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A major objective of Brain-Computer interfaces (BCI) is to restorecommunication and control in patients with severe motor impairments, likepeople with Locked-in syndrome. These patients are left only with limited eyeand eyelid movements. However, they do not benefit from efficient BCIsolutions, yet. Different signals can be used as commands for non-invasive BCI:mu and beta rhythm desynchronization, evoked potentials and slow corticalpotentials. Whatever the signal, clinical studies show a dramatic loss ofperformance in severely impaired patients compared to healthy subjects.Interestingly, the control principle is always the same, namely the replacementof an impossible (overt) movement by a (covert) attentional command. Drawingfrom the premotor theory of attention, from neuroimaging findings about thefunctional anatomy of spatial attention, from clinical observations and fromrecent computational accounts of attention for both action and perception, weexplore the hypothesis that these patients undergo negative plasticity thatextends their impairment from overt to covert attentional processes.

Why BCIs work poorly with the patients who need them the most?