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:

2

________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de fuerza muscular: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de funcionalidad: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Problema kinsico: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Objetivos kinsico: General: _________________________________________________________________________________ ________________________________________________________________________________________ Especficos: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Tratamiento kinsico: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________

3

Datos personales: Nombre: _________________________________________________________________________________ Edad: ___________________________________________________________________________________ Hijos: ___________________________________________________________________________________ Direccin: ________________________________________________________________________________ Fono: ___________________________________________________________________________________ Profesin: ________________________________________________________________________________ Diag Mdico: _____________________________________________________________________________ Fecha de ingreso: __________________________________________________________________________ Fecha de Alta: ____________________________________________________________________________ Exmenes: _______________________________________________________________________________ ________________________________________________________________________________________ Medicamentos: ___________________________________________________________________________ ________________________________________________________________________________________

4

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): _______________________________________________________________

5

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: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________

7

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: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________

9

Evaluacin de rangos articulares: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de fuerza muscular: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de funcionalidad: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Problema kinesico: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Objetivos kinesico: General: _________________________________________________________________________________ ________________________________________________________________________________________ Especificos: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Tratamiento kinesico: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________

10

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: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________

14

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: __________________________________________________________________________________

15

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: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________

16

Evaluacin de rangos articulares: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de fuerza muscular: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de funcionalidad: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Problema kinesico: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Objetivos kinesico: General: _________________________________________________________________________________ ________________________________________________________________________________________ Especificos: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Tratamiento kinesico: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________

17

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): _______________________________________________________

19

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:

20

________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Objetivos kinesico: General: _________________________________________________________________________________ ________________________________________________________________________________________ Especificos: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Tratamiento kinesico: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________

21

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:

22

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: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________

24

________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________

Datos personales: Nombre: _________________________________________________________________________________ Edad: ___________________________________________________________________________________ Hijos: ___________________________________________________________________________________ Direccin: ________________________________________________________________________________ Fono: ___________________________________________________________________________________ Profesin: ________________________________________________________________________________ Diag Medico: _____________________________________________________________________________ Fecha de ingreso: __________________________________________________________________________

25

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: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________

28

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: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________

30

Pruebas especiales pertinentes: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de rangos articulares: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de fuerza muscular: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Evaluacin de funcionalidad: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Problema kinesico: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Objetivos kinesico: General: _________________________________________________________________________________ ________________________________________________________________________________________ Especificos: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Tratamiento kinesico:

31

________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________

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:

34

________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Problema kinesico: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Objetivos kinesico: General: _________________________________________________________________________________ ________________________________________________________________________________________ Especificos: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Tratamiento kinesico: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________

35

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

____________________________________________________________________________________ ____________________________________________________________________________________ ___________________________________________