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_________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

ANAMNESIS REMOTA
o Antecedentes relevantes del embarazo y parto: _____________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

o Cirugías: _____________________________________________________________________________
____________________________________________________________________________________________
o Tratamientos invasivos: _________________________________________________________________
____________________________________________________________________________________________
o Medicamentos de uso habitual: ___________________________________________________________
____________________________________________________________________________________________
o Otros medicamentos usados: _____________________________________________________________
____________________________________________________________________________________________
o Tratamientos Kinésicos anteriores: ________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
o ANTECEDENTES FAMILIARES RELEVANTES: __________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
EXAMEN FÍSICO

Impresión general: ____________________________________________________________________________

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

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

Deformidades:
____________________________________________________________________________________________
____________________________________________________________________________________________

CAMBIOS DE POSICIÓN:

Salida de su silla: _____________________________________________________________________________

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

Destrezas funcionales, AVD: _____________________________________________________________________

____________________________________________________________________________________________
____________________________________________________________________________________________

Función respiratoria: __________________________________________________________________________

____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

OBJETIVOS
¿Qué espero yo de mi terapia?/ ¿Qué logros espera Ud. de la terapia de su hijo (a)?
____________________________________________________________________________________________
____________________________________________________________________________________________
Objetivo General:
____________________________________________________________________________________________
____________________________________________________________________________________________

Objetivos Específicos:
1. _____________________________________________________________________________________
_____________________________________________________________________________________
2. _____________________________________________________________________________________
_____________________________________________________________________________________
3. _____________________________________________________________________________________
_____________________________________________________________________________________
4. _____________________________________________________________________________________
_____________________________________________________________________________________
5. _____________________________________________________________________________________
_____________________________________________________________________________________

PLAN DE TRATAMIENTO:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________