Spinal Stimulation for Chronic Complete Tetraplegia

Inclusion Criteria: * Willing and able to give informed consent for participation in the study * Aged ≥18 years * Injury level C3-C7, American Spinal Cord injury Association Impairment Scale (ASIA) A * ≥1 year post-injury * Medically stable, cognitively intact, and able to breathe independently * Able to attend all sessions two or three times per week, for 2 h sessions and assessments Exclusion Criteria: * Any implanted active metallic device including, but not limited to neurostimulators, cochlear implants, pacemakers, implantable defibrillators, or drug delivery pumps * Possible, suspected, or confirmed pregnancy and/or lactation * Recent history or fracture, contractures or pressure sore, deep vein thrombosis (DVT) or urinary tract, or other infection that may interfere with the intervention and training * History of epilepsy and/or seizures * Severe spasticity which has been unstable over the 3 months prior to enrolment and is not expected to change and/or taking varying doses of anti-spasticity medications which could not be tapered to a stable dose and are not expected to change * Botulinum toxin injections within 6 months of participation * Non-injury related neurological impairment * Clinically significant severe depression in spite of treatment * Cardiovascular disease * Autonomic dysreflexia that is severe, ongoing, and has required medical treatment within the past month * Skin conditions or allergies that may affect electrode placement * Do not understand English * Received a stem cell treatment or other treatment that could possibly promote or attenuate neuroplastic changes in spinal or cortical function, within ≥2 years of enrolment; beyond this period, they may be included, provided the treatment was conducted in an accredited facility with proper ethics and regulatory approval. * Involved in any other study involving stimulation of the spinal cord within 6 months of enrolment * Information regarding recent rehabilitation or exercise programmes that participants may currently be engaged in will be discussed with clinical staff and fully documented for each participant