Innovative Brain-Computer Interface for People With Spinal Cord Injury

Inclusion Criteria: * Clinical diagnosis of SCI at the cervical level C4 or higher (C1-C4) * Complete or incomplete tetraplegia (quadriplegia) or tetraparesis (quadriparesis), i.e., level A or B at the American Spinal Injury Association (ASIA) Impairment Scale * Meeting surgical safety criteria, including surgical clearance by the study physicians * Meeting (neuro)psychological evaluation criteria * Ability to communicate reliably, via speech or other means * Willingness and ability to provide informed consent. * Lives within reasonable distance from UMC Utrecht * Participant consents to the study and still wishes to participate at the time of the study. * Vision and hearing largely intact. * For candidates who are not currently receiving invasive ventilation, and who have current respiratory problems (e.g., at night), there should be a clear and confirmed desire to proceed with tracheostomy ventilation whenever that would become necessary. Exclusion Criteria: * Having a spinal cord injury with a degenerative or progressive etiology. * Having evident swallowing problems. * Having a significant current or recent anxiety disorder or depression or cognitive impairment that would interfere with obtaining informed consent or fully participating in study activities. * Medical conditions contraindicating surgery of a chronically implanted device or that could interfere with study participation (for example active infections, unexplained fever, existing scalp lesions or skin breakdown, osteomyelitis, hepatitis, any autoimmune disease/disorder, epilepsy, skin disorders causing excessive skin sloughing or poor wound healing, cranioplasty, significant cardiovascular, metabolic, or renal impairments, chronic oral or intravenous use of steroids or immunosuppressive therapy, active cancer within the past year or requires chemotherapy, uncontrolled autonomic dysreflexia within the past 3 months, hydrocephalus with or without an implanted ventricular shunt or a medical contraindication to stop anti-coagulant medications during surgery, or a catabolic state, or strong and frequent spasms) * Presence of pre-surgical findings in anatomical, functional, and/or vascular neuroimaging that makes achieving implant locations too challenging or incompatible with desired risk levels. * Inability to undergo MRI for pre-implantation evaluation, for example due to the presence of implanted devices that are incompatible with MRI, which may include pacemakers, cardiac defibrillators, spinal cord or vagal nerve stimulators, deep brain stimulators, and cochlear implants or devices that deliver diaphragm pacing. * Anticipated need for MRI after implantation of the Brain InterChange system.