CENTRUL LOGOPEDIC INTERSCOLAR

Data___________ nr.___________

PROFESOR DR. LOGOPED,

FIŞĂ LOGOPEDICĂ INDIVIDUALĂ
I.DATE PERSONALE
Numele
şi
prenumele___________________________________________________________________
Data
naşterii__________________________________________________________________________
Domiciliul___________________________________________________________________________
Şcoala
/
grădiniţa
______________________________________________________________________
Clasa/grupa____________________________cadru
didactic_____________________________________
II.DATE FAMILIALE
NUMELE, DATA NAŞTERII,STUDII,OCUPATIA:
-mamei_____________________________________________________________________________
-tatălui_____________________________________________________________________________
-frati________________________________________________________________________________
-tipul
familial
__________________________________________________________________________
-probleme
familiale
particulare___________________________________________________________
-tulburări
de
limbaj
existente
în
familie_______________________________________________________
III.ANAMNEZA.EXAMEN SOMATIC ŞI FUNCŢIONAL
1.Anamneza:
-antecedente prenatale şi natale:
-sarcina__________________________________________________________________________
- naşterea________________________________________________________________________
greutatea__________________________________________________________________________
alimentatia___________________________________________________________________________
_
-primii paşi__________________________________________________________________________
-primele
cuvinte_______________________________________________________________________
socializarea__________________________________________________________________________
__
-evenimente
patologice
(boli,
accidente)______________________________________________________
2.Aspectul somatic şi motricitatea generală:
-conformatia
capului_____________________________________________________________________
-mimica
facială
( mobilitate,expresivitate)____________________________________________________
-aparat fono-articulator:
sistemul
labio-comisural
(simetrie,integritate,mobilitate,fortă)________________________________

forma arcurilor maxilare. TERAPIE. fren)___________________________ palatul dur ( forma.limba (formă. mărime.. ochi_____________.lueta ( mobilitate.ureche_____________picior_____________________ contrariată_____________ nedefinită______________consolidată____________________________ -respiratia: orală___nazală____diafragmatică_____abdominală____toracică -functia auditivă: auz elementar:______________________________________________________________________ . formă. mobilitate transversală . cornice)______________________________ -lateralitate: mână_________. cabinet.longitudinală. PROGNOSTIC . formă. şcoală)_____________________________________________________ V.maxilare (forma mandibulei. DIAGNOSTIC. aşezare ) ___________________________________________ -sistemul nasal ( malformatii.aparatul dentar ( integritate. prognatism)___________________________ .capacitate de analiză şi sinteză fonematică_______________________________________ V. amplitudinea boltii)_________________________________________________ palatal moale (mobilitate. mărime)______________________________________________ .auz fonematic: atentie auditivă______________________________________________________________ memoria auditivverbală_____________________________________________________ capacitate de diferentiere_______________________________________________________ . inflamatii acute. muşcătură. integritate.EXAMEN LOGOPEDIC. formulă dentară)______________________________ .DATE PSIHOLOGICE ( observatii generale) atentia_______________________________________________________________________________ memoria_____________________________________________________________________________ _ afectivitatea_________________________________________________________________________ __ -motivatia____________________________________________________________________________ vointa________________________________________________________________________________ inteligenta___________________________________________________________________________ __ -comportament ( familie. mărime. dureri de sept.

data__________________________________________________________________________ _ DIAGNOSTIC FINAL_________________________________________________________________ PROGNOSTIC_______________________________________________________________________ TERAPIE SPECIFICA_________________________________________________________________ OBSERVATII__________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ___________________________________________________________________________________ DATA: SEMNATURA: . timbru)_________________________________________________________ -ritmul şi fluienta vorbirii_________________________________________________________________ -citirea fluientă / defecte_________________________________________________________________ -scrierea: structura grafică a literei şi cuvintelor__________________________________________________ copierea unui text scris de tipar / mână_________________________________________________ scrierea după dictare______________________________________________________________ scrierea liberă/ compuneri___________________________________________________________ DIAGNOSTIC INITIAL____________________________________________________________________________ REEVALUARE DIAGNOSTICA_________________________________________________________ .data__________________________________________________________________________ _ .-etiologia tulburării de limbaj______________________________________________________________ -sunete afectate în mod izolat____________________________________________________________ -pronuntare silabe _______________________________________________________________________ -pronuntare cuvinte______________________________________________________________________ -exprimare în propozitii___________________________________________________________________ -calitatea vocii ( intensitate.

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FIIŞĂ LOGOPEDICĂ INDIVIDUALĂ DE LUCRU Numele şi prenumele...................................................... ................................... .................................. .................................................................................................................................................... ........................... ..................................... ................................................................................................................................................................................................................................................................................... ............................................................................................................................................................................................................................................................................................. ................................................................................................................ ..................................................................................................................... ............................................................................................. ................................................... .............................................................................. ..................................................................................................................... .................. .................................... ....................... Nr.................................................................... ..... .......... .................................................... .............................................. .................................................................................................................................................................................................................................... ........................................................................... ........................... ................................................................................... ......................................................... ............................................... ................................................ ................................................................................................................................................................................................................................ .......................... ............ ..................................................................................................................... ...................................................................................................................................................... ................................................................................................................................................................................................................................................... ........................... .... ............................ Şedinţă / Data / Observaţii: ............................................................................................................ .............................. Şedinţă / Data / Observaţii: .......................................... ........ ............................................................................................................................................................ ................................................................................................................................................................................................................................................................................................... ................................................................................................................................................... ……………………………………………........... ............................... ................ ...................................................................... .............. ......................................................................................... ............................................. ............................. ... .................... .............................. ....................... .................................................___________ PROFESOR DR................................................................................. .................... ............................................. ... ............................................................................................................................................................................................................................ .............................. ............................................................................................................................................................. ................... ......... ......................................................................................... ............ ....................................................................................................................................................... ................................................................. ....................................................................................................................... .......................................................................................................... ...... ........................................ .................................... ................................................ ................................................................................CENTRUL LOGOPEDIC INTERŞCOLAR LOGOPED Data___________ nr............................................................................................... ................................................................................................................................................................................................................................................................................................................................................................................................................................................ ................... ............................................................................................ ...................................

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