Pauta de Evaluación Fonoaudiológica Para La Fluidez Modificada

PAUTA DE EVALUACIÓN FONOAUDIOLÓGICA PARA PERSONAS QUE CONSULTAN POR TARTAMUDEZ MODIFICADA (P.E.F.T.) (D. Ahumada, D. Alda, M. M!"a#da, P. Zam$"a#$) NOMBRE DEL PACIENTE:____________________________________________  FECHA DE NACIMIENTO:_____________________EDAD:__________________  TELÉFONOS:________________________________MAIL:__________________  MOTIVO DE CONSULTA: ( ) Iniciativa Pr!ia ( ) Fa"i#iar ( ) T$ acn%$&arn '$ vini$ra% ( ) T$ #i*arn_____________________________________________________  ( ) D$riva+ +$ tr !r,$%ina# -C.#/__________________________________  Dia*n0%tic +$# Pr,$%ina#____________________________________________ 

MÓDULO I% ENTREVISTA 123 ANTECEDENTES 4ENERALES DEL PACIENTE PACIENTE  A.

MORBILIDAD

3 -Ti$n$% -Ti$n$%  5a% t$ni+ a#*6n !r#$"a  $n,$r"$+a+ i"!rtant$/ i"!rtant$/ ( ) S7 ( ) N -C.#/ ___________________________________________________________  Ti! +$ Trata"i$nt Trata"i$nt _________________________________________________  ____________________________________ _____________  3 -T"a% -T"a%  5a% t"a+ a#*6n ti! +$ "$+ica"$nt/ ( ) S7 ( ) N -C.#/ ___________________________________________________________ 

3 -Ha% $%ta+ $n trata"i$nt ,na+i#0*ic !r$vi/ ( ) S7 ( ) N

 ____________________________________________________ _____________  B2 ANTECEDENTES DEL LEN4UA8E 3 Sa$% +$ a#*na +i,ic#ta+ $n $# inici +$# #$n*a&$ ( ) S7 ( ) N -C.#/ (S$ t$ $nt$n+7a !c9 t$ c%t0 !rnnciar9 $tc2)  ____________________________________________________ ______________   ____________________________________________________ ______________  3 -Ha% i+ a $%c$#a +$ #$n*a&$/ ( ) S7 ( ) N Dia*n0%tic________________________________________________________  Ti$"! +$ !$r"an$ncia ______________________________________________  Cn+ici0n +$ $*r$% ( ) A#ta ( ) D$%$rci0n ( ) Pr"ci0n a E+2 B.%ica C2 ANTECEDENTES ESCOLARES 3 E%c#ari+a+: ( ) B.%ica ( ) M$+ia ( ) S!$rir  3 R$n+i"i$nt______________________________  3 R$!it$ncia: ( ) S7 ( ) N Cr%: ______________  3 -Ti$n$%  tvi%t$ !r#$"a% $n a#*na a%i*natra/ ( ) S7 ( ) N -Pr '/: ( ) nta% a&a% ( ) "a#a r$#aci0n cn $# !r,$%r ( ) !ca "tivaci0n ( ) Otr%___________________________________________________________  D2 SOCIABILIDAD 3 T$ cn%i+$ra%: ( ) T7"i+ ( ) S#itari ( ) Pc Scia#$ ( ) In'i$t ( ) E;trv$rti+ ( ) Otr%______________________________________________  3 -Va% a r$nin$% %cia#$%/ ( ) S ( ) CS ( ) AV ( ) N

3 -C0" t$ ##$va% cn t% !r,$%r$%/___________________________________   ____________________________________________________ ______________  3 -C0" t$ ##$va% cn t% c"!a<$r% +$ cr%/___________________________   ____________________________________________________ ______________  E2 ANTECEDENTES FAMILIARES 3 Viv$% cn: ( ) Pa+r$ ( ) Ma+r$ ( ) H$r"an% ( ) Otr%  ____________________________________________________ ______________  3 Niv$# +$ $%c#ari+a+ = Oc!aci0n +$ #% !a+r$%  ____________________________________________________ ______________  3 N6"$r +$ 5$r"an% ___________  3 L*ar '$ c!a___________  3 R$#aci0n cn !a+r$% = 5$r"an%  ____________________________________________________ ______________  F2 ANTECEDENTES FAMILIARES DEL PROBLEMA2 3 -Ha= a#*6n tr ,a"i#iar '$ tarta"+$$  '$ t$n*a a#*na tra +i,ic#ta+ !ara 5a#ar/ ( ) S7 ( ) N ->in/  ____________________________________________________ ______________  Ti! +$ !r#$"a  ____________________________________________________ ______________ 

?2 PERCEPCI@N DEL PROBLEMA (C$%tinari n 1) 3 -Cr$$% t6 '$ t$ c$%ta 5a#ar/ ( ) S7 ( ) N  ____________________________________________________ ______________ 

 ____________________________________________________ ______________  3 -T$ "#$%ta '$ t$ !r$*nt$n t n"r$/ ( ) S7 ( ) N  ____________________________________________________ ______________   ____________________________________________________ ______________  3 -T$ *%ta 5a#ar cn t !a!./9 -C0" t$ ##$va% cn #/  ____________________________________________________ ______________   ____________________________________________________ ______________  3 -T$ *%ta 5a#ar cn t "a"./9 -C0" t$ ##$va% cn $##a/  ____________________________________________________ ______________   ____________________________________________________ ______________  3 -C0" cr$$% '$ t$ tratan t% !a!.%/  ____________________________________________________ ______________   ____________________________________________________ ______________  3 -C0" %$ ##$van t% !a!.%/  ____________________________________________________ ______________   ____________________________________________________ ______________  3 -T$ *%ta 5a#ar cn t% 5$r"an% = !ri"%/9 -C0" t$ ##$va% cn $##%/  ____________________________________________________ ______________   ____________________________________________________ ______________  3 -T$ *%ta 5a#ar cn #% !$r%na% +$ t $+a+/9 -C0" t$ ##$va% cn $##%/  ____________________________________________________ ______________   ____________________________________________________ ______________  3 -T$ *%ta '$ t$ "an+$n a c"!rar/ ( ) S ( ) CS ( ) AV ( ) N  ____________________________________________________ ______________ 

 ____________________________________________________ ______________  3 -T$ *%ta 5a#ar !r t$#,n/ ( ) S ( ) CS ( ) AV ( ) N  ____________________________________________________ ______________   ____________________________________________________ ______________  3 -L#a"a% a tr% !r t$#,n/ ( ) S ( ) CS ( ) AV ( ) N  ____________________________________________________ ______________   ____________________________________________________ ______________  3 -Ati$n+$% $# t$#,n/ ( ) S ( ) CS ( ) AV ( ) N  ____________________________________________________ ______________   ____________________________________________________ ______________  3 -T$ *%ta 5a#ar can+ $%ta% $n *r!/ ( ) S ( ) CS ( ) AV ( ) N  ____________________________________________________ _____________   ____________________________________________________ _____________  3 -T$ inc"+a '$ t$ !r$*nt$n a#* !$r%na% +$%cnci+a%/ ( ) S ( ) CS ( ) AV ( ) N  ____________________________________________________ ______________   ____________________________________________________ ______________  3 -T$ "#$%ta t$n$r '$ r$!$tir # '$ =a +i&i%t$/ ( ) S ( ) CS ( ) AV ( ) N  ____________________________________________________ ______________   ____________________________________________________ ______________  3 -T$ *%ta ir a $%t+iar (C#$*i Univ$r%i+a+ In%titt)/ ( ) S ( ) CS ( ) AV ( ) N  ____________________________________________________ ______________   ____________________________________________________ ______________ 

3 -T$ *%ta #$$r $n v a#ta  +i%$rtar $n c#a%$%/ ( ) S ( ) CS ( ) AV ( ) N  ____________________________________________________ ______________   ____________________________________________________ ______________  3 -T$ !n$% n$rvi%(a) a# cnt$%tar can+ !a%an #i%ta/ ( ) S ( ) CS ( ) AV ( ) N  ____________________________________________________ ______________   ____________________________________________________ ______________  3 -An %ai$n+ #a r$%!$%ta crr$cta9 ti$n$% "i$+ +$ cnt$%tar #a% !r$*nta% $n c#a%$%/ ( ) S ( ) CS ( ) AV ( ) N  ____________________________________________________ ______________   ____________________________________________________ ______________  3 -Hac$% "c5a% !r$*nta% $n c#a%$%/ ( ) S ( ) CS ( ) AV ( ) N  ____________________________________________________ ______________   ____________________________________________________ ______________  3 -T$ *%ta 5a#ar cn t% !r,$%r$%/ ( ) S ( ) CS ( ) AV ( ) N  ____________________________________________________ ______________   ____________________________________________________ ______________  3 -T$ ac$rcar7a% a n c"!a<$r n$v  a#*na !$r%na '$ cnc$% %# +$ vi%ta/ ( ) S ( ) CS ( ) AV ( ) N  ____________________________________________________ ______________   ____________________________________________________ ______________  3 -Si$nt$% '$ #% +$".% t$ "iran rar can+ 5a#a%/ ( ) S ( ) CS ( ) AV ( ) N  ____________________________________________________ ______________   ____________________________________________________ ______________  3 -Pr$,i$r$% c"!artir cn n %# a"i*  cn vari%/  ____________________________________________________ ______________   ____________________________________________________ ______________ 

-Pr '/  ____________________________________________________ ______________  3 -Si$nt$% '$ t% !a!.% t$ $%cc5an can+ 5a#a%/  ____________________________________________________ ______________   ____________________________________________________ ______________  3 -Can+ 5a#a% t$ +ic$n: '+at$ tran'i#(a)9 r$%!ira9 $"!i$a +$ n$v222/ ( ) S ( ) CS ( ) AV ( ) N  ____________________________________________________ ______________  3 -Si$nt$% '$ a #% +$".% n #$% *%ta $%tar cnti*  %$ !n$n n$rvi%% !r'$ t$ traa%/ ( ) S ( ) CS ( ) AV ( ) N  ____________________________________________________ ______________   ____________________________________________________ ______________  3 -Si$"!r$ '$ 'i$r$% +$cir a#*9 # +ic$%/ ( ) S ( ) CS ( ) AV ( ) N  ____________________________________________________ ______________   ____________________________________________________ ______________  3 -A#*i$n %$ 5a r#a+ +$ ti/ ( ) S ( ) CS ( ) AV ( ) N  ____________________________________________________ ______________   ____________________________________________________ ______________  3 -> 5a% 5$c5 t6/  ____________________________________________________ ______________   ____________________________________________________ ______________  2 FACTORES 4ATILLANTES (C$%tinari n ?) 3 -> cr$$% '$ !rvc0 t ,r"a +$ 5a#ar/ 0 -T6 cr$$%  a%cia% a#*6n $v$nt  !r#$"a cn $# inici +$ t ,r"a +$ 5a#ar/  ____________________________________________________ ______________   ____________________________________________________ ______________ 

3 -Fr$nt$ a ' %itacin$%  !$r%na% a"$nta $%ta ,r"a +$ 5a#ar t=a/ ( ) P$r%na% cn atri+a+  ____________________________________________________ ______________  ( ) Fa"i#iar$%  ____________________________________________________ ______________  ( ) Par$%  ____________________________________________________ ______________  ( ) E;tra<%  ____________________________________________________ ______________  ( ) Ha#ar !r t$#,n  ____________________________________________________ ______________  ( ) Sitacin$% aca+"ica%____________________________________________  ( ) Di%$rtacin$%____________________________________________________  ( ) Otr% __________________________________________________________  3 -En ' %itacin$% n a!ar$c$ $%ta ,r"a +$ 5a#ar t=a/  ____________________________________________________ ______________   ____________________________________________________ ______________  G2 MANIOBRAS COMPENSATORIAS 3 -> 5ac$% 5aita#"$nt$ can+ a!ar$c$ $%ta ,r"a +$ 5a#ar/: ( ) Ha#a% ".% #$nt  ____________________________________________________ ______________  ( ) T$ ca##a%  ____________________________________________________ ______________  ( ) T$ $%,$ra% ".%  ____________________________________________________ ______________  ( ) T$ !n$% c#ra+  ____________________________________________________ ______________  ( ) T$ an*%tia% = tran%!ira%  ____________________________________________________ ______________  ( ) T$ !n$% a,0nic  +i%,0nic  ____________________________________________________ ______________  ( ) D$%v7a% #a "ira+a  ____________________________________________________ ______________  ( ) Hac$% a#*6n *$%t  ____________________________________________________ ______________  ( ) Hac$% a#*6n "vi"i$nt cn $# c$r!  ____________________________________________________ ______________ 

( ) L#ra%  ____________________________________________________ ______________  ( ) 4#!$a% $# !i% cn $# !i$  ____________________________________________________ ______________  ( ) L$ !i+$% a tr% '$ 5a#$n !r ti  ____________________________________________________ ______________  ( ) Otr%  ____________________________________________________ ______________  2 POSTURA FRENTE A LA TERAPIA 3 -E%ta ,r"a +$ 5a#ar t=a %i$nt$% '$ $% n !r#$"a/ ( ) S ( ) CS ( ) AV ( ) N -Pr '/  ____________________________________________________ ______________   ____________________________________________________ ______________  3 -T$ *%tar7a "$&rar/ ( ) S7 ( ) N ( ) N % ( ) M$ +a # "i%" -Pr '/  ____________________________________________________ ______________   ____________________________________________________ ______________  3 -> $;!$ctativa% ti$n$% $n cant a# trata"i$nt/  ____________________________________________________ ______________   ____________________________________________________ ______________ 

MÓDULO II% AUTOPERCEPCIÓN (C$%tinari n )

MÓDULO III% EVALUACIÓN FLUIDEZ I.& 'a Fu#*!$#al dl +ala 12 R$%!iraci0n M+ R$%!iratri:

( ) ca#

( ) na%a#

Ti! R$%!iratri:

( ) c%ta# a#t

( ) c%t+ia,ra*".tic ( ) a+"ina#

CFR:

3 L$ctraD$%cri!ci0n ( ) nr"a#

( ) a#t$ra+a

3 S!#

( ) a#t$ra+a

( ) nr"a#

( ) "i;t

S7nt$%i%  ____________________________________________________ ______________   ____________________________________________________ ______________  ?2 Tnici+a+ T$n%i0n 4$n$ra#:

( ) a"$nta+a

( ) +i%"ini+a

( ) nr"a#

3 Or,acia#:

( ) a"$nta+a

( ) +i%"ini+a

( ) nrna#

3 C$rvica#:

( ) a"$nta+a

( ) +i%"ini+a

( ) nr"a#

3 Para#ar7n*$a:

( ) a"$nta+a

( ) +i%"ini+a

( ) nr"a#

T$n%i0n S$*"$ntaria:

S7nt$%i%  ____________________________________________________ ______________   ____________________________________________________ ______________  2 V E"i%i0n:

( ) nr"a#

( ) +i%,0nica

( ) a,0nica

Tn:

( ) a+$ca+a

( ) a# a*+

( ) a# *rav$ varia#$

Int$n%i+a+:

( ) a+$ca+a

( ) ,$rt$

( ) +i#

R$%nancia:

( ) a+$ca+a

( ) na%a#

( ) 5i!ana%a#

Pr%+ia:

( ) a+$ca+a

( ) $;a*$ra+a

( ) "n0tna

( ) ,ar7n*$a

 A!$rtra ca#

( ) a+$ca+a

( ) a"$nta+a

( ) $%ca%a

S7nt$%i%:  __________________________________________________________________________________   __________________________________________________________________________________  II C"!n$nt$% +$ #a ,#i+$ 12 V$#ci+a+ L$ctra R$cnta+ Ha#a $%!ntan$a

?2 F#$ncia R$!$ticin +$ !a#ara% R$!$ticin +$ ,ra%$% Ha#a $%!ntan$a L$ctra  r$cnta+

:_______ ; "in :_______ ; "in :_______ ; "in

:( :( :( :(

) ,#i+ ) ,#i+ ) ,#i+ ) ,#i+

( ( ( (

( ( (

) ) ) )

) a"$nta+a ( ) +i%"ini+a ) a"$nta+a ( ) +i%"ini+a ) a"$nta+a ( ) +i%"ini+a

( ) nr"a# ( ) nr"a# ( ) nr"a#

n ,#i+ n ,#i+ n ,#i+ n ,#i+

S7nt$%i%:  _____________________________________________________________________________________   _____________________________________________________________________________________  21 R$!$tici0n +$ rit"%  a) Rit"% inari% %i"!#$% c) Rit"% ".% c"!#$&% E&$rcici N1 E&$rcici N E&$rcici N? E&$rcici N E&$rcici  ) Rit"%NJ t$rnari% %i"!#$% E&$rcici NK E&$rcici N E&$rcici NG

: ( ) #*ra+ : (: () #*ra+ ) #*ra+ : ( ) #*ra+ : ( ) #*ra+ : ( ) #*ra+ : ( ) #*ra+ : ( ) #*ra+

( ( ( (

( () ) ) ) ( (

) n #*ra+ n #*ra+ ) n #*ra+ n #*ra+ n #*ra+ n #*ra+ ) n #*ra+ ) n #*ra+

2? Rit"% a%cia+% a# 5a#a  a) Rit"% inari% E&$rcici N  : ( ) #*ra+ E&$rcici N 1 : ( ) #*ra+

( ) n #*ra+ ( ) n #*ra+

 a) Rit"% t$rnari% E&$rcici N 11

( ) n #*ra+

: ( ) #*ra+

S7nt$%i%:  __________________________________________________________________________________   ___________________________________________________________________________________  G Va#raci0n +$ #a ,r$c$ncia L$ctra  R$cnta+ Ha#a $%!nt.n$a

:_______ N +$ $%!a%"% ; "in :_______ N +$ $%!a%"% ; "in :_______ N +$ $%!a%"% ; "in

Va#raci0n +$ #a int$n%i+a+ 4rav$ ( ) "+$ra+ ( ) L$v$ ( )

activi+a+:______________________________________________  activi+a+:______________________________________________  activi+a+:________________________________ 

Va#raci0n +$# ti! +$ $%!a%"% T0nic ( ) C#0nic ( ) T0nic 3 C#0nic ( ) En '$ activi+a+ %$ !r$%$nta:

______________________________________________________ 

En '$ ti! +$ %ni+ %$ !r$%$nta: 3 "+ artic#atri : 3 ti! artic#atri : 3 !%ici0n +$ #a %i#aa :

______________________________________________________  ______________________________________________________  ______________________________________________________  ______________________________________________________ 

S7nt$%i%:  _____________________________________________________________________________________   _____________________________________________________________________________________ 

DERIVACIONES  _____________________________________________________________________________________   _____________________________________________________________________________________ 

N"r$ +$# $;a"ina+r: ________________________________________________________________ 

Fir"a:____________________

F$5a:  _______________