: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de funcionalidad: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Problema kinesico: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Objetivos kinesico: General: _________________________________________________________________________________ ________________________________________________________________________________________ Especificos: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Tratamiento kinesico: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________
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Datos personales: Nombre: _________________________________________________________________________________ Edad: ___________________________________________________________________________________ Hijos: ___________________________________________________________________________________ Direccin: ________________________________________________________________________________ Fono: ___________________________________________________________________________________ Profesin: ________________________________________________________________________________ Diag Medico: _____________________________________________________________________________ Fecha de ingreso: __________________________________________________________________________ Fecha de Alta: ____________________________________________________________________________ Exmenes: _______________________________________________________________________________ ________________________________________________________________________________________ Medicamentos: ___________________________________________________________________________18
________________________________________________________________________________________ Anamnesis Remota: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Anamnesis Prxima: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin Fsica: Dolor: ___________________________________________________________________________________ Observacin: ________________________________________________________________________________________ ________________________________________________________________________________________ ______________________________ __________________________________________________________ Inspeccin: Piel: ____________________________________________________________________________________ Edema: __________________________________________________________________________________ Hematoma: ______________________________________________________________________________ Vendaje: ________________________________________________________________________________ Cicatriz: _________________________________________________________________________________ Ulceras: _________________________________________________________________________________ Va externa: ______________________________________________________________________________ Palpacin: T corporal: ______________________________________________________________________________ Puntos dolorosos: _________________________________________________________________________ Contracturas: _____________________________________________________________________________ Acortamientos musculares: _________________________________________________________________ Tono muscular: ___________________________________________________________________________ Trofismo muscular: ________________________________________________________________________ Sensibilidad profunda (presin o dolor): _______________________________________________________
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Sensibilidad superficial (tacto): _______________________________________________________________ Sensibilidad a temperaturas (fro-calor): _______________________________________________________ Movimientos de fasias: _____________________________________________________________________ Test de rasguo: __________________________________________________________________________ Movimientos vertebrales: ___________________________________________________________________ Trax (rgido-flexible): ______________________________________________________________________ Evaluacin postural: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Pruebas especiales pertinentes: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de rangos articulares: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de fuerza muscular: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de funcionalidad: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Problema kinesico:
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________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Objetivos kinesico: General: _________________________________________________________________________________ ________________________________________________________________________________________ Especificos: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Tratamiento kinesico: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________
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Datos personales: Nombre: _________________________________________________________________________________ Edad: ___________________________________________________________________________________ Hijos: ___________________________________________________________________________________ Direccin: ________________________________________________________________________________ Fono: ___________________________________________________________________________________ Profesin: ________________________________________________________________________________ Diag Medico: _____________________________________________________________________________ Fecha de ingreso: __________________________________________________________________________ Fecha de Alta: ____________________________________________________________________________ Exmenes: _______________________________________________________________________________ ________________________________________________________________________________________ Medicamentos: ___________________________________________________________________________ ________________________________________________________________________________________ Anamnesis Remota: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Anamnesis Prxima: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin Fsica: Dolor: ___________________________________________________________________________________ Observacin: ________________________________________________________________________________________ ________________________________________________________________________________________ ______________________________ __________________________________________________________ Inspeccin:
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Piel: ____________________________________________________________________________________ Edema: __________________________________________________________________________________ Hematoma: ______________________________________________________________________________ Vendaje: ________________________________________________________________________________ Cicatriz: _________________________________________________________________________________ Ulceras: _________________________________________________________________________________ Va externa: ______________________________________________________________________________ Palpacin: T corporal: ______________________________________________________________________________ Puntos dolorosos: _________________________________________________________________________ Contracturas: _____________________________________________________________________________ Acortamientos musculares: _________________________________________________________________ Tono muscular: ___________________________________________________________________________ Trofismo muscular: ________________________________________________________________________ Sensibilidad profunda (presin o dolor): _______________________________________________________ Sensibilidad superficial (tacto): _______________________________________________________________ Sensibilidad a temperaturas (fro-calor): _______________________________________________________ Movimientos de fasias: _____________________________________________________________________ Test de rasguo: __________________________________________________________________________ Movimientos vertebrales: ___________________________________________________________________ Trax (rgido-flexible): ______________________________________________________________________ Evaluacin postural: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Pruebas especiales pertinentes: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________23
________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de rangos articulares: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de fuerza muscular: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de funcionalidad: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Problema kinesico: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Objetivos kinesico: General: _________________________________________________________________________________ ________________________________________________________________________________________ Especificos: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Tratamiento kinesico: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________
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________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________
Datos personales: Nombre: _________________________________________________________________________________ Edad: ___________________________________________________________________________________ Hijos: ___________________________________________________________________________________ Direccin: ________________________________________________________________________________ Fono: ___________________________________________________________________________________ Profesin: ________________________________________________________________________________ Diag Medico: _____________________________________________________________________________ Fecha de ingreso: __________________________________________________________________________
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Fecha de Alta: ____________________________________________________________________________ Exmenes: _______________________________________________________________________________ ________________________________________________________________________________________ Medicamentos: ___________________________________________________________________________ ________________________________________________________________________________________ Anamnesis Remota: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Anamnesis Prxima: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin Fsica: Dolor: ___________________________________________________________________________________ Observacin: ________________________________________________________________________________________ ________________________________________________________________________________________ ______________________________ __________________________________________________________ Inspeccin: Piel: ____________________________________________________________________________________ Edema: __________________________________________________________________________________ Hematoma: ______________________________________________________________________________ Vendaje: ________________________________________________________________________________ Cicatriz: _________________________________________________________________________________ Ulceras: _________________________________________________________________________________ Va externa: ______________________________________________________________________________ Palpacin: T corporal: ______________________________________________________________________________ Puntos dolorosos: _________________________________________________________________________ Contracturas: _____________________________________________________________________________ Acortamientos musculares: _________________________________________________________________26
Tono muscular: ___________________________________________________________________________ Trofismo muscular: ________________________________________________________________________ Sensibilidad profunda (presin o dolor): _______________________________________________________ Sensibilidad superficial (tacto): _______________________________________________________________ Sensibilidad a temperaturas (fro-calor): _______________________________________________________ Movimientos de fasias: _____________________________________________________________________ Test de rasguo: __________________________________________________________________________ Movimientos vertebrales: ___________________________________________________________________ Trax (rgido-flexible): ______________________________________________________________________ Evaluacin postural: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Pruebas especiales pertinentes: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de rangos articulares: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de fuerza muscular: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de funcionalidad: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________27
________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Problema kinesico: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Objetivos kinesico: General: _________________________________________________________________________________ ________________________________________________________________________________________ Especificos: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Tratamiento kinesico: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________
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Datos personales: Nombre: _________________________________________________________________________________ Edad: ___________________________________________________________________________________ Hijos: ___________________________________________________________________________________ Direccin: ________________________________________________________________________________ Fono: ___________________________________________________________________________________ Profesin: ________________________________________________________________________________ Diag Medico: _____________________________________________________________________________ Fecha de ingreso: __________________________________________________________________________ Fecha de Alta: ____________________________________________________________________________ Exmenes: _______________________________________________________________________________ ________________________________________________________________________________________ Medicamentos: ___________________________________________________________________________ ________________________________________________________________________________________ Anamnesis Remota: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Anamnesis Prxima: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin Fsica: Dolor: ___________________________________________________________________________________ Observacin: ________________________________________________________________________________________ ________________________________________________________________________________________29
______________________________ __________________________________________________________ Inspeccin: Piel: ____________________________________________________________________________________ Edema: __________________________________________________________________________________ Hematoma: ______________________________________________________________________________ Vendaje: ________________________________________________________________________________ Cicatriz: _________________________________________________________________________________ Ulceras: _________________________________________________________________________________ Va externa: ______________________________________________________________________________ Palpacin: T corporal: ______________________________________________________________________________ Puntos dolorosos: _________________________________________________________________________ Contracturas: _____________________________________________________________________________ Acortamientos musculares: _________________________________________________________________ Tono muscular: ___________________________________________________________________________ Trofismo muscular: ________________________________________________________________________ Sensibilidad profunda (presin o dolor): _______________________________________________________ Sensibilidad superficial (tacto): _______________________________________________________________ Sensibilidad a temperaturas (fro-calor): _______________________________________________________ Movimientos de fasias: _____________________________________________________________________ Test de rasguo: __________________________________________________________________________ Movimientos vertebrales: ___________________________________________________________________ Trax (rgido-flexible): ______________________________________________________________________ Evaluacin postural: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________
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Pruebas especiales pertinentes: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de rangos articulares: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de fuerza muscular: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de funcionalidad: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Problema kinesico: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Objetivos kinesico: General: _________________________________________________________________________________ ________________________________________________________________________________________ Especificos: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Tratamiento kinesico:
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________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________
Datos personales: Nombre: _________________________________________________________________________________ Edad: ___________________________________________________________________________________ Hijos: ___________________________________________________________________________________ Direccin: ________________________________________________________________________________ Fono: ___________________________________________________________________________________ Profesin: ________________________________________________________________________________ Diag Medico: _____________________________________________________________________________32
Fecha de ingreso: __________________________________________________________________________ Fecha de Alta: ____________________________________________________________________________ Exmenes: _______________________________________________________________________________ ________________________________________________________________________________________ Medicamentos: ___________________________________________________________________________ ________________________________________________________________________________________ Anamnesis Remota: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Anamnesis Prxima: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin Fsica: Dolor: ___________________________________________________________________________________ Observacin: ________________________________________________________________________________________ ________________________________________________________________________________________ ______________________________ __________________________________________________________ Inspeccin: Piel: ____________________________________________________________________________________ Edema: __________________________________________________________________________________ Hematoma: ______________________________________________________________________________ Vendaje: ________________________________________________________________________________ Cicatriz: _________________________________________________________________________________ Ulceras: _________________________________________________________________________________ Va externa: ______________________________________________________________________________ Palpacin: T corporal: ______________________________________________________________________________ Puntos dolorosos: _________________________________________________________________________ Contracturas: _____________________________________________________________________________33
Acortamientos musculares: _________________________________________________________________ Tono muscular: ___________________________________________________________________________ Trofismo muscular: ________________________________________________________________________ Sensibilidad profunda (presin o dolor): _______________________________________________________ Sensibilidad superficial (tacto): _______________________________________________________________ Sensibilidad a temperaturas (fro-calor): _______________________________________________________ Movimientos de fasias: _____________________________________________________________________ Test de rasguo: __________________________________________________________________________ Movimientos vertebrales: ___________________________________________________________________ Trax (rgido-flexible): ______________________________________________________________________ Evaluacin postural: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Pruebas especiales pertinentes: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de rangos articulares: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de fuerza muscular: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de funcionalidad:
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________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Problema kinesico: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Objetivos kinesico: General: _________________________________________________________________________________ ________________________________________________________________________________________ Especificos: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Tratamiento kinesico: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________
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FICHA KINSICA NEUROLGICA Antecedes Personales:
Nombre: _____________________________________________________________________________ Fecha de nacimiento: __________________________________________________________________ Edad Cronolgica: _____________________________________________________________________ Edad motriz: __________________________________________________________________________ Rut: _________________________________________________________________________________ Domicilio: ____________________________________________________________________________ Colegio: _____________________________________________________________________________ Nombre de los Padres: _________________________________________________________________ Domicilio de los Padres: ________________________________________________________________ Diagnstico Clnico: ____________________________________________________________________ Diagnstico Topogrfico: _______________________________________________________________ Patologas Asociadas: __________________________________________________________________ Fecha de Ingreso: ______________________________________________________________________ Procedencia: _________________________________________________________________________ Evaluador: ___________________________________________________________________________ Fecha de Evaluacin: ___________________________________________________________________
Anamnesis:
Prxima: ____________________________________________________________________________________36
____________________________________________________________________________________ ____________________________________________________________________________________ ___________________________________________