Segmental definition--Part IV. Updating the differential for somatic and visceral inputs.

The first three parts of this series presented a standardized method of motion testing for motor behaviors specific to segmental dysfunction. When applied to clinical research studies, analysis of these palpatory data differentiated viscero-somatic from somato-somatic reflex manifestations in the thoracic region of subjects with renal dysfunction and/or hypertension. This update for the differential adds new observations regarding palpable findings, specifically at the spinal levels where linkage of costal and vertebral motion asymmetries identified the presence of increased visceral inputs. At each level, the examiner can make a simple comparison for accord in response to two sidebending motion tests in the seated position, one introduced through the shoulders and trunk and one through the head and neck. Lack of accord is a distinctive characteristic of the linked spinal/costal site of visceral input. Also, with regard to linkage sites, behavioral responses to motion tests introduced through the lower extremities suggest new applications for manipulative intervention. The new descriptive clinical data about segmental motion behaviors described in this report provide a basis for new questions in neuromusculoskeletal research.