Inter-Provider Clinical Reference

When the Brainstem
Speaks Through the Test Score.

Prepared For
Neuropsychology Partners
Specialty
QSM3 Upper Cervical
Use Case
Post-Testing Referral Triage
Document
Interactive Visual Guide
Review · Discuss · Refer
1 / 5 Welcome
A Lazar Method Referral Reference for Neuropsychology Partners

Some test scores aren't cortical.
They're structural.

When the atlas (C1) carries the head out of orthogonal alignment, the brainstem is mechanically loaded — and the signature shows up across specific subtests. This guide walks through where to look, and when to refer.

Five steps · Roughly two minutes · Printable handout included
i.
Mechanism
Atlas misalignment → brainstem pressure → three predictable symptom clusters.
ii.
Tests
Five batteries with literature-defensible thresholds that flag a brainstem-level pattern.
iii.
Refer
When findings cross two clusters, or any single brainstem-pattern flag in a trauma history.
i.

The Structural–Neurological Pathway

Many neuropsych findings that look "central" are downstream of a structural problem at the craniocervical junction. When the atlas (C1) carries the head out of orthogonal alignment, the brainstem is mechanically loaded. The clinical signature shows up across three predictable domains — and across specific subtests on standardized batteries.

Mechanism · Fig. 01
Structural Origin
Atlas Misalignment
Loss of orthogonal relationship at the craniocervical junction
Mechanical loading
Neurological Interface
Brainstem Pressure
Sustained mechanical stress on midbrain, pons & medulla pathways
— Cluster —
Cluster A
Attention & Processing Speed
Cluster B
Vestibular & Oculomotor Dysfunction
Cluster C
Headache & Pain Syndromes
— Anatomy —
Reticular activating system · ascending arousal pathways
Vestibular nuclei · PPRF · oculomotor nuclei
Trigeminocervical complex · TNC convergence
— Presenting Symptoms —
  • Slowed reaction time
  • Variable sustained attention
  • Reduced symbol/digit speed
  • Working-memory bottleneck without primary memory loss
  • Saccadic slowing & inaccuracy
  • Convergence insufficiency
  • Position-dependent dizziness
  • Visual-motion sensitivity
  • Cervicogenic headache
  • Migraine with cervical trigger
  • Occipital neuralgia patterns
  • Post-concussive head pain

Clinical note — Patients presenting with deficits across two or more of these clusters, especially with a history of head/neck trauma (MVA, concussion, fall, birth trauma), warrant structural evaluation. QSM3 assessment is non-invasive and does not interfere with concurrent testing, therapy, or medical management.

ii.

Test-by-Test Referral Triggers

Use this matrix when a patient's neuropsychological profile shows a subcortical / brainstem-level signature rather than a focal cortical pattern. The findings below are not diagnostic of structural cervical pathology — they are flags that warrant a Lazar Method / Upper Cervical evaluation. Tap a test to see the threshold and brainstem rationale.

ImPACT
Immediate Post-Concussion Assessment & Cognitive Testing
Cluster A + B
What it measures
Verbal & Visual Memory, Visual Motor Speed, Reaction Time, Impulse Control, Symptom Score
Pattern / threshold
Reaction Time > 0.65 sec — or — RCI decline ≥ 0.06 sec from baseline Visual Motor Speed below 25th %ile
Especially when paired with elevated symptom scores in vestibular / cognitive clusters lasting > 4 weeks.
Why it implicates the brainstem
Reaction time and visual-motor speed are dominated by brainstem arousal and ponto-mesencephalic relay timing. When memory composites are preserved but speed is degraded, the lesion is rarely cortical — it is a throughput problem.
SDMT
Symbol Digit Modalities Test
Cluster A
What it measures
Processing speed, sustained attention, white-matter integrity (highly sensitive to subcortical involvement)
Pattern / threshold
Z-score ≤ –1.5 — or — Age-adjusted score < 25th %ile With WMS Immediate / Delayed Memory in normal range
The dissociation is the signal. Slow SDMT + intact memory = subcortical pattern.
Why it implicates the brainstem
SDMT is the most sensitive single test for white-matter and subcortical disease. A flat SDMT in the absence of cortical findings points toward brainstem / cerebellar / upper-spinal-cord pathway integrity — exactly what upper cervical mechanics influence.
CPT
Continuous Performance Test (Conners CPT-3, IVA, TOVA)
Cluster A
What it measures
Inattentiveness, impulsivity, sustained attention, vigilance, response variability
Pattern / threshold
T-score ≥ 65 on Variability (HRT SE) — and — Elevated HRT Block Change Without classic developmental ADHD profile
High variability matters more than mean RT. Variability = arousal dysregulation.
Why it implicates the brainstem
Reticular activating system tone is what stabilizes moment-to-moment attention. Elevated variability with age-of-onset that doesn't fit ADHD — especially post-trauma — is a brainstem-arousal signature, not a developmental one.
King-Devick
Saccadic Eye Movement Test
Cluster B
What it measures
Rapid number-naming under saccadic load; oculomotor and attentional integration
Pattern / threshold
≥ 3 sec slower than baseline — or — Performance outside age-normative range With any error increase
Among the strongest single indicators of brainstem / oculomotor pathway involvement.
Why it implicates the brainstem
Saccades are generated in the paramedian pontine reticular formation and oculomotor nuclei — pure brainstem real estate. A slowed K-D test, especially post-trauma, is essentially a clinical readout of brainstem oculomotor integrity.
WMS
Wechsler Memory Scale, 4th Ed.
Cluster A
What it measures
Auditory, Visual, Visual Working Memory, Immediate, Delayed
Pattern / threshold
Visual Working Memory Index < 85 — with — Immediate & Delayed Memory in normal range Symbol Span < Spatial Addition pattern
Working memory dropout without encoding/retrieval failure.
Why it implicates the brainstem
Disproportionate working-memory loss with intact mesial-temporal memory points to attentional / arousal substrates rather than hippocampal injury. Consistent with brainstem-mediated processing-speed bottleneck rather than cortical amnestic syndrome.
iii.

Discuss with Your Patient

Once the pattern is clear, here's how to introduce The Lazar Method in the room — and what to send the patient afterward in writing. Both versions are framed as complementary, not a replacement, and explain why a structural workup is worth their time.

In the Room

What to Say

"Your testing showed a pattern that often comes from how the head sits on the upper neck — the atlas, specifically. There's a comprehensive workup called The Lazar Method — postural assessment, nerve scans, and motion x-ray studies — that determines whether this has a mechanical component. If it does, the correction itself (called Quantum Spinal Mechanics) is non-invasive — no popping, cracking, or twisting of the spine. It doesn't replace anything we're doing here — it just looks at the same problem from a structural angle. I'd like you to see Dr. Jonathan Lazar at Lazar Spinal Care."

Tone notes The evaluation is The Lazar Method (postural, nerve scans, motion x-ray). The correction is Quantum Spinal Mechanics — no popping, cracking, twisting. Frame as additive, not corrective of anything you've done.
In Writing

What to Send

Hi [First Name] — following up on your testing today.

I'm referring you to Dr. Jonathan Lazar at Lazar Spinal Care for The Lazar Method — a postural assessment, nerve scans, and motion x-ray studies — to see whether this has a mechanical component to it.

If it does, their correction protocol (Quantum Spinal Mechanics) is non-invasive — no popping, cracking, or twisting of the spine. It's complementary to what we're doing here, not a replacement.

You can scan the QR code or click the link in the guide I'm sharing to schedule directly. Their team will keep our office in the loop.

— Dr. [Provider Name]
iii.

When to Refer & How

Refer When
Findings cross two or more clusters in Fig. 01, or any single test above shows a brainstem-pattern flag in a patient with history of cervical trauma, persistent post-concussive symptoms, or a presentation that doesn't localize cleanly to a cortical lesion.
Direct Referral Contact
Lazar Spinal Care Attn: Patient Coordinator
203 S. Zeeb Rd., Suite 106
Ann Arbor, MI
lazarspinalcare.com
Method
QSM3 — Quantum Spinal Mechanics, an orthogonal-based upper cervical specialty within the NUCCA / Grostic family. Non-invasive structural correction; no rotation, no twisting.
What We Send Back
Structural assessment summary, alignment imaging review, and a clear yes / no on whether the patient is a QSM3 candidate. Co-management welcomed.
Patient Referral Card
Prepared for Neuropsychology Partners
How to Use This Guide
01
Step One

Review this guide.

Walk through the mechanism and the test thresholds. Two minutes — on screen, or print the handout for the chart.

02
Step Two

Chat with your patient.

If their profile shows a brainstem-level signature, mention LSC and The Lazar Method — a postural assessment, nerve scans, and motion x-ray studies to see whether this has a mechanical component.

03
Step Three

Scan to refer.

The patient coordinator receives the referral immediately. Most candidates are seen within a week.

Open the LSC referral portal →
Or visit lazarspinalcare.com/refer/neuropsychology-partners
Scan to open the LSC referral portal
Scan to refer
Print options. The full guide includes margins and contact footer on every page. The suite card is a single page with the QR + portal link, sized for an exam-room display.
Lazar Spinal Care · The Lazar Method · Clarity Before Change
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