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Avaliao de Fisioterapia Motora da UCIP
Nome: __________________________________________________________________________
Idade: ________ Peso: ________ Data de Nascimento:______________ RH:________________
Data Admisso: _____________ Data da Avaliao: _____________ Data Alta: _____________
HD: ___________________________________________________________________________________________________________________________________________________________
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HMA:
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Patologias associadas: ____________________________________________________________
Distrbios associados: ____________________________________________________________
Cirurgias: Torcica ( ) Cardaca ( ) Neurolgica ( ) Abdominal ( ) Ortopdica ( )
Alteraes ortopdicas: ___________________________________________________________
Glasgow: ________________ Ramsay: _____________
Tnus muscular:
Admisso: ______________________________________________________________________
Alta: ___________________________________________________________________________
Trofismo muscular:
MMSS:
Admisso: ______________________________________________________________________
Alta: ___________________________________________________________________________
MMII:
Admisso: ______________________________________________________________________
Alta: ___________________________________________________________________________
Fora muscular:
MMSS:
Admisso: ______________________________________________________________________
Alta: ___________________________________________________________________________
MMII:
Admisso: ______________________________________________________________________
Alta: ___________________________________________________________________________
Reflexos Tendinosos:
Reflexo
Aquileu
Patelar
Cubital
Bicipital
Tricipital
Estilorradial
Admisso
Alta
Amplitude de Movimento:
MMSS:
Admisso: ______________________________________________________________________
Alta: ___________________________________________________________________________
MMII:
Admisso: ______________________________________________________________________
Alta: ___________________________________________________________________________
Diagnstico cinticofuncional: ____________________________________________
Objetivos do tratamento fisioteraputico: ___________________________________
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Conduta fisioteraputica: ________________________________________________
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Fisioterapeuta