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Daniela Navarrete H.

Kinesióloga
Ficha Neurokinésica Pediátrica

FECHA EVALUACIÓN: ______ / _____ /_______

ANTECEDENTES GENERALES:
Nombre: ____________________________________________________________________________________
Edad: ______ años Fecha de nacimiento: ______/ ______ / ____ RUT: _______________________________
Diagnóstico Médico: ___________________________________________________________________________
Quién lo acompaña: _______________________Con quién vive: _______________________________________
Ayudas técnicas/ Prótesis / Silla de ruedas: ________________________________________________________
Escolaridad: _________________________________________________________________________________
Motivo de consulta: ___________________________________________________________________________

ANAMNESIS_________________________________________________________________________________
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ANAMNESIS REMOTA
o Antecedentes relevantes del embarazo y parto: _____________________________________________
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o Cirugías: _____________________________________________________________________________
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o Tratamientos invasivos: _________________________________________________________________
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o Medicamentos de uso habitual: ___________________________________________________________
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o Otros medicamentos usados: _____________________________________________________________
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o Tratamientos Kinésicos anteriores: ________________________________________________________
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o ANTECEDENTES FAMILIARES RELEVANTES: __________________________________________________
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EXAMEN FÍSICO

Impresión general: ____________________________________________________________________________


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Piel y fanéreos: _______________________________________________________________________________
Tono: _______________________________________________________________________________________
MMSS: _______________________________________ MMII: _________________________________________

Reflejos:_____________________________________________________________________________________
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Acortamientos: _______________________________________________________________________________
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Habilidades sociales
 Comportamiento: __________________________________________________________________________
 Comunicación: _____________________________________________________________________________
 Comprensión: _____________________________________________________________________________
Capacidades: ______________________________________________________________________________

Deformidades:
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CAMBIOS DE POSICIÓN:

Salida de su silla: _____________________________________________________________________________


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Decúbito supino: ______________________________________________________________________________
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Decúbito lateral: ______________________________________________________________________________
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Decúbito prono: ______________________________________________________________________________
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Sedestación: _________________________________________________________________________________
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Bipedestación: : ______________________________________________________________________________
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Marcha: ____________________________________________________________________________________
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Reacciones de protección:
Anterior: ___________Posterior: __________Lateral derecha: __________Lateral izquierda: ____________

Destrezas funcionales, AVD: _____________________________________________________________________


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Función respiratoria: __________________________________________________________________________


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OBJETIVOS
¿Qué espero yo de mi terapia?/ ¿Qué logros espera Ud. de la terapia de su hijo (a)?
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Objetivo General:
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Objetivos Específicos:
1. _____________________________________________________________________________________
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2. _____________________________________________________________________________________
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3. _____________________________________________________________________________________
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4. _____________________________________________________________________________________
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5. _____________________________________________________________________________________
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PLAN DE TRATAMIENTO:
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