FYSIOTERAPIAN YHTEENVETO                                                                                 

 

Kuntoutujan nimi                                                                                                        Syntymäaika                      

Diagnoosi                                                                                                         

Lähettävä lääkäri                                                                                                       Lähetepäivämäärä             

 

ALKUSTATUS                                                                                                             Pvm                                    

 

Subjektiivinen haitta-aste                           %       Erottelupisteet                                     Vaippatesti                         

BMI               

Oirekuvaus                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       

Wc-käyntien määrä              

Lantionpohjan lihasvoima  selinmakuulla    lepoarvo                 maksimi          μV       kesto          s       nopeus          μV

Lantionpohjan lihasvoima  seisten              lepoarvo                 maksimi          μV       kesto          s       nopeus          μV Sähkön tunnistamisarvo                           

 

LOPPUSTATUS                                                                                                          Pvm                                    

 

Terapiakertoja yhteensä                       kpl

Subjektiivinen haitta-aste                           %       Erottelupisteet                                      Vaippatesti                         

Wc-käyntien määrä              

Lantionpohjan lihasvoima  selinmakuulla    lepoarvo                 maksimi          μV       kesto          s       nopeus          μV

Lantionpohjan lihasvoima  seisten              lepoarvo                 maksimi          μV       kesto          s       nopeus          μV

Sähkön tunnistamisarvo                              

Fysioterapia                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

Fysioterapeutin arvio kuntoutujan tämän hetkisestä tilanteesta                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            

Kuntoutujan oma arvio tämän hetkisestä tilanteestaan                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          

                                                                                                                                                                              

Pvm                                     Paikka                                                       Nimi

 

KONTROLLIKÄYNTI                                                                                                    Pvm                                    

 

Subjektiivinen haitta-aste                           %       Erottelupisteet                                      Vaippatesti                         

Wc-käyntien määrä              

Lantionpohjan lihasvoima  selinmakuulla    lepoarvo                 maksimi          μV       kesto          s       nopeus          μV

Lantionpohjan lihasvoima  seisten              lepoarvo                 maksimi          μV       kesto          s       nopeus          μV

Sähkön tunnistamisarvo                              

Fysioterapeutin arvio kuntoutujan tämän hetkisestä tilanteesta                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            

Kuntoutujan oma arvio tämän hetkisestä tilanteestaan                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          

                                                                                                                                                                              

Pvm                          Paikka                                    Nimi