Navigating the Neuro Chart Review Part 1: Imaging, Vitals, and Medications

Presented by Kristen Keech and Jessica Asiello

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Effective and timely chart review is essential for providing safe and individualized care to patients with stroke or traumatic brain injury in the acute hospital setting. This course provides clinicians with a structured framework to interpret neuroimaging, vital signs, lab values, and pharmacologic data that influence rehabilitation readiness. Through clinical examples and red-flag indicators, learners will develop critical reasoning to identify neurologic risk factors, detect instability, and anticipate medical changes that may impact intervention. Key content includes differentiating CT and MRI findings, evaluating blood pressure and oxygenation trends, and understanding the functional effects of neuro-specific medications such as sedatives, osmotic agents, and antiepileptics. Designed for therapists working in ICU, step-down, or neuro units, this course empowers providers to integrate chart data into safe, informed, and collaborative care decisions.

Learning Objectives

Differentiate between CT and MRI modalities and interpret common findings such as infarcts, hemorrhage, edema, and mass effect in the context of brain injury rehabilitation
Interpret vital signs and lab values to determine appropriate timing and precautions for initiating therapy
Recognize key medications used in neurocritical care (e.g., antiepileptics, sedatives, osmotic agents) and describe how they impact therapy readiness and safety
Identify functional red flags (e.g., acute neurological changes, mobility decline) that require holding therapy or escalating care, using structured clinical decision tools
Recall strategies to improve team communication and coordination, including best practices for escalating care, handoffs, and consistent documentation

Meet your instructors

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Kristen Keech

Dr. Kristen Keech is an occupational therapist passionate about advancing care and advocating for survivors of brain injury. She holds a Master of Science in Occupational Therapy from the University of New Hampshire and a Doctorate in Occupational Therapy from the MGH Institute of Health Professions. She is recognized as a…

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Jessica Asiello

Jessica Asiello is an assistant professor in the Department of Occupational Therapy in the School of Health and Rehabilitation Sciences at the MGH Institute for Health Professions in Boston, Massachusetts. She primarily teaches in the online postprofessional OTD program. Her clinical practice is in acute care at…

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Chapters & learning objectives

1. Acute Neuroimaging: CT, MRI, and Key Findings

This chapter equips clinicians to interpret CT and MRI imaging reports for patients with stroke or brain injury, focusing on findings such as infarcts, hemorrhage, mass effect, edema, and midline shift. Participants will learn how to correlate imaging with functional impairments, recognize red flags requiring escalation, and apply structured terminology to support communication and care planning.

2. Key Vital Signs and Neurological Scales

Participants will explore how vital signs—such as blood pressure, heart rate, oxygenation, and temperature—affect brain perfusion and therapy timing. The chapter also covers key neurological scoring systems (e.g., GCS, FOUR Score, TOAST, Hunt & Hess), teaching clinicians how to interpret scores in context and identify trends that signal readiness or instability.

3. Interpreting Lab Values: Implications for Acute Neuro Rehab

This chapter provides guidance on identifying and responding to lab abnormalities that impact safety and participation, including sodium, potassium, and calcium. Clinicians will learn how to recognize signs of electrolyte imbalance, understand how labs guide intensity and precautions, and collaborate with the medical team to adjust interventions accordingly.

4. Understanding Medication Effects in Acute Stroke and TBI Rehabilitation

In the final chapter, learners will examine how common neuro medications—including sedatives, antiepileptics, thrombolytics, vasopressors, and neurostimulants—affect cognition, mobility, and rehab participation. The content emphasizes timing, side effect recognition, and strategies for safe engagement when medications pose risks to alertness, blood pressure, or neurologic stability.