Rehabilitation and Cortical Remodeling After Surgical Intervention for Spinal Cord Injury

Inclusion Criteria: * Tetraplegia (cervical lesion) with some degree of motor dysfunction in the hand * Motor incomplete or complete lesion (measured by the ASIA Impairment Scale, A, B, C, D). * Chronic lesion (at least 6months after the injury) * Demonstrate stability of motor examination for at least six months. * Retain intact innervation within paralyzed target muscles (axon recipient) as determined by electrodiagnostics. * Have muscles innervated by the nerves to be used for the transfers (axon donors) of MRC grade 4/5 or greater and sufficient innervation as determined by electrodiagnostics. * Have access to an at home caregiver who can assist with customary postsurgical physical therapy. * Ability to give informed consent and understand the tasks involved. Exclusion Criteria: * Presence of potential risk factor for brain stimulation: history of seizures, presence of surgically implanted foreign bodies such as a pacemaker, metal plate in the skull, and metal inside the skull. * History of head trauma and/or cognitive deficit * Medically unstable * Contraindicated for nerve transfer surgery.