Korsten et al. 2004; USA
PEDro = 6
RCT
N=16

Population: Age range=23-67 years ( part A subjects), mean=48 years (part B subjects); 9 subject with tetraplegia, 7 subjects with paraplegia; mean length of injury=13 yrs
Treatment: An abdominal belt with embedded electrodes was wrapped around at the umbilicus level. Device activation was random, subjects did not know whether the device was activated. Subjects used the belt for six bowel care sessions over 2 weeks (the belt was activated for three sessions and deactivated for three sessions).
Outcome Measures: time to first stool, time for total bowel care.

1. Activation of the abdominal belt resulted in a significant reduction in time to first stool and time for total bowel care independent of the level of injury.
2. The time to first stool and time for total bowel care were significantly shortened in the 6 subjects with tetraplegia, but not in the 2 subjects with paraplegia.

Hascakova-Bartova et al. 2008; Belgium
Downs & Black = 20
Prospective Controlled Trial
N = 10

Population: 7 subjects with injury level T10 or higher and complete paralysis of abdominal muscles (6 male, 1 female, age 42 + 19 yrs) were divided into treatment (4 subjects) and control (3 subjects) groups. The 3 subjects in control groups subsequently decided to receive the treatment, at which point 3 new subjects (all male, ages 25, 43, and 63) were recruited as control.
Treatment: Surface abdominal neuromuscular electrical stimulation (NMES), administered for 25 minutes per day, 5 days a week, for 8 weeks
Outcome Measures: colonic transit times

1. Accelerated colonic transit times in the ascending, transverse, and descending colon in all subjects who received treatment.
2. No changes in the colonic transit times in the control group.

Tsai et al. 2009;
Taiwan
Downs & Black = 20
Pre-Post
N = 22

Population: 22 chronic SCI subjects with intractable neurogenic bowel dysfunction (19 male, 3 female, mean age 46.7 yrs, range 22 – 65); divided into group 1 (supraconal lesion) and group 2 (conal/caudal lesion)
Treatment: Functional magnetic stimulation, in 20-minute sessions twice daily for 3 weeks
Outcome Measures: Colonic transit times; Knowles-Eccersley-Scott Symptom Questionnaire (KESS, evaluates frequency of bowel movement using existing therapy, difficulty of evacuation, laxative use, and time taken for bowel evacuation)

1. Mean colonic transit times decreased from 62.6 h to 50.4 h
2. Frequency of laxative use, unsuccessful evacuation attempts, feeling of incomplete defecation, difficulty with evacuation, and time taken significantly decreased (p<0.02)
3. Mean scores on the KESS significantly decreased from 24.5 to 19.2 points (p<0.001), indicating a significant overall improvement in bowel symptoms.

Mentes et al. 2007
Turkey
Downs & Black = 13
Pre-post
N=2

Population: A 51-year-old woman who had undergone discectomy for lumbar disc herniation 3 years ago and a 31-year-old man with a 10-year history of lumbar cavernous haemangioma.
Treatment: Posterior tibial nerve stimulation was performed for 30 min, every other day for 4 weeks, and was then repeated every 2 months for 3 months.
Outcome Measures: Rectal sensory threshold, Wexner faecal incontinence score, faecal incontinence severity index, faecal incontinence quality of life scales, resting pressure, and maximum squeeze pressure measurements.

1. Patients showed improvements in Wexner FI score, FIQL score, clinical parameters and physiological measurements. Significance of improvements not reported in this study.

Lin et al. 2001; USA
Downs & Black = 12
Pre-post
N=15

Population: 13 SCI, 2 controls, level of injury range=C3-L1; length of injury range=11-35 years (protocol 2 only); AIS classes=7 A, 3 B, 1 C.
Treatment: Protocol 1: measured the effects of functional magnetic stimulation (FMS) on rectal pressure by placing the magnetic coil on the transabdominal and lumbosacral regions. Protocol 2: consisted of a 5-week stimulation period to investigate the effects of functional magnetic stimulation on total and segmental colonic transit times.
Outcome Measures: rectal pressure and total and segmental transit times

1. Rectal pressures increased with sacrolumbar stimulation, and with transabdominal stimulation.
2. With stimulation, the mean colonic transit times decreased from 105.2 to 89.4 hours.

Lin et al. 2002; USA
Downs & Black = 11
Pre-post
N=9

Population: 4 subjects with a SCI, 5 controls, mean age: 42+/-5.8 years; level of injury: C3-C7; AIS classes: 3 B, 1 D
Treatment: Each subject participated in a 3-day protocol. On the first day subjects received a baseline gastric emptying study. On day 2 there was no change in the eating pattern and the subject did not undergo any intervention. On day 3, subjects received functional magnetic stimulation (FMS) while undergoing a second gastric emptying study.
Outcome Measures: Rate of gastric emptying

1. The gastric emptying time of post-stimulation was significantly shorter than the baseline. 
2. There was significantly more gastric emptying after FMS than at baseline.
3. Gastric emptying with FMS was accelerated by 25 minutes when compared to baseline values.