FI DE EXAMINARE LOGOPEDIC

Nr.fiei___________
Data ntocmirii__________________
Numele examinatorului_______________________________
I. DATE GENERALE
1.1.Personale
Numele de familie____________________prenumele_____________________nscut n
anul________luna________ziua______.Domiciliul______________________________
__________________________.Instituia______________________________________
1.2.Familiale
Numele
Prinilor
TATA:
_________
MAMA:
_________

Naionalitate

Vrsta

Studii

Ocupaia

Locul de munc

__________

_______

_______

___________

____________

__________

_______

_______

___________

____________

1.3.Motivul examinrii
Trimis de_____________________________________________________________
Cu ce acuze este trimis__________________________________________________
II.ANAMNEZA
2.1.Familial
Structura familiei______________________________________________________
Al ctelea copil este_________Starea de sntate a membrilor familiei____________
_______________________________________________________________________
Persoane cu tulburri de limbaj n familie___________________________________
Relaiile n familie:a.ntre prini__________________________________________
b.fa de copil______________________c.atitudinea fa de defectul de vorbire al co
pilului_______________________________________________________________
Dac sunt stngaci sau ambidextri n familie_________________________________
Condiiile materiale,igienice,educative ale familiei____________________________
____________________________________________________________________
_
2.2.Personal
Sarcina_______________________________________________________________
Naterea:la termen_______;la ___luni;greutatea____________nlimea__________.
Alimentaia suptul
4
6
8
10
12

mnnc independent

16

ade
Merge

18

20

22

24
Motricitatea

7
10

8
12

9
14

10
16

18
Apariia dinilor
5
6
7
8
9
Deprinderi igicontrolul deenico-sanitare
fecaiei
4
6
8
10
12
controlul miciunii diurne
8
10
12
14
16
conrtolul miciunii nocturne14 16
18
20
22
Antecedente fiziologice i patologice_______________________________________
_______________________________________________________________________
_
Tulburri psihice_______________________________________________________
2.3.Date asupra auzului si limbajului
Gnguritul_______________________________________________________________
Evolutia vorbirii lalatiunea 4
6
8
10
12
primul cuvnt 8
10
12
14
16
prima propozitiune
14
16
18
20
22
Ritmul vorbirii___________________________________________________________
Limba matern si cea a mediului nconjurtor___________________________________
_______________________________________________________________________
_
nelegerea vorbirii persoanelor din jur_________________________________________
_______________________________________________________________________
_
nsuirea unei limbi strine__________________________________________________
nsuirea scierii i a citirii___________________________________________________
Cnd a aprut tulburarea de limbaj____________________________________________
Cauza real sau presupus__________________________________________________
Dac a beneficiat de tratament logopedic_______________________________________
_______________________________________________________________________
_
III. EXAMENUL SOMATIC I FUNCIONAL
3.1. Aspectul somatic
Conformaia capului_______________________________________________________
Cavitatea toracic_________________________________________________________
Membrele_______________________________________________________________
MECANISMELE periferice ale vorbirii_______________________________________
Cavitate bucala_____________________vlul palatin____________________________

Limba_____________buzele________________________________maxilarele________
__________________Dantura_______________________________________________
3.2. Motricitatea
Mersul__________________________________________________________________
Coordonarea general a micrilor____________________________________________
Lateralitate______________________________________________________________
Motricitatea mimico-facial_________________________________________________
Motricitatea limbii________________________________________________________
Motricitatea buzelor_______________________________________________________
Motricitatea vlului palatin__________________________________________________
Ritmul acustico-motor_____________________________________________________
3.3. Respiraia
Diferenierea dintre respiraia oral i nazal____________________________________
_______________________________________________________________________
_
Durata expiraiei i pauzele expiratorii_________________________________________
_______________________________________________________________________
_
Tipul de respiraie_________________________________________________________
3.4. Funcia auditiv
Acuitatea auditiv_________________________________________________________
Atentia auditiv___________________________________________________________
Memoria auditiv_________________________________________________________
Capacitatea de difereniere fonematic________________________________________
Capacitatea de analiz i sintez fonematic____________________________________
Auzul fonematic__________________________________________________________
Auzul muzical____________________________________________________________
3.5. Funcia fonatorie
Intensitatea vocii__________________________________________________________
Calitatea vocii____________________________________________________________
Mutaia vocii_____________________________________________________________
IV. LIMBAJUL ORAL I SCRIS
4.1. Pronunia sunetelor i a cuvintelor
Reproducerea fonemelor pe baz de auz_______________________________________
Reproducerea fonemelor dup modelul logopedului______________________________
Reproducerea fonemelor pe baz de citire______________________________________
Micri articulatorii defectuoase______________________________________________
Omisiuni de sunete________________________________________________________
Confundarea sunetelor_____________________________________________________
Estomparea terminatiei cuvintelor____________________________________________

Capacitatea fonematica_____________________________________________________
4.2. Ritmul si fluenta vorbirii
Ritmul vorbirii___________________________________________________________
Poticniri : la sunete_________silabe_________cuvinte___________________________
Repetri: de sunete_________silabe________cuvinte____________________________
Spasme articulatorii (i muchii afectai)_______________________________________
Calitatea vorbirii : independent_______________reflectat_______________n
soapt________structuri verbale memorate____________________________________
Calitatea citirii : independent__________________reflectat_____________________
Asociat _____________________________________________________________
Fluena vorbirii________________________________________________________
Diverse fobii__________________________________________________________
Micari concomitente___________________________________________________
Vorbirea n diferite situaii_______________________________________________
Blbiala n cnt (si la instrumernte)_______________________________________
Blbiala n scris_______________________________________________________
4.3. Scrierea i citirea
Copiere______________________________________________________________
Dictare______________________________________________________________
Compunere___________________________________________________________
Structura grafic_______________________________________________________
Structura logic________________________________________________________
Limbajul scris_________________________________________________________
Citirea_______________________________________________________________
V. DIAGNOSTICUL TULBURRILOR DE LIMBAJ
5.1. Caracterizarea limbajului si a persoanei examinate.
Vorbirea ______________________________________________________________
Scrisul________________________________________________________________
Cititul_________________________________________________________________
Succesul colar__________________________________________________________
Conduita_______________________________________________________________
5.2. Cauzele i diagnosticul
Cauze presupuse__________________________________________________________
Cauze confirmate_________________________________________________________
Diagnosticul iniial________________________________________________________
Evoluia diagnosticului_____________________________________________________
Diagnosticul final_________________________________________________________