脑卒中- 颅脑外伤评定计分表姓名_________________ 性别__________ 年龄____________ 病区_____________ 床号_________________ 住院号__________________ ID号___________________ 发病日期___________ 入院日期____________ 首次康复治疗时间__________________ 病情摘要:_______________________________________________________________________ ________________________________________________________________________________ 临床诊断:_______________________________________________________________________ 躯体运动功能障碍部位: 右侧左侧左侧右侧_____________________________________________________________ 主要问题: Glasgow-Liege 昏迷量表: __________________________________________________________ 简易精神状态检查表( MMSE ): ____________________________________________________ 徒手肌力检查: ___________________________________________________________________ ________________________________________________________________________________ 关节活动度评定: ________________________________________________________________ ________________________________________________________________________________ Fugl-Meyer 四肢感觉功能评定: _____________________________________________________ ________________________________________________________________________________ Fugl-Meyer 四肢运动功能评定: _____________________________________________________ ________________________________________________________________________________ Brumnstrom 分期: ________________________________________________________________ 改良 Ashworth 痉挛量表: __________________________________________________________ Berg 平衡量表: __________________________________________________________________ ADL 评定: ______________________________________________________________________ ________________________________________________________________________________ 实用手功能评定: ________________________________________________________________ ________________________________________________________________________________ 单侧忽略评定: ________________________________________________________________ ____________________________________________________________________________
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