Nerve Transfer Surgery to Restore Upper-limb Function After Cervical Spinal Cord Injury

The goal of this prospective, open-label cohort study is to assess functional outcomes in individuals with cervical spinal cord injury who have undergone nerve transfer surgery to restore upper limb function. The main questions it aims to answer are: * Does nerve transfer improve hand function in individuals with cervical spinal cord injury? * What factors are associated with functional improvement following nerve transfer? Researchers will compare functional outcomes at 24 months post-surgery to 1) baseline outcomes and 2) individuals with cervical spinal cord injury who did not undergo nerve transfer. Participants who have received nerve transfer surgery as part of their regular medical care will complete functional hand tests, electrodiagnostic assessments, and questionnaires on independence and mood every 3 months for 24 months after surgery.

Inclusion Criteria: * Traumatic, motor-complete cervical SCI (AIS A or B) * Male or female, ages 18-70 * Consent and plan to undergo nerve transfer to restore grasp function in at least one limb * Motor grade 4-5 at C5 * Motor grade 0-1 at C8/T1 * Injury duration within 6 months at the time of surgery * English-speaking and cognitively intact * Able to provide informed written consent * Able to attend and comply with the testing protocols Exclusion Criteria: * Inability or unwillingness to participate in post-operative rehabilitation (in person or virtual) * Secondary complication of SCI (e.g., intractable neuropathic pain, edema, contracture) or major medical comorbidity (e.g., traumatic brain injury) that would independently influence response to surgery or ability to participate in rehabilitation