• Change in Medical Research Council Scale Upper Extremity Manual Muscle Test [ Time Frame: Change from baseline at immediately post-intervention, 1-month follow-up, 4-month follow-up ]
  This evaluates the strength of various muscles in the upper extremity. Each muscle that is tested can be scored from a minimum of 0, indicating no strength, up to a maximum of 5, indicating normal strength. Scores are assigned to each side by summing the scores from each of the 41 individual muscles, with a minimum possible total score of 0 and a maximum possible total score of 205. Higher values indicate greater strength.
• Change in Canadian Occupational Performance Measure [ Time Frame: Change from baseline at immediately post-intervention, 1-month follow-up, 4-month follow-up ]
  The participant selects 5 tasks they would like to be able to perform, and score their performance as well as satisfaction with their performance of the tasks.
• Change in Graded and Redefined Assessment of Strength, Sensibility, and Prehension [ Time Frame: Change from baseline at immediately post-intervention, 1-month follow-up, 4-month follow-up ]
  This measures strength, sensibility, and prehension to obtain information about motor and sensory function.
• Change in Van Lieshout Test [ Time Frame: Change from baseline at immediately post-intervention, 1-month follow-up, 4-month follow-up ]
  This test evaluates upper extremity motor performance in cervical spinal cord injury.
• Change in cortical motor map volume [ Time Frame: Change from baseline at immediately post-intervention, 1-month follow-up, 4-month follow-up ]
  This is performed using non-invasive transcranial magnetic stimulation to determine which parts of the brain control a muscle in the arm or hand.
• Semi-structured interview about study [ Time Frame: Baseline ]
  Participants will be asked about motivations and goals for the study.
• Semi-structured interview about study [ Time Frame: Immediately post-intervention, 4-month follow-up ]
  Participants will be asked about their experience in the study, whether they experienced any changes in function during the study, and whether they have recommendations for change.

• Spinal Cord Injuries
• Tetraplegia, Unspecified, Incomplete, Chronic

• Device: transcranial direct current stimulation
  This is a non-invasive form of stimulation which delivers safe, low levels of electrical current to the brain through the scalp.
• Behavioral: Intensive upper extremity motor training
  This training is administered one-on-one with an occupational therapist. Activities will be focused on skills the participant wants to regain.

• Experimental: Active tDCS
  Subjects will receive 20 minutes of active transcranial direct current stimulation at 2.5mA, followed by 2 hours of intensive motor therapy of the more affected upper extremity.
  Interventions:

  • Device: transcranial direct current stimulation
  • Behavioral: Intensive upper extremity motor training
• Sham Comparator: Sham tDCS
  Subjects will receive 20 minutes of sham transcranial direct current stimulation, followed by 2 hours of intensive motor therapy of the more affected upper extremity.
  Interventions:

  • Device: transcranial direct current stimulation
  • Behavioral: Intensive upper extremity motor training

Inclusion Criteria:

1. traumatic, incomplete cervical SCI sustained at neurological level C4-C7 and classified as B, C or D by the American Spinal Injury Association Impairment Scale (AIS);
2. sustained injury at least 1 year prior to enrollment (i.e., chronic); and
3. Men and women between the ages of 18-65.

Exclusion Criteria:

1. history of head injury, seizures, severe alcohol or drug abuse, or psychiatric illness;
2. cognitive deficits severe enough to preclude informed consent;
3. positive pregnancy test or being of childbearing age and not using appropriate contraception;
4. presence of ferromagnetic material in the cranium except in the mouth, including metal fragments from occupational exposure and surgical clips in or near the brain;
5. decubitus ulcers that might interfere with intervention;
6. cardiac or neural pacemakers;
7. fixed UE contractures;
8. untreated depression;
9. concurrent participation in occupational therapy;
10. within 3 months of recruitment, an addition or change in the dosage of drugs known to exert detrimental effects on motor recovery.