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EVALUACIN DE LA TARTAMUDEZ

I. ANTECEDENTES PERSONALES
Nombre
Fecha de Nacimiento
Edad
Escolaridad
Fecha de Evaluacin
Examinador

: ____________________________________________________
: ____________________________________________________
: ____________________________________________________
: ____________________________________________________
: ____________________________________________________
: ____________________________________________________

II. MOTIVO DE CONSULTA


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III. ANTECEDENTES DEL PROBLEMA
a) Comienzo:
Cundo: ___________________________________________________
Espontneo: ________________________________________________
Provocado: _________________________________________________
b) Evolucin: _______________________________________________________
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c) Tratamiento anterior: _______________________________________________
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d) Caractersticas de la personalidad: ____________________________________
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e) Conciencia de la alteracin: __________________________________________
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f) Fenmenos emocionales: ____________________________________________
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g) Factor hereditario: _________________________________________________
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h) Relacin Familiar: _________________________________________________
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IV. ANTECEDENTES DE EVALUACIN:


Evaluacin de O.F.A.:
Labios: _______________________
____________________________
Dientes: ______________________
Paladar blando: ________________
Frenillo: ______________________

Lengua:
Paladar duro: ________________________
Mordida: ___________________________
Maxilar: ____________________________

Praxias Bucolingofaciales: ________________________________________


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Caractersticas de la Respiracin:
a) Tipo Respiratorio:
Costodiafragmtico: _________
Mixto:
_________
Costal Superior:
_________
b) Modo Respiratorio:
Bucal: ________
Nasal: ________
Mixto: ________
c) Coordinacin Fonorespiratoria:
Adecuada:
________
Inadecuada: ________
Caractersticas de la musculatura:
a) En Reposo:
-Facial: _______________________________________________
-Cuello: _______________________________________________
-Hombros: _____________________________________________
b) En Fonacin:
-Facial: _______________________________________________
-Cuello: _______________________________________________
-Hombros: _____________________________________________

Parmetros del Habla:


Fluidez:____________________________________________________________
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Ritmo:_____________________________________________________________
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Prosodia:___________________________________________________________
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Habla espontnea:
Conducta verbal:
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Conducta Motora Asociada:
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Caractersticas de los enunciados:
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Fenmenos Emocionales asociados:
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Lectura sin ritmo:
Conducta verbal:
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Conducta Motora Asociada:
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Caractersticas de los enunciados:
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Fenmenos Emocionales asociados:
______________________________________________________________________
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Lectura con ritmo:
Conducta verbal:
______________________________________________________________________
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Conducta Motora Asociada:
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Caractersticas de los enunciados:
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Fenmenos Emocionales asociados:
______________________________________________________________________
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Repeticin de palabras y oraciones:


Conducta verbal:
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Conducta Motora Asociada:
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Caractersticas de los enunciados:
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Fenmenos Emocionales asociados:
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Series automticas:
Conducta verbal:
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Conducta Motora Asociada:
______________________________________________________________________
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Caractersticas de los enunciados:
______________________________________________________________________
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Fenmenos Emocionales asociados:
______________________________________________________________________
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HIPTESIS DIAGNSTICA:
a) Tipo de Tartamudez:
- Tnica: ____________
- Clnica:____________
- Mixta:_____________
b) Gravedad:
- Ligera:______________
- Moderada:___________
- Grave:_______________
- Muy grave:___________