tSCS and 5-Azacitidine for Enhanced Motor Outcomes in Cerebral Palsy

Inclusion Criteria:

* Diagnosis of cerebral palsy (CP) classified as Gross Motor Function Classification System (GMFCS) Levels I-V.
* Between 4 and 17 years old at the time of enrollment/consent.
* Diagnosis of spastic CP hemiplegia, diplegia, or quadriplegia.
* Stable medical condition as determined by the investigator.
* Adequate caregiver support to be able to participate in training and assessment sessions for the duration of the study, at the discretion of the Investigator.
* Capable of performing simple cued motor tasks and can follow 2-3 step commands.
* Capable of communicating an accurate yes or no answer to questions according to parent or guardian.
* Able to localize pain/ discomfort.
* Physician approval for participation.
* Parent/ guardian permission.

Exclusion Criteria:

* Concurrent neurological disease affecting the central nervous system.
* Cardiovascular or musculoskeletal disease or injury that would prevent full participation in physical therapy intervention
* Orthopedic dysfunction, injury, or surgery that would impact an individual's ability to use the upper and/or lower extremity
* Unhealed fracture or other musculoskeletal impairment that might interfere with upper or lower extremity rehabilitation or testing activities
* Implanted stimulator (e.g., epidural stimulator, vagus nerve stimulator, pacemaker, cochlear implant) or drug delivery device (e.g., baclofen pump)
* Dependence on an electro-magnetic medical implant (e.g., cardiac pacemaker, implanted drug pump), ventilation support, or another external device.
* History of uncontrolled seizures
* Unexplained presence of persistent complaints of pain of any kind
* Unable to localize pain/discomfort
* Severe cortico-visual impairment
* Active pressure sores
* Active urinary tract infection
* Active cancer or cancer in remission less than 5 years
* Clinically significant depression, psychiatric disorders, or ongoing drug abuse
* Immunodeficiency or hematologic condition
* Allergy to AZA or mannitol
* Plans to receive a vaccine within 30 days of the planned AZA or placebo injection to take place at week 10
* Pregnancy
* Orthopedic surgery completed in the prior 12 months
* Intrathecal medication titration that may affect muscle spasticity
* Botulinum toxin treatment within 3 months preceding enrollment unless given approval by the treating physician
* Current enrollment in a conflicting research study
* Any other health condition or diagnosis not listed above that may put the participant at risk as determined by the investigator or treating physician