{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:28:22Z","timestamp":1760146102445,"version":"build-2065373602"},"reference-count":78,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2024,9,30]],"date-time":"2024-09-30T00:00:00Z","timestamp":1727654400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>The determinants and driving forces of communication abilities in the locked-in state are poorly understood so far. Results from an experimental\u2013clinical study on a completely paralyzed person involved in communication sessions after the implantation of a microelectrode array were retrospectively analyzed. The aim was to focus on the prerequisites and determinants for learning to control a brain\u2013computer interface for communication in paralysis. A comparative examination of the communication results with the current literature was carried out in light of an ideomotor theory of thinking. We speculate that novel skill learning took place and that several aspects of the wording of sentences during the communication sessions reflect preserved cognitive and conscious processing. We also present some speculations on the operant learning procedure used for communication, which argues for the reformulation of the previously postulated hypothesis of the extinction of response planning and goal-directed ideas in the completely locked-in state. We highlight the importance of feedback and reinforcement in the thought\u2013action\u2013consequence associative chain necessary to maintain purposeful communication. Finally, we underline the necessity to consider the psychosocial context of patients and the duration of complete immobilization as determinants of the \u2018extinction of thinking\u2019 theory and to identify the actual barriers preventing communication in these patients.<\/jats:p>","DOI":"10.3390\/s24196366","type":"journal-article","created":{"date-parts":[[2024,10,1]],"date-time":"2024-10-01T03:57:52Z","timestamp":1727755072000},"page":"6366","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Brain Function, Learning, and Role of Feedback in Complete Paralysis"],"prefix":"10.3390","volume":"24","author":[{"given":"Stefano","family":"Silvoni","sequence":"first","affiliation":[{"name":"Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, 68159 Mannheim, Germany"},{"name":"ALS Voice gGmbH, 72116 M\u00f6ssingen, Germany"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0950-7399","authenticated-orcid":false,"given":"Chiara","family":"Occhigrossi","sequence":"additional","affiliation":[{"name":"ALS Voice gGmbH, 72116 M\u00f6ssingen, Germany"}]},{"given":"Marco","family":"Di Giorgi","sequence":"additional","affiliation":[{"name":"ALS Voice gGmbH, 72116 M\u00f6ssingen, Germany"}]},{"given":"Doroth\u00e9e","family":"Lul\u00e9","sequence":"additional","affiliation":[{"name":"Department of Neurology, Ulm University, 89081 Ulm, Germany"}]},{"given":"Niels","family":"Birbaumer","sequence":"additional","affiliation":[{"name":"Institute of Medical Psychology and Behavioral Neurobiology, T\u00fcbingen University, 72076 T\u00fcbingen, Germany"},{"name":"Physical Medicine and Rehabilitation, University of Padua, 35121 Padua, Italy"}]}],"member":"1968","published-online":{"date-parts":[[2024,9,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Aristotle (1970). 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