This study is designed to examine arm and hand function after receiving fine motor training combined with stimulation to increase brain excitability in individuals with cervical spinal cord injuries. The project will study two types of stimulation- transcranial direct current stimulation, a type of non-invasive brain stimulation, and peripheral nerve somatosensory stimulation, which is stimulation to the median nerve. A total of 83 participants are expected to enroll in the study, 58 participants with acute spinal cord injuries 6 months post injury and 15 participants with chronic injuries 1 year post injury. We estimate enrolling 10 additional participants due to attrition. The project will be performed in a real-world clinical setting, so that the results can be immediately relevant for application to clinical practice. We believe that increasing the ability of the brain to push information through the remaining spinal pathways will result in more effective therapy and larger improvements in hand function. In this past reporting period, 46 additional participants have been enrolled into the study, bringing the total number of enrolled participants to 61. Additionally, new staff was trained to take on study roles, including a new postdoctoral fellow, a new occupational therapy and physical therapy fellow, coverage staff for primary assessor and anew biomedical engineer. Continued recruitment and enrollment is expected to run through 2019.