FICHA DE EVALUACION POSTURAL

Klga. Lic. Natalia Chahin I

Nombre:_______________________________________________ Fecha:_____________
Edad (F/n):___________ Sexo:________ Establecimiento:________________________

HUELLA PLANTAR
Derecha:____________________________________________________________________
Izquierda:___________________________________________________________________
EVALUACIN POSTURAL SUBJETIVA
FRONTAL ANTERIOR
Ortejos:________________________
Piernas:_________________________
Patelas:________________________
Rodillas:_______________________
Ingle:__________________________
EIAS:__________________________
Ombligo:_______________________
Trax:__________________________
< Charpy:_______________________
Mamilas:_______________________
Hombros:_______________________
Clavculas:______________________
SAGITAL
Arcos pies:________________________
Rodillas:__________________________
Pelvis:____________________________
Lordosis lumbar:___________________
Cifosis Dorsal:______________________
Tono abdominal:____________________
Hombros:__________________________
Lordosis Cervical:___________________
Cabeza:____________________________

FRONTAL POSTERIOR
Calcneo:________________________________
Pliegues Poplteos:________________________
Rodillas:________________________________
Muslos:_________________________________
Pliegues glteos:__________________________
EIPS:___________________________________
Columna:_______________________________
^ Talla:_________________________________
Escpulas:_______________________________
Hombros:_______________________________
Cabeza:_________________________________

EVALUACIN SIMETRIA FACIAL:

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REGLA 30 mm
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PLOMADA:
Plano Frontal:_______________________________________________________________
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Plano Sagital:________________________________________________________________
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Peso:_____________
Talla:_____________
IMC:___________%
Medicin Subjetiva de EEII:___________________________________________________
Fuerza muscular abdominales:_________________________________________________
Elongacin isquiotibiales:______________________________________________________
Laxitud Ligamentosa:_________________________________________________________
Percepcin de la Postura:______________________________________________________
Prueba de Adams:____________________________________________________________
Signo del Muro:______________________________________________________________
Dolor:______________________________________________________________________
Otros:______________________________________________________________________
CONCLUSIN DIAGNSTICA:______________________________________________
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Derivacin:(Fono)___________________________________________________________
Evaluadores:________________________________________________________________