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AVALIAO NEUROLGICA PEDITRICA

Dados Pessoais
Nome: _______________________________________________________________________________
Data de Nascimento: _____________ Sexo: _____________ Cor:________________________________
Nome da me ou responsvel: _________________________________Idade: ______________________
Profisso da me: ____________________________Grau de instruo:___________________________
Nome do pai: _____________________________________________Idade: _______________________
Profisso do pai: ______________________ Grau de instruo: _________________________________
Endereo:_____________________________________________________________________________
Telefone: _____________________ Cidade:_________________________________________________
Mdico:____________________________________Nacionalidade______________________________
Diagnstico mdico: ___________________________________________________________________
Hiptese de Diagnstico fisioterpico: ______________________________________________________
Data da avaliao:______________________________________________________________________
N Pronturio__________________________________________________________________________
I.

ANAMNESE:

Queixa Principal
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H.M.P/ H.M.A
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AVALIAO NEUROLGICA PEDITRICA

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Antecedentes Pessoais e Familiares
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Exames Complementares e Cirurgias
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Medicamentos:
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III- EXAME FSICO
Inspeo:
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Palpao:
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Grau
0
1
1+
2

Escala de Aschworth- ESCALA DE ASCHWORTH

Comportamento do msculo ou grupos musculares
Sem aumento do tnus muscular
Leve aumento manifestado por mnima resistncia no final do arco do movimento
Leve aumento manifestado por leve resistncia por leve resistncia em 50% do arco do movimento
Moderado aumento na maior parte do arco do movimento, porm os segmentos so facilmente
mobilizados

AVALIAO NEUROLGICA PEDITRICA

3
4

Considerado aumento com movimentao passiva dificultada

Rigidez em flexo ou extenso

Tnus:
Palpao:
Tnus:escala de Ashworth modificada
MMSS:_
Grupos Musculares
D
Flexores do cbito
Extensores do cbito
Flexores do punho
Extensores do punho
Flexores do ombro
Extensores do ombro

MMII:
Grupos Musculares
Flexores do joelho
Extensores do joelho
Flexores do quadril
Extensores doquadril
Adutores do quadril
Abdutores do quadril
Flexores plantar
Dorsiflexores

Trofismo:
MMSS:________________________________________________________________________________
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MMII:_________________________________________________________________________________
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REAES E REFLEXOS
Decbito Dorsal
Reflexo de busca
( ) Presente ( ) Ausente
Reflexo de Preenso Palmar
( ) Presente ( ) Ausente

AVALIAO NEUROLGICA PEDITRICA

Reflexo de Preenso Plantar
( ) Presente ( ) Ausente
Reflexo Cutneo Plantar em Extenso
( ) Presente ( ) Ausente
Reflexo de Retirada
( ) Presente ( ) Ausente
Reflexo de Extenso Cruzada
( ) Presente ( ) Ausente
RTCA
( ) Presente ( ) Ausente
Reflexo de Endireitamento Cervical
( ) Presente ( ) Ausente
Reflexo de Moro
( ) Presente ( ) Ausente
Reflexos de Olhos de Boneca
( ) Presente ( ) Ausente
Reflexo Mo Boca ( Babkin)
( ) Presente ( ) Ausente
Reflexo Tnico Labirntico
( ) Presente ( ) Ausente
Decbito Ventral
Reflexo de Gallant
( ) Presente ( ) Ausente
Reflexo de Defesa
( ) Presente ( ) Ausente
Reflexo de Landau
( ) Presente ( ) Ausente
Reflexo de Pra- quedas
( ) Presente ( ) Ausente
RTCS
( ) Presente ( ) Ausente
Reao de Anfbio
( ) Presente ( ) Ausente
Sentado
Reao de proteo para frente
( ) Presente ( ) Ausente
Reao de Proteo para os lados
( ) Presente ( ) Ausente
Reao de Proteo para Trs
( ) Presente ( ) Ausente

AVALIAO NEUROLGICA PEDITRICA

Em P
Reflexo de Marcha
( ) Presente ( ) Ausente
Reao Positiva de Apoio
( ) Presente ( ) Ausente
Reao de Colocao dos Ps
( ) Presente ( ) Ausente
Reao de Colocao das Mos
( ) Presente ( ) Ausente
Reaes Labirnticas de Retificao
( ) Presente ( ) Ausente
IV- EXAME FUNCIONAL
Mobilidade articular: ( paresias, paralisias, rigidez, retraes...)
MMSS:________________________________________________________________________________
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MMII:_________________________________________________________________________________
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Tronco:________________________________________________________________________________
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Padro postural
Decbitodorsal:__________________________________________________________________________
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Decbitoventral:_________________________________________________________________________
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Sedestao:_____________________________________________________________________________
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Gato:__________________________________________________________________________________
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RolarparaDeE:___________________________________________________________________________
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AVALIAO NEUROLGICA PEDITRICA

DDparasedestao:_______________________________________________________________________
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Sedestaoparabipedestao:_______________________________________________________________
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SemiAjoelhado:__________________________________________________________________________
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Emp:_________________________________________________________________________________
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Marcha:________________________________________________________________________________
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Funo Neurovegetativa
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Distrbios Associados
Visual: _______________________________________________________________________________
Auditivo: _____________________________________________________________________________
Fala:_________________________________________________________________________________
Estado Emocional:______________________________________________________________________
V-OBSERVAES GERAIS
DNPM:________________________________________________________________________________
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VI-CONCLUSO
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AVALIAO NEUROLGICA PEDITRICA

VII- OBJETIVOS
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VIII-CONDUTA
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AVALIAO NEUROLGICA PEDITRICA

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ESTAGIRIOS

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SUPERVISOR