In-home Telerehabilitation for Quadriplegic Hand Function

Inclusion Criteria: * Chronic C5, 6 or 7 SCI subjects who have sustained a cervical SCI resulting in complete or incomplete quadriplegia. Time since injury at least one year at time of entry to study. Subjects may have a complete or an incomplete injury but must demonstrate loss of finger grasp and release as well as loss of thumb lateral (key) pinch bilaterally or unilaterally. Subjects must be stable neurologically and medically, cognitively intact, and willing and able to attend the requisite appointments for participation in the study. Exclusion Criteria: * Subjects with unresolved medical issues such as easily triggered autonomic dysreflexia and/or hypotension. * Subjects demonstrating severe spasticity affecting the upper extremities, fixed hand contractures with loss of suppleness and range of movement at the metacarpal-phalangeal joints, absence of voluntary ability to extend the wrist against gravity and/or insufficient muscle strength to abduct (lift) the arm against gravity. * Subjects with unresolved substance abuse problems * Subjects with a history of head injury, epilepsy in self or close relative and/or cognitive impairment * Subjects with intracranial metal inclusions * Subjects, who upon initial testing, demonstrate partial or complete denervation (loss of nerve supply) of the nerves to the the targeted muscle.