I review efforts to establish communication with completely locked-in patients in the late stage of amyotrophic lateral sclerosis through brain-computer interfacing, and discuss potential explanations for the apparent inability of this patient group to make use of a brain-computer interface. In particular, I argue that disease progression in amyotrophic lateral sclerosis is accompanied by a broad range of neurophysiological- and cognitive changes, which must be taken into account when designing brain-computer interfaces for this patient group.

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