Pauta de Evaluación Fonoaudiológica Para La Fluidez Modificada

8/19/2019 Pauta de Evaluación Fonoaudiológica Para La Fluidez Modificada

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PAUTA DE EVALUACIÓN FONOAUDIOLÓGICA PARA PERSONASQUE CONSULTAN POR TARTAMUDEZ MODIFICADA (P.E.F.T.)

(D. Ahumada, D. Alda, M. M!"a#da, P. Zam$"a#$)

NOMBRE DEL PACIENTE:____________________________________________

FECHA DE NACIMIENTO:_____________________EDAD:__________________

TELÉFONOS:________________________________MAIL:__________________

MOTIVO DE CONSULTA:

( ) Iniciativa Pr!ia ( ) Fa"i#iar ( ) T$ acn%$&arn '$ vini$ra%

( ) T$ #i*arn_____________________________________________________

( ) D$riva+ +$ tr !r,$%ina# -C.#/__________________________________

Dia*n0%tic +$# Pr,$%ina#____________________________________________

MÓDULO I% ENTREVISTA

123 ANTECEDENTES 4ENERALES DEL PACIENTE

A. MORBILIDAD

3 -Ti$n$% 5a% t$ni+ a#*6n !r#$"a $n,$r"$+a+ i"!rtant$/ ( ) S7 ( ) N

-C.#/ ___________________________________________________________

Ti! +$ Trata"i$nt _________________________________________________

3 -T"a% 5a% t"a+ a#*6n ti! +$ "$+ica"$nt/ ( ) S7 ( ) N

-C.#/ ___________________________________________________________

3 -Ha% $%ta+ $n trata"i$nt ,na+i#0*ic !r$vi/ ( ) S7 ( ) N


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_________________________________________________________________

B2 ANTECEDENTES DEL LEN4UA8E

3 Sa$% +$ a#*na +i,ic#ta+ $n $# inici +$# #$n*a&$ ( ) S7 ( ) N

-C.#/ (S$ t$ $nt$n+7a !c9 t$ c%t0 !rnnciar9 $tc2)

__________________________________________________________________

__________________________________________________________________

3 -Ha% i+ a $%c$#a +$ #$n*a&$/ ( ) S7 ( ) N

Dia*n0%tic________________________________________________________

Ti$"! +$ !$r"an$ncia ______________________________________________

Cn+ici0n +$ $*r$% ( ) A#ta ( ) D$%$rci0n ( ) Pr"ci0n a E+2 B.%ica

C2 ANTECEDENTES ESCOLARES

3 E%c#ari+a+: ( ) B.%ica ( ) M$+ia ( ) S!$rir

3 R$n+i"i$nt______________________________

3 R$!it$ncia: ( ) S7 ( ) N Cr%: ______________

3 -Ti$n$% tvi%t$ !r#$"a% $n a#*na a%i*natra/ ( ) S7 ( ) N

-Pr '/: ( ) nta% a&a% ( ) "a#a r$#aci0n cn $# !r,$%r ( ) !ca "tivaci0n

( ) Otr%___________________________________________________________

D2 SOCIABILIDAD

3 T$ cn%i+$ra%: ( ) T7"i+ ( ) S#itari ( ) Pc Scia#$ ( ) In'i$t

( ) E;trv$rti+ ( ) Otr%______________________________________________ 3 -Va% a r$nin$% %cia#$%/ ( ) S ( ) CS ( ) AV ( ) N


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3 -C0" t$ ##$va% cn t% !r,$%r$%/___________________________________

__________________________________________________________________

3 -C0" t$ ##$va% cn t% c"!a


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__________________________________________________________________

3 -T$ "#$%ta '$ t$ !r$*nt$n t n"r$/ ( ) S7 ( ) N __________________________________________________________________

__________________________________________________________________

3 -T$ *%ta 5a#ar cn t !a!./9 -C0" t$ ##$va% cn #/ __________________________________________________________________

__________________________________________________________________

3 -T$ *%ta 5a#ar cn t "a"./9 -C0" t$ ##$va% cn $##a/ __________________________________________________________________

__________________________________________________________________

3 -C0" cr$$% '$ t$ tratan t% !a!.%/ __________________________________________________________________

__________________________________________________________________

3 -C0" %$ ##$van t% !a!.%/

__________________________________________________________________

__________________________________________________________________

3 -T$ *%ta 5a#ar cn t% 5$r"an% = !ri"%/9 -C0" t$ ##$va% cn $##%/ __________________________________________________________________

__________________________________________________________________

3 -T$ *%ta 5a#ar cn #% !$r%na% +$ t $+a+/9 -C0" t$ ##$va% cn $##%/ __________________________________________________________________

__________________________________________________________________

3 -T$ *%ta '$ t$ "an+$n a c"!rar/ ( ) S ( ) CS ( ) AV ( ) N __________________________________________________________________


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__________________________________________________________________

3 -T$ *%ta 5a#ar !r t$#,n/ ( ) S ( ) CS ( ) AV ( ) N __________________________________________________________________

__________________________________________________________________

3 -L#a"a% a tr% !r t$#,n/ ( ) S ( ) CS ( ) AV ( ) N __________________________________________________________________

__________________________________________________________________

3 -Ati$n+$% $# t$#,n/ ( ) S ( ) CS ( ) AV ( ) N __________________________________________________________________

__________________________________________________________________

3 -T$ *%ta 5a#ar can+ $%ta% $n *r!/ ( ) S ( ) CS ( ) AV ( ) N _________________________________________________________________

_________________________________________________________________

3 -T$ inc"+a '$ t$ !r$*nt$n a#* !$r%na% +$%cnci+a%/ ( ) S ( ) CS( ) AV ( ) N

__________________________________________________________________

__________________________________________________________________

3 -T$ "#$%ta t$n$r '$ r$!$tir # '$ =a +i&i%t$/ ( ) S ( ) CS ( ) AV ( ) N

__________________________________________________________________

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3 -T$ *%ta ir a $%t+iar (C#$*i Univ$r%i+a+ In%titt)/ ( ) S ( ) CS ( ) AV ( ) N __________________________________________________________________

__________________________________________________________________


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3 -T$ *%ta #$$r $n v a#ta +i%$rtar $n c#a%$%/ ( ) S ( ) CS ( ) AV ( ) N __________________________________________________________________

__________________________________________________________________

3 -T$ !n$% n$rvi%(a) a# cnt$%tar can+ !a%an #i%ta/ ( ) S ( ) CS ( ) AV ( ) N __________________________________________________________________

__________________________________________________________________

3 -An %ai$n+ #a r$%!$%ta crr$cta9 ti$n$% "i$+ +$ cnt$%tar #a% !r$*nta% $nc#a%$%/ ( ) S ( ) CS ( ) AV ( ) N

__________________________________________________________________

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3 -Hac$% "c5a% !r$*nta% $n c#a%$%/ ( ) S ( ) CS ( ) AV ( ) N __________________________________________________________________

__________________________________________________________________

3 -T$ *%ta 5a#ar cn t% !r,$%r$%/ ( ) S ( ) CS ( ) AV ( ) N __________________________________________________________________

__________________________________________________________________

3 -T$ ac$rcar7a% a n c"!a


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-Pr '/ __________________________________________________________________

3 -Si$nt$% '$ t% !a!.% t$ $%cc5an can+ 5a#a%/ __________________________________________________________________

__________________________________________________________________

3 -Can+ 5a#a% t$ +ic$n: '+at$ tran'i#(a)9 r$%!ira9 $"!i$a +$ n$v222/( ) S ( ) CS ( ) AV ( ) N

__________________________________________________________________

3 -Si$nt$% '$ a #% +$".% n #$% *%ta $%tar cnti* %$ !n$n n$rvi%%!r'$ t$ traa%/ ( ) S ( ) CS ( ) AV ( ) N

__________________________________________________________________

__________________________________________________________________

3 -Si$"!r$ '$ 'i$r$% +$cir a#*9 # +ic$%/ ( ) S ( ) CS ( ) AV ( ) N __________________________________________________________________

__________________________________________________________________

3 -A#*i$n %$ 5a r#a+ +$ ti/ ( ) S ( ) CS ( ) AV ( ) N

__________________________________________________________________

__________________________________________________________________

3 -> 5a% 5$c5 t6/ __________________________________________________________________

__________________________________________________________________

2 FACTORES 4ATILLANTES (C$%tinari n ?)

3 -> cr$$% '$ !rvc0 t ,r"a +$ 5a#ar/ 0 -T6 cr$$% a%cia% a#*6n $v$nt !r#$"a cn $# inici +$ t ,r"a +$ 5a#ar/

__________________________________________________________________

__________________________________________________________________


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3 -Fr$nt$ a ' %itacin$% !$r%na% a"$nta $%ta ,r"a +$ 5a#ar t=a/

( ) P$r%na% cn atri+a+ __________________________________________________________________ ( ) Fa"i#iar$%

__________________________________________________________________ ( ) Par$%

__________________________________________________________________ ( ) E;tra 5ac$% 5aita#"$nt$ can+ a!ar$c$ $%ta ,r"a +$ 5a#ar/:( ) Ha#a% ".% #$nt

__________________________________________________________________ ( ) T$ ca##a%

__________________________________________________________________ ( ) T$ $%,$ra% ".%

__________________________________________________________________ ( ) T$ !n$% c#ra+

__________________________________________________________________ ( ) T$ an*%tia% = tran%!ira%

__________________________________________________________________

( ) T$ !n$% a,0nic +i%,0nic __________________________________________________________________ ( ) D$%v7a% #a "ira+a

__________________________________________________________________ ( ) Hac$% a#*6n *$%t

__________________________________________________________________ ( ) Hac$% a#*6n "vi"i$nt cn $# c$r!

__________________________________________________________________


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( ) L#ra% __________________________________________________________________ ( ) 4#!$a% $# !i% cn $# !i$

__________________________________________________________________ ( ) L$ !i+$% a tr% '$ 5a#$n !r ti

__________________________________________________________________ ( ) Otr%

__________________________________________________________________ 2 POSTURA FRENTE A LA TERAPIA

3 -E%ta ,r"a +$ 5a#ar t=a %i$nt$% '$ $% n !r#$"a/ ( ) S ( ) CS ( ) AV( ) N -Pr '/

__________________________________________________________________

__________________________________________________________________

3 -T$ *%tar7a "$&rar/ ( ) S7 ( ) N ( ) N % ( ) M$ +a # "i%"-Pr '/

__________________________________________________________________

__________________________________________________________________

3 -> $;!$ctativa% ti$n$% $n cant a# trata"i$nt/ __________________________________________________________________

__________________________________________________________________


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MÓDULO II% AUTOPERCEPCIÓN (C$%tinari n )


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MÓDULO III% EVALUACIÓN FLUIDEZ

I.& 'a Fu#*!$#al dl +ala12 R$%!iraci0n

M+ R$%!iratri: ( ) ca# ( ) na%a# ( ) "i;t

Ti! R$%!iratri: ( ) c%ta# a#t ( ) c%t+ia,ra*".tic ( ) a+"ina#

CFR: 3 L$ctraD$%cri!ci0n ( ) nr"a# ( ) a#t$ra+a

3 S!# ( ) nr"a# ( ) a#t$ra+aS7nt$%i%

__________________________________________________________________ __________________________________________________________________

?2 Tnici+a+

T$n%i0n 4$n$ra#: ( ) a"$nta+a ( ) +i%"ini+a ( ) nr"a#

T$n%i0n S$*"$ntaria:

3 Or,acia#: ( ) a"$nta+a ( ) +i%"ini+a ( ) nrna#

3 C$rvica#: ( ) a"$nta+a ( ) +i%"ini+a ( ) nr"a#

3 Para#ar7n*$a: ( ) a"$nta+a ( ) +i%"ini+a ( ) nr"a#

S7nt$%i%

__________________________________________________________________ __________________________________________________________________

2 V

E"i%i0n: ( ) nr"a# ( ) +i%,0nica ( ) a,0nica

Tn: ( ) a+$ca+a ( ) a# a*+ ( ) a# *rav$ varia#$

Int$n%i+a+: ( ) a+$ca+a ( ) ,$rt$ ( ) +i#

R$%nancia: ( ) a+$ca+a ( ) na%a# ( ) 5i!ana%a# ( ) ,ar7n*$a

Pr%+ia: ( ) a+$ca+a ( ) $;a*$ra+a ( ) "n0tna


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A!$rtra ca# ( ) a+$ca+a ( ) a"$nta+a ( ) $%ca%a

S7nt$%i%: __________________________________________________________________________________ __________________________________________________________________________________

II C"!n$nt$% +$ #a ,#i+$

12 V$#ci+a+ L$ctra :_______ ; "in ( ) a"$nta+a ( ) +i%"ini+a ( ) nr"a# R$cnta+ :_______ ; "in ( ) a"$nta+a ( ) +i%"ini+a ( ) nr"a# Ha#a $%!ntan$a :_______ ; "in ( ) a"$nta+a ( ) +i%"ini+a ( ) nr"a#

?2 F#$ncia

R$!$ticin +$ !a#ara% : ( ) ,#i+ ( ) n ,#i+

R$!$ticin +$ ,ra%$% : ( ) ,#i+ ( ) n ,#i+

Ha#a $%!ntan$a : ( ) ,#i+ ( ) n ,#i+

L$ctra r$cnta+ : ( ) ,#i+ ( ) n ,#i+

S7nt$%i%: _____________________________________________________________________________________ _____________________________________________________________________________________

21 R$!$tici0n +$ rit"% a) Rit"% inari% %i"!#$%

E&$rcici N1 : ( ) #*ra+ ( ) n #*ra+

E&$rcici N? : ( ) #*ra+ ( ) n #*ra+

) Rit"% t$rnari% %i"!#$%

E&$rcici N : ( ) #*ra+ ( ) n #*ra+

E&$rcici NG : ( ) #*ra+ ( ) n #*ra+

c) Rit"% ".% c"!#$&% E&$rcici N : ( ) #*ra+ ( ) n #*ra+

E&$rcici N : ( ) #*ra+ ( ) n #*ra+ E&$rcici NJ : ( ) #*ra+ ( ) n #*ra+ E&$rcici NK : ( ) #*ra+ ( ) n #*ra+

2? Rit"% a%cia+% a# 5a#a a) Rit"% inari%

E&$rcici N : ( ) #*ra+ ( ) n #*ra+ E&$rcici N 1 : ( ) #*ra+ ( ) n #*ra+

a) Rit"% t$rnari%E&$rcici N 11 : ( ) #*ra+ ( ) n #*ra+ E&$rcici N 1? : ( ) #*ra+ ( ) n #*ra+


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S7nt$%i%: __________________________________________________________________________________ ___________________________________________________________________________________

G Va#raci0n +$ #a ,r$c$ncia

L$ctra :_______ N +$ $%!a%"% ; "in

R$cnta+ :_______ N +$ $%!a%"% ; "in

Ha#a $%!nt.n$a :_______ N +$ $%!a%"% ; "in

Va#raci0n +$ #a int$n%i+a+

4rav$ ( ) activi+a+:______________________________________________ "+$ra+ ( ) activi+a+:______________________________________________

L$v$ ( ) activi+a+:________________________________

Va#raci0n +$# ti! +$ $%!a%"%T0nic ( )C#0nic ( )T0nic 3 C#0nic ( )

En '$ activi+a+ %$ !r$%$nta: ______________________________________________________

En '$ ti! +$ %ni+ %$ !r$%$nta: ______________________________________________________ 3 "+ artic#atri : ______________________________________________________

3 ti! artic#atri : ______________________________________________________

3 !%ici0n +$ #a %i#aa : ______________________________________________________

S7nt$%i%: _____________________________________________________________________________________ _____________________________________________________________________________________

DERIVACIONES _____________________________________________________________________________________ _____________________________________________________________________________________

N"r$ +$# $;a"ina+r: ________________________________________________________________


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Fir"a:____________________ F$5a: _______________

Pauta de Evaluación Fonoaudiológica Para La Fluidez Modificada

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