FI DE EXAMINARE LOGOPEDIC

Nr. fiei_______________ Numele examinatorului________

Datele examinatorului____________
I. DATE GENERALE
1.1 Personale
Numele de familie_________________prenumele_______________________________
nscut n anul__________luna_______ziua_____domiciliul_______________________
instituia________________________________________________________________
1.2. Familiale
numele prinilor naionalitatea vrsta studii ocupaia locul de munc
tata _________ ___________ _____ _____ ______ ____________
mama________ ___________ _____ _____ ______ ____________
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 pronunie al copilului_____________________________
Dac sunt stngaci sau ambidextri n familie____________________________________
Condiiile materiale, igenice, educative ale familiei_______________________________
2.2. Personal
Sarcina__________________________________________________________________
Naterea : la termen_____________la _____luni;greutatea_________________________
Tulburri psihice__________________________________________________________
2.3.Date asupra auzului i limbajului
Gnguritul_______________________________________________________________
Evoluia vorbirii lalaiunea 4 6 8 10 1
pimul cuvnt 8 10 12 14 1
prima propoziie 14 16 18 20 2
Ritmul vorbirii___________________________________________________________
Limba matern i cea a mediului nconjurtor___________________________________
________________________________________________________________________
nelegera vorbirii persoanelor din jur_________________________________________
________________________________________________________________________
nsuirea unei limbi strine__________________________________________________
nsuirea scrierii 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_______________________________________________________
________________________________________________________________________
________________________________________________________________________
Mecanisme periferice ale vorbirii_____________________________________________
Cavitatea bucal_________________vlul palatin_______________________________
______________________limba_____________________________________________
buzele_________________maxilarele_________________________________________
dantura__________________________________________________________________
3.2.Motricitatea
Mersul__________________________________________________________________
Coordonarea general a micrilor____________________________________________
Lateralitatea______________________________________________________________
Motricitatea limbii________________________________________________________
Motricitatea mimico-facial_________________________________________________
Motricitatea buzelor_______________________________________________________
Motricitatea vlului palatin_________________________________________________
Ritmul acustico-motor_____________________________________________________
3.3.Respiraia
Diferenierea dintre respiraia oral i cea nazal_________________________________
Tipul de respiraie_________________________________________________________
3.4.Funcia auditiv
Atenia auditiv___________________________________________________________
Memoria auditiv_________________________________________________________
Capacitatea de difereniere 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 pe baz de citire______________________________________
Micri articulatorii defectuoase______________________________________________
Micri asociate__________________________________________________________
Omisiuni de sunete________________________________________________________
Confundarea sunetelor_____________________________________________________
Estomparea terminaiei cuvintelor____________________________________________
4.2.Ritmul i fluena vorbirii
Fluena__________________________________________________________________
Ritmul vorbirii___________________________________________________________
Poticniri la sunete_______________________silabe_____________________________
_____cuvinte_____________________________________________________________
Repetri de sunete______________________silabe______________________________
_____cuvinte_____________________________________________________________
Spasme articulatorii i muchii afectai________________________________________
Calitateavorbirii:independent_______________________________________________
reflectat________________________________________________________________
Calitatea citirii:independente:________________________________________________
reflectat_____________________________________________________________
Diverse fobii_____________________________________________________________
Micri concomitente______________________________________________________
Vorbirea n diferite situaii__________________________________________________
Blbiala n cnt i la instrumente____________________________________________
Blbiala n scris__________________________________________________________
4.3.Scrierea i citirea
Copiere_________________________________________________________________
Dictare__________________________________________________________________
Compunere______________________________________________________________
Structura grafic__________________________________________________________
Structura logic___________________________________________________________
Citire___________________________________________________________________

V. DIAGNOSTICUL TULBURRILOR DE LIMBAJ

5.1.Caracterizarea limbajului i a persoanei examinate
Vorbirea________________________________________________________________
Scrisul__________________________________________________________________
Cititul__________________________________________________________________
Succesul colar___________________________________________________________
Conduita________________________________________________________________
5.2.Cauzele i diagnosticul
Cauze presupuse__________________________________________________________
Cauze confirmate_________________________________________________________
Diagnosticul iniial________________________________________________________
Evoluia diagnosticului_____________________________________________________
Diagnosticul final_________________________________________________________