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Ficha de Avaliação em Neurologia
Data de Avaliação: _____/______/______
Identificação
Nome: ________________________________________________________________________________
Sexo: ( ) F ( )M Data de Nascimento: ______ / ______ / ______ Idade: ______
Raça/ cor: ( ) Branca ( ) Negra ( ) Parda
Naturalidade: _____________________
Estado Civil: ( ) Solteiro ( ) Casado ( ) Viúvo ( ) Divorciado ( ) Outro
Nível educacional: _______________________________
Ocupação: ______________________________
Endereço: _____________________________________________________________________________
Telefone: ( ) _________________________ ou ( ) _________________________
Nome do Cuidador / Acompanhante: ______________________________________________
Anamnese
Queixa principal:
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História da doença
atual:______________________________________________________________________________________
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História Pregressa
História Pessoal: ( ) HAS ( ) Etilista ( ) Tabagista ( ) DM Outros: ________________________________________
História Social: ______________________________________________________________________________
História Familiar: ____________________________________________________________________________
Medicação em uso: __________________________________________________________________________
Histórico cirurgico: ___________________________________________________________________________
Sinais Vitais
PA: __________________ FC: ______________ Sat. O2: ______________ Temp.: _______________
Linguagem e Fala
( ) Disfonia ( ) Disartria ( ) Dislalia ( ) Afasia ( ) Outra: ________________________________
Nível e estado de consciência
( ) Orientado ( ) Desorientado ( ) Consciente ( ) Letárgico ( ) Obnubilado
Inspeção
Fascies: ( ) Normal ( ) Hipomímia ( ) Paralisia Facial ( ) Outra: ___________________________________
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AVALIAÇÃO POSTURAL
( ) Sem Alterações ( ) Hipercifose ( ) Hiperlordose ( ) Escoliose ( ) Outro: ____________________________
Dor
( ) Não ( ) Sim: Local _________________________________________________________ EVA: _________
Sensibilidade
Reflexos
Apresenta clônus? _________________________________________________________________________
Motricidade e função muscular
Avaliação de função muscular
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Licenciado para - Karollyne Farias - 70829333479 - Protegido por [Link]
Nervos Cranianos
Tônus
TROFISMO: ( ) Atrofia ( ) Hipotrofia ( ) Hipertrofia ( ) Normotrofia. Local: ___________________________
Coordenação
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Equilíbrio estático
Marcha
TIPO DE MARCHA: ____________________________________
LOCOMOÇÃO: ( ) Independente ( ) Muletas ( ) Andador ( ) Cadeira de Rodas ( ) Outro: _____________________
Atividades Funcionais
CIF
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Diagnóstico Clínico
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Diagnóstico Cinético-Funcional
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Exames complementares
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Objetivos e Propostas de Tratamento
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Licenciado para - Karollyne Farias - 70829333479 - Protegido por [Link]
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