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Individuals with stroke and spinal cord injury (SCI) experience permanent disability resulting from total or partial upper extremity (UE) paralysis, sensory and autonomic impairments which limit their independence in self-care and instrumental activities of daily living. UE paralysis is typically unilateral for individuals following stroke and bilateral following tetraplegia. Reaching, grasping, and manipulation are vital components of UE function that allow individuals to use the sensorimotor integrity of their arm and hand, to perform activities that meet their personal needs, and meaningfully participate in their external environment. This chapter provides a detailed discussion of the role of functional electrical stimulation therapy (FEST) in augmenting UE reaching and grasping in these two client groups.