Ficha de evaluacin Equinoterapia 2015

Fecha de evaluacin: __/__/__

Historia y entrevista.

Nombre:_____________________________________ Escuela:____________________________________
Fecha de nacimiento: ___________________ Rut: _______________________
Edad: ____________ Peso: _______________ Estatura: _____________________
Nombres Padres o tutores: __________________________________________________________________
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Telfonos:________________________________________________________________________ ______
Direccin: ______________________________________________________________________________
Ncleo Familiar: ________________________________________________________________________
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Diagnstico o motivo de la hipoterapia: _____________________________________________________

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Tratamientos recibidos: ____________________________________________________________________
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Enfermedades: ___________________________________________________________________________
Alergias: _______________________________________________________________________________
Frmacos: ______________________________________________________________________________
Cirugas: _______________________________________________________________________________
Antecedentes Familiares: ___________________________________________________________________
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Antecedentes de educacin bsica
Conocimientos generales: Colores: _____ Das:_____ Meses:_____ Estaciones:_____
Operaciones bsicas: Suma:_____ Resta:_____ Multiplicacin:_____ Divisin:_____
Lenguaje y comunicacin: habla:_____ Lee:______ Escribe:______

Cognicin y aspecto social.

Conexin con el medio:
Si No
Se adapta a las actividades?
Se encuentra orientado en tiempo y espacio?
Establece relacin con los compaeros?

Lenguaje Oral y corporal:

Entiende rdenes simples? Si No
Establece una conversacin fluida?
Presenta coherencia entre lo que dice y hace?
Realiza expresiones o gestos al habla?

Concentracin: ___________________________________________________________________________
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Atencin: _______________________________________________________________________________

Aspectos de la Psicoconductual:
Individual Si No
Autoestima y superacin
Hiperactividad?
Creativo?
Grupal
Liderazgo?
Agresividad?
Compaerismo?

Aspectos Sensoriales.
Visin: _________________________________________________________________________________
Audicin: _______________________________________________________________________________
Sensibilidad cutnea: ______________________________________________________________________
Exploracin Fsica:
Observacin Inicial.
Postura Ayudas tcnicas Acompaado/a

Examen motriz

Movilidad activa: _________________________________________________________________________

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Movilidad pasiva: ________________________________________________________________________
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Tono muscular: __________________________________________________________________________
Fuerza muscular: _________________________________________________________________________
Acortamiento muscular: ___________________________________________________________________

Tolerancia a posiciones
Decbito Supino Decbito Prono Sedente Gateo Bpedo

Si
No

Anlisis de Componentes del Movimiento.

Base de sustentacin: ______________________________________________________________________
Largo del paso:_____________________________________________________________________
Equilibrio esttico: ________________________________________________________________________
Equilibrio dinmico: ______________________________________________________________________
Tipo de marcha: __________________________________________________________________________

Anlisis Neurolgico.
Mecanismos de control postural Ausente Presente
Reacciones de enderezamiento
Reacciones de equilibrio
Reacciones protectoras
Control de cabeza
Control de tronco
Giro Derecho
Giro Izquierdo

Observacin sobre el caballo.

Tolerancia en el caballo: ___________________________________________________________________________
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Control postural: Cabeza:__________________________________________________________________________
Cuello:________________________________________ Tronco:_________________________________________
Control de extremidades: ___________________________________________________________________________
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Apertura de piernas: ______________________________________________________________________________
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Tono muscular: __________________________________________________________________________________
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Equilibrio: ______________________________________________________________________________________
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Coordinacin: __________________________________________________________________________________
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Concentracin: __________________________________________________________________________________
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Cuidados especficos y contraindicaciones: ___________________________________________________

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Objetivos.
Objetivos generales: ______________________________________________________________________
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Objetivos especficos: _____________________________________________________________________

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Pautas de tratamiento: ___________________________________________________________________

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Otras Observaciones: ____________________________________________________________________

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Nombre del evaluador: ___________________________

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