AVALIAO FONOAUDIOLGICA DISARTROFONIA ASPECTOS GERAIS 1. Descrio fsica e comportamental _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ 2. Contato com o avaliador _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ 3. Habilidades de comunicao " Aspectos morfo-sintaticos-semanticos: _____________________________________________________________________ " Velocidade: ___________________________________________________ __________________ " Inteligibilidade: _____________________________________________________________________ " Naturalidade: _____________________________________________________________________ " Fluncia: _________________________________________________ ____________________ Sistema Sensorio-Motor-Oral 1. FACE " Sensibilidade: ____________________________________________________________________ " Mobilidade: ____________________________________________________________________ " Simetria: __________________ ___________________________________________________ 2. LBIOS " Aspecto: _____________________________________________________________________ " Postura: _____________________________________________________________________ " Sensibilidade:_________________________________________________________ " Tnus: ______________________________________________________________ " Mobilidade: __________________________________________________________ " Diadococinesia:_______________________________________________________

3. LNGUA " Aspecto: _____________________________________________________________________ " Postura: _____________________________________________________________________ " Tnus: ____________________________________________________________________ _ " Sensibilidade:__________________________________________________________ " Mobilidade: ___________________________________________________________________ " Diadococinesia:_________________________________________________________ 4. BOCHECHAS " Aspectos: _____________________________________________________________________ " Sensibilidade:__________________________________________________________ " Tnus: _____________________________________________________________________ " Mobilidade: ___________ _________________________________________________________ 5. MANDBULA " Postura: _____________________________________________________________________ " Mobilidade: ___________________________________________________________________ " M. masseter: ______ ____________________________________________________________ " M. temporal: __________________________________________________________________ " ATM: _____________________________________________________________________ 6. DENTES _____________________________________________________________________ 7. OCLUSAO _____________________________________________________________________ 8. PALATO DURO _____________________________________________________________________ 9. VU PALATINO " Aspecto: _______________ ______________________________________________________ " Extenso: ____________________________________________________________________ " Mobilidade:

___________________________________________________________________ " Reflexo gag: _______________________ ___________________________________________ " Diadococinesia:_________________________________________________________ 10. FARINGE " Aspecto: _____________________________________________________________________ " Mobilidade: ____________________________ _______________________________________ " Sensibilidade:__________________________________________________________ 11. LARINGE " Aspecto: ____________________________________________________________ " Movimento vertical: ___________________________________________________ " Posio vertical da laringe:______________________________________________ " Diadococinesia:_________________________________________________________ 12. MASTIGAO _____________________________________________________________________ 13. DEGLUTIO " Saliva: _____________________________________________________________________ " Pastosos: _____________________________________________________________________ " Slidos: _________________________________________________________________ ____ Deglutio dos 4 dedos (LOGEMAN, 1983) " Movimento submandibular: _____________________________________________________________________ " Movimento do hiide:_______________________________________________________________ " Movimento larngeo:_____________________________________________________________ " Tempo de transito oral:_____________________________________________________________ Avaliao da aspirao " Qualidade vocal pos-aspirao: ___________________________________________________________ ______________ ____ " Qualidade vocal ps-respiraes curtas e rpidas: _________________________________________________________________________ ____ " Presena de tosse:

_________________________________________________________________________ ____ Postura facilitadora da deglutio " Melhor posicionamento do alimento na cavidade oral: __________________________________ " Melhor seqncia de instrues:____________________________________________________ " Provvel natureza da disfagias:_____________________________________________________ Funo Respiratria 1. TIPO: _________________________________________________________________________ ____ 2. MODO: _________________________________________________________________________ ___ 3. CAPACIDADE VITAL " Com ocluso nasal:_______________________________________________________________ " Sem ocluso nasal:_______________________________________________________________ " Diferena: ______________________________________________________________________ 4. PADRAO RESPIRATORIO: _________________________________________________________________________ ____________ 5. COORDENAO PNEUMO-FONOARTICULATORIA _________________________________________________________________________ ____________ Funo Fonatoria 1. QUALIDADE VOCAL " Tipo de voz: __________________________________________________________________ " Grau de alterao:______________________________________________________________ " Estabilidade: __________________________________________________________________ " Ataque vocal: __________________________________________________________________ 2. RESSONNCIA " Foco

vertical:__________________________________________________________________ " Foco horizontal: _____________________________________________________________ __ " Estabilidade:_______________________________________________________________ ___ 3. FREQUNCIA " Pitch: _______________________________________________________________________ " Estabilidade: ___________________________________________________________ ______ " Modulao: __________________________________________________________________ " Campo dinmico:______________________________________________________________ 4. INTENSIDADE " Loudness: _____________________________________________________________ _______ " Estabilidade: __________________________________________________________________ " Modulao: ___________________________________________________________________ " Campo dinmico:_______________________________________________________________ 5. TEMPOS MAXIMOS FONATRIOS /a/ = _________ /i/ = _________ /u/ = _________ /s/ = _________ /z/ = _________ nos. = ________ rel. s/z = ________ 6. FLUXO AEREO CFS = _____________________ CFC = _____________________ FA = ______________________ Funo do Esfncter Velofaringeo 1. NASALILADE _________________________________________________________________________ __________ 2. EMISSO NASAL " Espelho De Glatzel /a/ = ________________ /f/ = _________________ /v/ = ________________ /i/ = _______________ /s/ = ________________ /z/ = _________________ /u/ = _______________ /x/ = ________________ / / = _________________

Susi piscou por causa do cisco. _________________________________________________________________________ __________ Papai fez a pipa. _________________________________________________________________________ __________ Juju saiu cedo. _________________________________________________________________________ __________ Kiki gosta de ch. _________________________________________________________________________ __________ " Teste de ressonncia.___________________________________________________________ Articulao oral 1. Quadro fonmico /p/ -_____________________ /b/ -______________________ /t/ -_____________________ /d/ -______________________ / k/ -_____________________ /g/ -______________________ /f/ -_____________________ /v/ -______________________ /s/ -_____________________ /z/ -______________________ /S/ -_____________________ /j/ -______________________ /m/ -_____________________ /n/ -______________________ /n/ -_____________________ /l/ -______________________ /r/ -_____________________ /R/ -______________________ /?/ -_____________________ gr./R/ -______________________ gr /l/ -_____________________ {s} -______________________ {r} -_____________________ 2. Padro articulatrio: ________________________________________________

CONCLUSO _________________________________________________________________________ _______ _________________________________________________________________________ _______ CODUTA _________________________________________________________________________ _______ _________________________________________________________________________ _______

____________________________________________ Fonoaudiloga ________________________________ Data

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