EVALUACION DE TERAPIA OCUPACIONAL

1) DATOS GENERALES:
Apellidos y Nombres:_____________________________________________
Edad: __________________________________________________________
Fecha de Nacimiento:_____________________________________________
Escolaridad: ____________________________________________________
Fecha de Evaluación:_____________________________________________
Especialista: ____________________________________________________
2) OBSERVACIONES GENERALES:
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3) COMPONENTES NEUROMOTORES Y MOTRICIDAD FINA:

*Tono Muscular: _________________________________________________
*Fuerza Muscular: _______________________________________________
*Rangos Articulares: _____________________________________________
*Postura: _______________________________________________________
*Dominancia/Lateralidad:__________________________________________
*Coordinación Bimanual Simétrica:_________________________________
*Coordinación Bimanual Asimétrica:________________________________

4) AREA SENSOPERCEPTUAL:
Nos referimos a la capacidad de recibir, organizar y utilizar en forma adecuada
las sensaciones provenientes del medio ambiente traducido a una respuesta
adaptativa esto va relacionado con el proceso de madurez del Sistema
Nervioso.
*Sistema Táctil:
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*Sistema Visual:
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*Sistema Auditivo:
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*Sistema Gustativo:
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*Sistema Vestibular:
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*Sistema Propioceptivo:
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*Sistema Olfativo:
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5) JUEGO:
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6) ACTIVIDADES ESCOLARES:
*Prensión: ______________________________________________________
*Garabateo/Pintado:
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*Recortado: _____________________________________________________

7) ACTIVIDADES DE LA VIDA DIARIA:

*Vestido:
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*Alimentación:
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*Higiene Menor:
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*Higiene Mayor:
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*Control de heces:
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*Control de orina:
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8) COMUNICACIÓN:
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9) OBJETIVOS:
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10) CONCLUSIONES: