Spine and Brain Stimulation for Movement Recovery After Cervical Spinal Cord Injury

Inclusion Criteria: * Patients aged ≥18 years with incomplete traumatic SCI (American Spinal Injury Association (ASIA) B-D, levels between C4 to T1) incurred \> 1 year before the start of the study * At least 2/5 motor power in at least one upper extremity muscle group * International Standards for Neurological Classification of Spinal Cord Injury Upper Extremity Motor Score (ISNCSCI-UEMS) ≤ 40/50 * Able to follow multistep commands * Ability and willingness to provide informed consent * English speaking Exclusion Criteria: * Cervical or thoracic stenosis that would preclude safe lead placement * Any ongoing ventilator use (continuous or intermittent) * Urinary tract infection or pneumonia requiring treatment (within past 3 months) * Skin ulcers or other lesions * History of posterior cervical fusion * Autonomic dysreflexia requiring treatment (within past 3 months) * Implanted brain stimulators * Intracranial aneurysm clips * Ferromagnetic metallic implants in the head (except for within mouth) * Any active implanted device including intrathecal medication pumps or existing spinal cord stimulators (does not include non-active spinal instrumentation such as rods, screws, or interbody devices) * Cochlear implants * Cardiac pacemaker/defibrillator * Any history of seizures * Family history of idiopathic epilepsy in a first degree relative * Bipolar disorder * Any history of suicide attempt * Active psychosis * Intracranial lesion or increased intracranial pressure * History of stroke or intracranial neurologic conditions with structural damage * Medications that lower seizure threshold * Substance use that lowers seizure threshold (heavy alcohol use) * Moderate to severe heart disease * Pregnancy or plans to become pregnant within the study period * Any other medical or psychological condition that precludes involvement in the study as determined by a study physician