قسم العلاج الطبيعي (تقييم العلاج الطبيعي)

PERSONAL DATA

Name

Age

Gender

PRESENT HISTORY

PRESENT HISTORY

PAST HISTORY:

PAST HISTORY

Diagnosis:

Diagnosis:

Surgical interference (Operation):

Surgical interference (Operation)

complication (problems):

Due to past history

Due to present history

Examination and Assessment :

Balance: During Sitting

Balance :During standing

Balance :During walking

Comments

Gait:

Activity of daily living:

Sitting

Standing

walking

DOWN stairs

Upstairs

Comments

A: Muscles :(( see muscle chart included))

Comments

B: posture:

Comments

C: ROM:

D: Deformities:

Rolling:From supine to sitting

Rolling:From supine to side

Rolling:From side to prone

Rolling:From side to side

Comments

Wheelchair activities:From bed to W.C

Wheelchair activities:From W.C TO Bed

Wheelchair activities:From W.c to TOILET

Comments:

Aim of physiotherapy:

Physiotherapy treatments:

Physiotherapist :

Physiotherapist :