Is controlling a brain-computer interface just a matter of presence of mind? The limits of cognitive-motor dissociation

TL;DR

This paper explores how cognitive-motor dissociation impacts brain-computer interface control, emphasizing that motor system injuries may cause cognitive deficits affecting BCI performance, especially in severely paralyzed patients.

Contribution

It introduces the hypothesis that motor system injuries influence cognitive functions like attention, which are essential for effective BCI control, highlighting the need for better assessment.

Findings

Patients with severe paralysis often have injuries in cognitive motor areas.

Motor system injuries may impair attention, affecting BCI control.

Cognitive deficits in these patients could explain BCI reliability issues.

Abstract

Brain-computer interfaces (BCI) are presented as a solution for people with global paralysis, also known as locked-in syndrome (LIS). The targeted population includes the most severe patients, with no residual eye movements, who cannot use any communication device (Complete LIS). However, BCI reliability is low precisely in these cases, technical pitfalls being considered responsible so far. Here, we propose to consider also that global paralysis could have an impact on cognitive functions that are crucial for being able to control a BCI. We review a bundle of arguments about the role of motor structures in cognition. Especially, we uncover that these patients without oculomotor activity often have injuries in more 'cognitive' structures such as the frontal eye field or the midbrain, exposing them to cognitive deficits further than canonical LIS population. We develop a hypothesis about the putative role of the motor system in (covert) attention, a capacity which is a prerequisite for most BCI paradigms and which should therefore be both better assessed in patients and considered.