CENTRUL LOGOPEDIC INTERSCOLAR

Data___________ nr.___________

PROFESOR DR. LOGOPED,

FI LOGOPEDIC INDIVIDUAL
I.DATE PERSONALE
Numele
i
prenumele___________________________________________________________________
Data
naterii__________________________________________________________________________
Domiciliul___________________________________________________________________________
coala
/
grdinia
______________________________________________________________________
Clasa/grupa____________________________cadru
didactic_____________________________________
II.DATE FAMILIALE
NUMELE, DATA NATERII,STUDII,OCUPATIA:
-mamei_____________________________________________________________________________
-tatlui_____________________________________________________________________________
-frati________________________________________________________________________________
-tipul
familial
__________________________________________________________________________
-probleme
familiale
particulare___________________________________________________________
-tulburri
de
limbaj
existente
n
familie_______________________________________________________
III.ANAMNEZA.EXAMEN SOMATIC I FUNCIONAL
1.Anamneza:
-antecedente prenatale i natale:
-sarcina__________________________________________________________________________
- naterea________________________________________________________________________
greutatea__________________________________________________________________________
alimentatia___________________________________________________________________________
_
-primii pai__________________________________________________________________________
-primele
cuvinte_______________________________________________________________________
socializarea__________________________________________________________________________
__
-evenimente
patologice
(boli,
accidente)______________________________________________________
2.Aspectul somatic i motricitatea general:
-conformatia
capului_____________________________________________________________________
-mimica
facial
( mobilitate,expresivitate)____________________________________________________
-aparat fono-articulator:
sistemul
labio-comisural
(simetrie,integritate,mobilitate,fort)________________________________

- aparatul dentar ( integritate, form, muctur, formul

dentar)______________________________
- maxilare (forma mandibulei,forma arcurilor maxilare,
prognatism)___________________________
- limba (form, mobilitate transversal - longitudinal, mrime,
fren)___________________________
palatul
dur
(
forma,
amplitudinea
boltii)_________________________________________________
palatal
moale
(mobilitate,
form,
mrime)______________________________________________
- lueta ( mobilitate, integritate, mrime, aezare )
___________________________________________
-sistemul
nasal
(
malformatii,
dureri
de
sept,
inflamatii
acute,
cornice)______________________________
-lateralitate:
mn_________,
ochi_____________,ureche_____________picior_____________________
contrariat_____________
nedefinit______________consolidat____________________________
-respiratia: oral___nazal____diafragmatic_____abdominal____toracic
-functia auditiv:
auz
elementar:______________________________________________________________________
- auz fonematic:
atentie
auditiv______________________________________________________________
memoria
auditivverbal_____________________________________________________
capacitate
de
diferentiere_______________________________________________________
- capacitate de analiz i sintez
fonematic_______________________________________
V.DATE PSIHOLOGICE
( observatii generale)
atentia_______________________________________________________________________________
memoria_____________________________________________________________________________
_
afectivitatea_________________________________________________________________________
__
-motivatia____________________________________________________________________________
vointa________________________________________________________________________________
inteligenta___________________________________________________________________________
__
-comportament
(
familie,
cabinet,
coal)_____________________________________________________
V.EXAMEN LOGOPEDIC. DIAGNOSTIC, TERAPIE, PROGNOSTIC

-etiologia
tulburrii
de
limbaj______________________________________________________________
-sunete
afectate
n
mod
izolat____________________________________________________________
-pronuntare
silabe
_______________________________________________________________________
-pronuntare
cuvinte______________________________________________________________________
-exprimare
n
propozitii___________________________________________________________________
-calitatea
vocii
(
intensitate,
timbru)_________________________________________________________
-ritmul
i
fluienta
vorbirii_________________________________________________________________
-citirea
fluient
/
defecte_________________________________________________________________
-scrierea:
structura
grafic
a
literei
i
cuvintelor__________________________________________________
copierea
unui
text
scris
de
tipar
/
mn_________________________________________________
scrierea
dup
dictare______________________________________________________________
scrierea
liber/
compuneri___________________________________________________________
DIAGNOSTIC
INITIAL____________________________________________________________________________
REEVALUARE DIAGNOSTICA_________________________________________________________
- data__________________________________________________________________________
_
- data__________________________________________________________________________
_
DIAGNOSTIC FINAL_________________________________________________________________
PROGNOSTIC_______________________________________________________________________
TERAPIE SPECIFICA_________________________________________________________________
OBSERVATII__________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
___________________________________________________________________________________
DATA:

SEMNATURA:

CENTRUL LOGOPEDIC INTERCOLAR

LOGOPED
Data___________ nr.___________

PROFESOR DR.

FII LOGOPEDIC INDIVIDUAL DE LUCRU

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