Virtual treadmill technology (C-mill) in gait rehabilitation after stroke: A qualitative interview study.

Background: In stroke rehabilitation, VR-based technologies like the C-Mill treadmill combine physical and cognitive training to enhance motivation and motor learning. While quantitative studies show functional benefits, little is known about patients' experiences. Aim: This study aims to explore stroke survivors' subjective experiences of motivation during C-Mill training. Method: A qualitative design was employed. Seven inpatients at Sunnaas Hospital who had engaged in gait rehabilitation with C-Mill participated in semi-structured interviews. Data were transcribed verbatim and analyzed using systematic text condensation. Results: One overarching theme - motivation - was identified, comprising two subthemes: intrinsic and extrinsic motivation. The patients described how the C-Mill fostered intrinsic motivation by providing challenging, meaningful, and engaging activities that reflected everyday-life situations. They experienced that the system encouraged them to push their limits and attempt tasks they might otherwise hesitate to try, while still feeling supported and safe. Additionally, the technology enhanced extrinsic motivation through engaging feedback mechanisms, including gamification elements, and the visualization of performance statistics. Conclusion: C-Mill appears to constitute a promising adjunct to conventional rehabilitation by strengthening motivation. Its technological features, including safety scaffolding, gamification, and task variability, appeared to facilitate engagement and promote motivation.