ESTÁGIO SUPERVISIONADO PEDIATRIA

FICHA DE AVALIAÇÃO FISIOTERAPÊUTICA

Data da avaliação: ___/___/______

Acadêmicos
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I.FATORES PESSOAIS
Nome da criança:__Ester Militão
lima________________________________________________________________________________________
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Data de nascimento: _02__/10___/___2022___ Idade cronológica:_______________________ Idade
corrigida:__________________________ Peso:_____________ Estatura:___________
Nome da mãe: __________________________________________________ Idade:
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Grau de escolaridade: ____________________________________________
Profissão:_________________________________
Nome do pai: ___________________________________________________ Idade:
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Grau de escolaridade: ____________________________________________
Profissão:_________________________________
Endereço:_______________________________________________________
Telefone:__________________________________
Médico responsável: ______________________________________________
Diagnóstico Clínico:_______________________________________________

Queixa Principal:
__medo do fato do pé esquerdo rodado para dentro atrapalhar na de
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História da Moléstia Atual/Pregressa

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Doenças Associadas
Não
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Cirurgias
Não
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Exames Complementares
_Não possui __________________________________________________
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II.FATORES AMBIENTAIS

Produtos e tecnologia (medicação e tecnologia assistiva, adaptações ambientais/ facilitadores e barreiras – casa e
escola/trabalho)
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Apoio e relacionamentos (família, amigos e terapeutas), atitudes individuais, membros da família e sociais
(positivas e negativas)
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____________________ III- PARTICIPAÇÃO SOCIAL
Desempenho em situações de vida em casa, escola e comunidade. Participação em esportes, recreação, lazer, religião.
Comunicação, relacionamento interpessoais.

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IV- ATIVIDADE
AUTOCUIDADO (Lavar-se, cuidar de partes do corpo, cuidados relacionados com os processos de excreção,
vestir-se, comer e beber) MOVIMENTAÇÃO ATIVA, POSTURA E TRANSFERÊNCIAS
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____________________ DESCRIÇÃO DA MARCHA OU OUTRA FORMA DE LOCOMOÇÃO

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DESCRIÇÃO DE MOVIMENTOS FUNDAMENTAIS (correr, pular, escadas, etc)
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HABILIDADE MOTORA MANUAL

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TESTES FUNCIONAIS PADRONIZADOS
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____________________ V- ESTRUTURA E FUNÇÃO DO CORPO
1: AVALIAÇÃO DO TÔNUS
Escala Modificada de Ashworth:
Direito Esquerdo Direito Esquerdo

Ombro 0 0 Quadril 0 0
Cotovelo 0 0 Joelho 0 0
Punho 0 0 Tornozelo 0 0

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Distúrbios de Movimento:
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2: ESTRUTURA E FUNÇÕES ARTICULARES (contraturas, deformidades, encurtamentos, ADM) e ESTRUTURA E

FUNÇÕES
MUSCULARES (força e resistência)

TORNOZELO: estrutura, alinhamento, presença de deformidades, encurtamento (Manobra de Silverskiold), ADM, força e
resistência

Dorsiflexão direito 40
Dorsiflexão esquerdo 40

Flexão plantar esquerdo 90

Flexão plantar direito 79

JOELHO: estrutura, presença de deformidades, ângulo coxa-pé, encurtamento (ângulo poplíteo), ADM, força e resistência.
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Flexor de joelho direito110
Flexão de joelho esquerdo 120

QUADRIL e PELVE: encurtamentos, contraturas e deformidades, encurtamento (Thomas, Galeazi), anteversão femoral, ADM,
força.

Flexor de quadril direito 110

Esquerdo 130

TRONCO: força (abdominais, paravertebrais)

MMSS: contraturas e deformidades, ADM, força e resistência.

3.Escala de Pirani

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4.Escala Denver

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Não anda nem reclina nem retorna

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5. AIMS

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6. Rotação do quadril: (Normal – cerca de 45º)
Direito: ____________________________________________________________________
Esquerdo: ____________________________________________________________________

7. Ângulo Coxa-Pé: (Normal – Entre -5 e 30º)

Direito: ____________________________________________________________________
Esquerdo: ____________________________________________________________________

5.Clônus (ocorre por movimento rápido e súbito):

( ) Esgotável – movimento visível que começa e para;
( ) Inesgotável – movimento visível, mas
não para; ( ) Esboço – quase não se vê o
movimento.

6.Descarga de peso.
Lado Direito: ( ) Presente ( ) Ausente
Lado Esquerdo: ( ) Presente ( ) Ausente

7.Jack Test ou Jack toe-rising test

No paciente em ortostase, elevaremos o hálux passivamente. Com isso, haverá formação do arco
longitudinal devido ao retensionamento das estruturas plantares, o que elevará o arco plantar, reduzindo
a talonavicular, corrigindo a posição do tálus.
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DIAGNÓSTICO FISIOTERAPÊUTICO
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OBJETIVOS E CONDUTAS

Deficiência/Limitação/Restrição Objetivo Conduta

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 Fatores contextuais

Facilitadores Barreiras

Condição de saúde

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Deficiências na estrutura e Limitações de atividade Restrições de participação
função do corpo

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