Inclusion Criteria:  Full time manual wheelchair users Motor complete SCI from C6-T4 Age 18-70 at time of testing Time since injury > 3 month at time of testing  Exclusion Criteria:  Weight >250 pounds Current pressure ulcer at time of testing Significant shoulder pain that precludes independent mobility at time of testing Insufficient range of motion to achieve neutral pelvis and spine at time of testing Orthopedic restrictions requiring a brace that would impact functional outcome measures Shoulder flexion range of motion <120 degrees at time of testing PSIS-to-Inferior Angle of scapula measurement less than 8 inches or greater than 16 inches Cognitive deficits or visual impairment that would impair ability to give informed consent or to follow simple instructions during testing Children, pregnant women and prisoners will not participate in this study