Using brain-computer interfaces to overcome the extinction of goal-directed thinking in minimally conscious state patients

Minimally conscious state (MCS) is a condition of severely altered consciousness, in which patients appear to be wakeful and exhibit fluctuating but reproducible signs of awareness. MCS patients do not respond and are therefore dependent on others. In agreement with the embodied cognition assumption that motor actions influence our cognition, the absence of movement and the decrease in consequences for any type of covert or overt response may cause an extinction of goal-directed thinking. Brain-computer interfaces, which allow a direct output without muscular involvement, may be used to promote goal-directed thinking by allowing the performance of spatial and motor imagery tasks and could facilitate the interaction of MCS patients with their environment, possibly regaining some degree of communication and autonomy.