CE-STAND: Cervical Epidural STimulation After Neurologic Damage

Inclusion Criteria:

* Twenty two years of age or older
* Able to undergo the informed consent/assent process
* Stable, motor-complete SCI
* Discrete SCI between C4 and C7 (upper extremity weakness)
* ASIA A or B SCI Classification
* Medically stable in the judgment of the PI
* Intact segmental reflexes below the lesion of injury
* Greater than 1 year since initial injury and at least 6 months from any required spinal instrumentation
* Normal or corrected-to-normal vision to accurately perceive visual stimuli on the N-back task screen, and sufficient hearing ability to accurately perceive auditory stimuli during the task
* Willing to attend all scheduled appointments

Exclusion Criteria:

* Diseases and conditions that would increase the morbidity and mortality of this surgery such as cardiopulmonary.
* Individuals who require respiratory support, including ongoing or intermittent use of a ventilator and/or diaphragmatic pacer
* Inability to withhold antiplatelet/anticoagulation agents perioperatively
* Individuals who have history of recurrent autonomic dysreflexia in the judgment of the PI
* Significant dysautonomia that would prohibit rehabilitation or any history of cerebrovascular accident or myocardial infarction associated with autonomic dysreflexia. A single tilt table test with syncope, presyncope, or SBP \< 50 or \> 200
* Failure to exhibit cardiovascular autonomic dysfunction on tilt table testing
* Other conditions that would make the subject unable to participate in testing/rehabilitation in the judgment of the PI
* Patients who have participated in another study within the last 12 months in which they have received fluoroscopic or other related radiation exposure
* Current and anticipated need for opioid pain medications or pain that would prevent full participation in the program in the judgment of the PI
* Clinically significant mental illness in the judgment of the PI
* Treatment with botulinum toxin, intrathecal baclofen pump, and antispasmodics will not be permitted unless discussed with and approved by the study PI
* Patients with a history of significant depression or drug abuse
* Volitional movements present during EMG testing in bilateral lower extremities
* Unhealed spinal fracture
* Presence of significant contracture with loss of greater than two-thirds range of motion
* Presence of pressure ulcers
* Current Pregnancy