Feasibility of a walking virtual reality system for rehabilitation: objective and subjective parameters

Go Across Immersive Technology: A Preliminary Study of the Design and Development of a System for Gait Training Using Virtual Reality

Virtual reality (VR) allows visuotactile interaction in a virtual environment. VR has several potential applications such as surgical training, phobia treatments, and gait rehabilitation. However, further interface development is required. Therefore, the objective of this study was to develop a noninvasive wearable device control to a VR gait training program. It consists of custom-made insoles with vibratory actuators, and plantar pressure sensor-based wireless interface with a VR game. System usability testing involved a habituation period and three gaming sessions. Significant gait improvement was associated with game scores (P < 0.05). This VR gait training system allowed real-time virtual immersive interaction with anticipatory stimulus and feedback during gait.

Evaluation of a Low-Cost Virtual Reality Surround-Screen Projection System

Two of the most popular mediums for virtual reality are head-mounted displays and surround-screen projection systems, such as CAVE Automatic Virtual Environments. In recent years, HMDs suffered a significant reduction in cost and have become widespread consumer products. In contrast, CAVEs are still expensive and remain accessible to a limited number of researchers. This study aims to evaluate both objective and subjective characteristics of a CAVE-like monoscopic low-cost virtual reality surround-screen projection system compared to advanced setups and HMDs. For objective results, we measured the head position estimation accuracy and precision of a low-cost active infrared (IR) based tracking system, used in the proposed low-cost CAVE, relatively to an infrared marker-based tracking system, used in a laboratory-grade CAVE system. For subjective characteristics, we investigated the sense of presence and cybersickness elicited in users during a visual search task outside personal space, beyond arms reach, where the importance of stereo vision is diminished. Thirty participants rated their sense of presence and cybersickness after performing the VR search task with our CAVE-like system and a modern HMD. The tracking showed an accuracy error of 1.66 cm and .4 mm of precision jitter. The system was reported to elicit presence but at a lower level than the HMD, while causing significant lower cybersickness. Our results were compared to a previous study performed with a laboratory-grade CAVE and support that a VR system implemented with low-cost devices could be a viable alternative to laboratory-grade CAVEs for visual search tasks outside the user's personal space.

Pedestrian Crossing Decisions in Virtual Environments: Behavioral Validity in CAVEs and Head-Mounted Displays

OBJECTIVE

To contribute to the validation of virtual reality (VR) as a tool for analyzing pedestrian behavior, we compared two types of high-fidelity pedestrian simulators to a test track.

BACKGROUND

While VR has become a popular tool in pedestrian research, it is uncertain to what extent simulator studies evoke the same behavior as nonvirtual environments.

METHOD

An identical experimental procedure was replicated in a CAVE automatic virtual environment (CAVE), a head-mounted display (HMD), and on a test track. In each group, 30 participants were instructed to step forward whenever they felt the gap between two approaching vehicles was adequate for crossing.

RESULTS

Our analyses revealed distinct effects for the three environments. Overall acceptance was highest on the test track. In both simulators, crossings were initiated later, but a relationship between gap size and crossing initiation was apparent only in the CAVE. In contrast to the test track, vehicle speed significantly affected acceptance rates and safety margins in both simulators.

CONCLUSION

For a common decision task, the results obtained in virtual environments deviate from those in a nonvirtual test bed. The consistency of differences indicates that restrictions apply when predicting real-world behavior based on VR studies. In particular, the higher susceptibility to speed effects warrants further investigation, since it implies that differences in perceptual processing alter experimental outcomes.

APPLICATION

Our observations should inform the conclusions drawn from future research in pedestrian simulators, for example by accounting for a higher sensitivity to speed variations and a greater uncertainty associated with crossing decisions.

Global trends and hotspots in research on extended reality in sports: A bibliometric analysis from 2000 to 2021

Objective

Extended reality technologies (e.g. virtual reality (VR), augmented reality (AR) and mixed reality (MR)) are gaining popularity in sports owing to their unique advantages. This study aims to analyse the progress of the application of extended reality technology in sports and reveal its cooperative features, research hotspots and development trends.

Methods

We searched the literature in the Web of Science Core Collection (WoSCC) database within the period 2000 to 2021 and conducted a bibliometric analysis. The analysis methods included statistical, co-occurrence, hierarchical clustering and social network analyses.

Results

A total of 340 articles were gathered. The literature related to its research showed an increasing trend over time. The paper collaboration rate was 90.88% (309/340 papers), and the degree of author collaboration was 3.96 (1345/340). VR was found to be the most productive journal, and Queen's University Belfast was the most productive institution. The United States, China and the United Kingdom were the three main contributors to the field. The foundational themes in sports extended reality research were (i) sports games and extended reality systems, (ii) virtual simulation devices and artificial intelligence, (iii) sports training and performance and (iv) age-appropriate physical activity, sports rehabilitation and physical education.

Conclusion

The level of author collaboration was low, but the degree of author collaboration is largely on the rise. The closeness of the collaboration between institutions and countries was also low. In addition, the subject of sport extended reality is relatively fragmented. Therefore, more research is needed to strengthen it in the future.

A Wearable Mixed Reality Platform to Augment Overground Walking: A Feasibility Study

Humans routinely modify their walking speed to adapt to functional goals and physical demands. However, damage to the central nervous system (CNS) often results in abnormal modulation of walking speed and increased risk of falls. There is considerable interest in treatment modalities that can provide safe and salient training opportunities, feedback about walking performance, and that may augment less reliable sensory feedback within the CNS after injury or disease. Fully immersive virtual reality technologies show benefits in boosting training-related gains in walking performance; however, they lack views of the real world that may limit functional carryover. Augmented reality and mixed reality head-mount displays (MR-HMD) provide partially immersive environments to extend the virtual reality benefits of interacting with virtual objects but within an unobstructed view of the real world. Despite this potential advantage, the feasibility of using MR-HMD visual feedback to promote goal-directed changes in overground walking speed remains unclear. Thus, we developed and evaluated a novel mixed reality application using the Microsoft HoloLens MR-HMD that provided real-time walking speed targets and augmented visual feedback during overground walking. We tested the application in a group of adults not living with disability and examined if they could use the targets and visual feedback to walk at 85%, 100%, and 115% of each individual’s self-selected speed. We examined whether individuals were able to meet each target gait speed and explored differences in accuracy across repeated trials and at the different speeds. Additionally, given the importance of task-specificity to therapeutic interventions, we examined if walking speed adjustment strategies were consistent with those observed during usual overground walking, and if walking with the MR-HMD resulted in increased variability in gait parameters. Overall, participants matched their overground walking speed to the target speed of the MR-HMD visual feedback conditions (all p-values > 0.05). The percent inaccuracy was approximately 5% across all speed matching conditions and remained consistent across walking trials after the first overall walking trial. Walking with the MR-HMD did not result in more variability in walking speed, however, we observed more variability in stride length and time when walking with feedback from the MR-HMD compared to walking without feedback. The findings offer support for mixed reality-based visual feedback as a method to provoke goal-specific changes in overground walking behavior. Further studies are necessary to determine the clinical safety and efficacy of this MR-HMD technology to provide extrinsic sensory feedback in combination with traditional treatments in rehabilitation.

Comparison of Controller-Based Locomotion Techniques for Visual Observation in Virtual Reality

Many virtual reality (VR) applications use teleport for locomotion. The non-continuous locomotion of teleport is suited for VR controllers and can minimize simulator sickness, but it can also reduce spatial awareness compared to continuous locomotion. Our aim was to create continuous, controller-based locomotion techniques that would support spatial awareness. We compared the new techniques, slider and grab, with teleport in a task where participants counted small visual targets in a VR environment. Task performance was assessed by asking participants to report how many visual targets they found. The results showed that slider and grab were significantly faster to use than teleport, and they did not cause significantly more simulator sickness than teleport. Moreover, the continuous techniques provided better spatial awareness than teleport.

Simulation-based assessments of fire emergency preparedness and response in virtual reality

The current study aimed at evaluating the prospects of a three-dimensional gas power plant (GPP) simulation in an immersive virtual reality (IVR) environment for fire emergency preparedness and response (EPR). To achieve this aim, the study assessed the possibility of safety situational awareness, evacuation drills and hazard mitigation exercises during a fire emergency simulation scenario. The study likewise evaluated the safety and ergonomics of the environment while addressing this aim. We employed the virtual reality accident causation model (VR-ACM) for the assessment with 54 participants individually in IVR. Participants were grouped into two according to whether they had work experience in engineering or not. The obtained results suggested that IVR can be realistic and safe, with the potential for presenting hazardous scenarios necessary for fire EPR. Furthermore, the results indicated that there were no statistically significant differences in the perceptions of both groups regarding the prospects of IVR towards EPR.

Analysis of Street-Crossing Behavior: Comparing a CAVE Simulator and a Head-Mounted Display among Younger and Older Adults

Interactive pedestrian simulators have become a valuable research tool for investigating street-crossing behavior and developing solutions for improving pedestrian safety. There are two main kinds of pedestrian simulators: one uses a technology based on rear-projection screens (Cave Automatic Virtual Environment, or CAVE), the other a head-mounted display (HMD). These devices are used indiscriminately, regardless of the research objective, and it is not yet known whether they are equally effective for studying street crossing. The present study was aimed at comparing the street crossing behavior and subjective evaluations of younger and older adult pedestrians when they are using a CAVE-like or HMD-based (HTC Vive Pro) pedestrian simulator. Thirty younger adults and 25 older adults performed 36 street-crossing trials (combining different speeds, two-way traffic conditions, and gap sizes) on each of the two types of simulators. The results indicated that participants in the HMD condition crossed the street significantly more often (58.6 %) than in the CAVE condition (42.44%) and had shorter safety margins. The most striking difference pertained to crossing initiation, which occurred considerably earlier (1.78 s) in the HMD condition than in the CAVE condition. Synchronization of crossing initiation with oncoming traffic was not as good in the CAVE condition because visual information in front of the pedestrian was missing due to the absence of ground projection. In both simulators, older adults caused more collisions than did younger ones, had shorter safety margins, and a slower crossing speed. Hence, the HMD reproduced classical age-related differences in most street-crossing behaviors already found on the CAVE. Usually observed speed effects were also found for both simulators. Neither cybersickness nor any adverse effects on stereoacuity or postural balance were found for either simulator. The HMD produced a higher level of presence and preference than the CAVE did. These findings provide evidence that HMDs have a clear potential for studying pedestrian behaviour.

Head-Mounted Display-Based Therapies for Adults Post-Stroke: A Systematic Review and Meta-Analysis

Immersive virtual reality techniques have been applied to the rehabilitation of patients after stroke, but evidence of its clinical effectiveness is scarce. The present review aims to find studies that evaluate the effects of immersive virtual reality (VR) therapies intended for motor function rehabilitation compared to conventional rehabilitation in people after stroke and make recommendations for future studies. Data from different databases were searched from inception until October 2020. Studies that investigated the effects of immersive VR interventions on post-stroke adult subjects via a head-mounted display (HMD) were included. These studies included a control group that received conventional therapy or another non-immersive VR intervention. The studies reported statistical data for the groups involved in at least the posttest as well as relevant outcomes measuring functional or motor recovery of either lower or upper limbs. Most of the studies found significant improvements in some outcomes after the intervention in favor of the virtual rehabilitation group. Although evidence is limited, immersive VR therapies constitute an interesting tool to improve motor learning when used in conjunction with traditional rehabilitation therapies, providing a non-pharmacological therapeutic pathway for people after stroke.

Emotion Recognition in Immersive Virtual Reality: From Statistics to Affective Computing

Emotions play a critical role in our daily lives, so the understanding and recognition of emotional responses is crucial for human research. Affective computing research has mostly used non-immersive two-dimensional (2D) images or videos to elicit emotional states. However, immersive virtual reality, which allows researchers to simulate environments in controlled laboratory conditions with high levels of sense of presence and interactivity, is becoming more popular in emotion research. Moreover, its synergy with implicit measurements and machine-learning techniques has the potential to impact transversely in many research areas, opening new opportunities for the scientific community. This paper presents a systematic review of the emotion recognition research undertaken with physiological and behavioural measures using head-mounted displays as elicitation devices. The results highlight the evolution of the field, give a clear perspective using aggregated analysis, reveal the current open issues and provide guidelines for future research.

Development and Calibration of an Eye-Tracking Fixation Identification Algorithm for Immersive Virtual Reality

Fixation identification is an essential task in the extraction of relevant information from gaze patterns; various algorithms are used in the identification process. However, the thresholds used in the algorithms greatly affect their sensitivity. Moreover, the application of these algorithm to eye-tracking technologies integrated into head-mounted displays, where the subject's head position is unrestricted, is still an open issue. Therefore, the adaptation of eye-tracking algorithms and their thresholds to immersive virtual reality frameworks needs to be validated. This study presents the development of a dispersion-threshold identification algorithm applied to data obtained from an eye-tracking system integrated into a head-mounted display. Rules-based criteria are proposed to calibrate the thresholds of the algorithm through different features, such as number of fixations and the percentage of points which belong to a fixation. The results show that distance-dispersion thresholds between 1-1.6° and time windows between 0.25-0.4 s are the acceptable range parameters, with 1° and 0.25 s being the optimum. The work presents a calibrated algorithm to be applied in future experiments with eye-tracking integrated into head-mounted displays and guidelines for calibrating fixation identification algorithms.

Walking with head-mounted virtual and augmented reality devices: Effects on position control and gait biomechanics

What was once a science fiction fantasy, virtual reality (VR) technology has evolved and come a long way. Together with augmented reality (AR) technology, these simulations of an alternative environment have been incorporated into rehabilitation treatments. The introduction of head-mounted displays has made VR/AR devices more intuitive and compact, and no longer limited to upper-limb rehabilitation. However, there is still limited evidence supporting the use of VR and AR technology during locomotion, especially regarding the safety and efficacy relating to walking biomechanics. Therefore, the objective of this study is to explore the limitations of such technology through gait analysis. In this study, thirteen participants walked on a treadmill in normal, virtual and augmented versions of the laboratory environment. A series of spatiotemporal parameters and lower-limb joint angles were compared between conditions. The center of pressure (CoP) ellipse area (95% confidence ellipse) was significantly different between conditions (p = 0.002). Pairwise comparisons indicated a significantly greater CoP ellipse area for both the AR (p = 0.002) and VR (p = 0.005) conditions when compared to the normal laboratory condition. Furthermore, there was a significant difference in stride length (p<0.001) and cadence (p<0.001) between conditions. No statistically significant difference was found in the hip, knee and ankle joint kinematics between the three conditions (p>0.082), except for maximum ankle plantarflexion (p = 0.001). These differences in CoP ellipse area indicate that users of head-mounted VR/AR devices had difficulty maintaining a stable position on the treadmill. Also, differences in the gait parameters suggest that users walked with an unusual gait pattern which could potentially affect the effectiveness of gait rehabilitation treatments. Based on these results, position guidance in the form of feedback and the use of specialized treadmills should be considered when using head-mounted VR/AR devices.

Sick Moves! Motion Parameters as Indicators of Simulator Sickness

We explore motion parameters, more specifically gait parameters, as an objective indicator to assess simulator sickness in Virtual Reality (VR). We discuss the potential relationships between simulator sickness, immersion, and presence. We used two different camera pose (position and orientation) estimation methods for the evaluation of motion tasks in a large-scale VR environment: a simple model and an optimized model that allows for a more accurate and natural mapping of human senses. Participants performed multiple motion tasks (walking, balancing, running) in three conditions: a physical reality baseline condition, a VR condition with the simple model, and a VR condition with the optimized model. We compared these conditions with regard to the resulting sickness and gait, as well as the perceived presence in the VR conditions. The subjective measures confirmed that the optimized pose estimation model reduces simulator sickness and increases the perceived presence. The results further show that both models affect the gait parameters and simulator sickness, which is why we further investigated a classification approach that deals with non-linear correlation dependencies between gait parameters and simulator sickness. We argue that our approach could be used to assess and predict simulator sickness based on human gait parameters and we provide implications for future research.

Neurorehabilitation of Spatial Memory Using Virtual Environments: A Systematic Review

In recent years, virtual reality (VR) technologies have become widely used in clinical settings because they offer impressive opportunities for neurorehabilitation of different cognitive deficits. Specifically, virtual environments (VEs) have ideal characteristics for navigational training aimed at rehabilitating spatial memory. A systematic search, following PRISMA guidelines, was carried out to explore the current scenario in neurorehabilitation of spatial memory using virtual reality. The literature on this topic was queried, 5048 papers were screened, and 16 studies were included, covering patients presenting different neuropsychological diseases. Our findings highlight the potential of the navigational task in virtual environments (VEs) for enhancing navigation and orientation abilities in patients with spatial memory disorders. The results are promising and suggest that VR training can facilitate neurorehabilitation, promoting brain plasticity processes. An overview of how VR-based training has been implemented is crucial for using these tools in clinical settings. Hence, in the current manuscript, we have critically debated the structure and the length of training protocols, as well as a different type of exploration through VR devices with different degrees of immersion. Furthermore, we analyzed and highlighted the crucial role played by the selection of the assessment tools.

Development of a Virtual Floor Maze Test - Effects of Distal Visual Cues and Correlations With Executive Function in Healthy Adults

Virtual reality (VR) is a useful tool to assess and improve spatial navigation, a complex skill and relevant marker for progression of dementia. A fully-immersive VR system that allows the user to physically navigate in the space can provide an ecologically valid environment for early detection and remediation of cognitive and navigational deficits. The aim of this study was to develop a virtual version of the floor maze test (VR-FMT), a navigational test that requires navigating through an unfamiliar two-dimensional floor maze. With the VR-FMT, mazes of desired complexity and walls of preferred height can be built to challenge navigational ability and mask visual clues. Fifty-five healthy adults completed the FMT in three different conditions: real environment (RE), virtual environment with no walls (VE-NW), and virtual environment with walls (VE-W). In addition, they completed two neuropsychological tests, the Trail Making Test and Digit Symbol Substitution Test. Results showed that the time to complete the maze in the VE was significantly higher than in the RE. The introduction of walls increased the number of errors, the completion time, and the length of the path. Only time to exit in the VE-W correlated with results of the cognitive tests. Participants were further subdivided on the basis of their time to exit the maze in the RE, VE-NW, and VE-W (low navigational time - LNT, and high navigational time - HNT). Only when analyzing the time to exit the maze in the VE-W, the LNT group outperformed the HNT group in all cognitive tests.

Facial Emotion Recognition: Virtual Reality Program for Facial Emotion Recognition—A Trial Program Targeted at Individuals With Schizophrenia

People with severe mental illness (SMI), schizophrenia in particular, show considerable functional impairment in emotional recognition and social perception, which negatively affects interpersonal relationships and social functioning. Owing to its ecological validity, virtual reality (VR) has been observed to improve both assessment and training of emotional recognition skills of people with SMI. This article includes two studies: (a) a descriptive study on the Virtual Reality program for Facial Emotion Recognition (VR-FER) and (b) an empirical study that presents the results of the application of the VR-FER’s first module. For the second study, data were collected using two samples: a group of 12 people with schizophrenia and a reference group of 12 people who were mentally healthy. Data analysis comprised descriptive (mean, standard deviation) and inferential statistics (Mann–Whitney U test). Results showed that the first group presented a lower number of correct answers and a higher number of incorrect answers compared with the second group regarding facial emotion recognition (FER), thereby confirming the need to develop strategies to improve emotional recognition and social perception in people with schizophrenia. VR-FER is regarded a strategic training program for FER, using latest technology and following rehabilitation guidelines for SMI.

Presence and Cybersickness in Virtual Reality Are Negatively Related: A Review

In order to take advantage of the potential offered by the medium of virtual reality (VR), it will be essential to develop an understanding of how to maximize the desirable experience of "presence" in a virtual space ("being there"), and how to minimize the undesirable feeling of "cybersickness" (a constellation of discomfort symptoms experienced in VR). Although there have been frequent reports of a possible link between the observer's sense of presence and the experience of bodily discomfort in VR, the amount of literature that discusses the nature of the relationship is limited. Recent research has underlined the possibility that these variables have shared causes, and that both factors may be manipulated with a single approach. This review paper summarizes the concepts of presence and cybersickness and highlights the strengths and gaps in our understanding about their relationship. We review studies that have measured the association between presence and cybersickness, and conclude that the balance of evidence favors a negative relationship between the two factors which is driven principally by sensory integration processes. We also discuss how system immersiveness might play a role in modulating both presence and cybersickness. However, we identify a serious absence of high-powered studies that aim to reveal the nature of this relationship. Based on this evidence we propose recommendations for future studies investigating presence, cybersickness, and other related factors.

Navigating Virtual Environments Using Leg Poses and Smartphone Sensors

Realization of navigation in virtual environments remains a challenge as it involves complex operating conditions. Decomposition of such complexity is attainable by fusion of sensors and machine learning techniques. Identifying the right combination of sensory information and the appropriate machine learning technique is a vital ingredient for translating physical actions to virtual movements. The contributions of our work include: (i) Synchronization of actions and movements using suitable multiple sensor units, and (ii) selection of the significant features and an appropriate algorithm to process them. This work proposes an innovative approach that allows users to move in virtual environments by simply moving their legs towards the desired direction. The necessary hardware includes only a smartphone that is strapped to the subjects' lower leg. Data from the gyroscope, accelerometer and campus sensors of the mobile device are transmitted to a PC where the movement is accurately identified using a combination of machine learning techniques. Once the desired movement is identified, the movement of the virtual avatar in the virtual environment is realized. After pre-processing the sensor data using the box plot outliers approach, it is observed that Artificial Neural Networks provided the highest movement identification accuracy of 84.2% on the training dataset and 84.1% on testing dataset.

The Clinical Utility of Virtual Reality in Neurorehabilitation: A Systematic Review

Background:

Virtual reality (VR) experiences (through games and virtual environments) are increasingly being used in physical, cognitive, and psychological interventions. However, the impact of VR as an approach to rehabilitation is not fully understood, and its advantages over traditional rehabilitation techniques are yet to be established.

Method:

We present a systematic review which was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). During February and March of 2018, we conducted searches on PubMed (Medline), Virtual Health Library Search Portal databases (BVS), Web of Science (WOS), and Embase for all VR-related publications in the past 4 years (2015, 2016, 2017, and 2018). The keywords used in the search were “neurorehabilitation” AND “Virtual Reality” AND “devices.”

Results:

We summarize the literature which highlights that a range of effective VR approaches are available. Studies identified were conducted with poststroke patients, patients with cerebral palsy, spinal cord injuries, and other pathologies. Healthy populations have been used in the development and testing of VR approaches meant to be used in the future by people with neurological disorders. A range of benefits were associated with VR interventions, including improvement in motor functions, greater community participation, and improved psychological and cognitive function.

Conclusions:

The results from this review provide support for the use of VR as part of a neurorehabilitation program in maximizing recovery.

The Past, Present, and Future of Virtual and Augmented Reality Research: A Network and Cluster Analysis of the Literature

The recent appearance of low cost virtual reality (VR) technologies - like the Oculus Rift, the HTC Vive and the Sony PlayStation VR - and Mixed Reality Interfaces (MRITF) - like the Hololens - is attracting the attention of users and researchers suggesting it may be the next largest stepping stone in technological innovation. However, the history of VR technology is longer than it may seem: the concept of VR was formulated in the 1960s and the first commercial VR tools appeared in the late 1980s. For this reason, during the last 20 years, 100s of researchers explored the processes, effects, and applications of this technology producing 1000s of scientific papers. What is the outcome of this significant research work? This paper wants to provide an answer to this question by exploring, using advanced scientometric techniques, the existing research corpus in the field. We collected all the existent articles about VR in the Web of Science Core Collection scientific database, and the resultant dataset contained 21,667 records for VR and 9,944 for augmented reality (AR). The bibliographic record contained various fields, such as author, title, abstract, country, and all the references (needed for the citation analysis). The network and cluster analysis of the literature showed a composite panorama characterized by changes and evolutions over the time. Indeed, whether until 5 years ago, the main publication media on VR concerned both conference proceeding and journals, more recently journals constitute the main medium of communication. Similarly, if at first computer science was the leading research field, nowadays clinical areas have increased, as well as the number of countries involved in VR research. The present work discusses the evolution and changes over the time of the use of VR in the main areas of application with an emphasis on the future expected VR's capacities, increases and challenges. We conclude considering the disruptive contribution that VR/AR/MRITF will be able to get in scientific fields, as well in human communication and interaction, as already happened with the advent of mobile phones by increasing the use and the development of scientific applications (e.g., in clinical areas) and by modifying the social communication and interaction among people.

A Novel Integrating Virtual Reality Approach for the Assessment of the Attachment Behavioral System

Virtual reality (VR) technology represents a novel and powerful tool for behavioral research in psychological assessment. VR provides simulated experiences able to create the sensation of undergoing real situations. Users become active participants in the virtual environment seeing, hearing, feeling, and actuating as if they were in the real world. Currently, the most psychological VR applications concern the treatment of various mental disorders but not the assessment, that it is mainly based on paper and pencil tests. The observation of behaviors is costly, labor-intensive, and it is hard to create social situations in laboratory settings, even if the observation of actual behaviors could be particularly informative. In this framework, social stressful experiences can activate various behaviors of attachment for a significant person that can help to control and soothe them to promote individual’s well-being. Social support seeking, physical proximity, and positive and negative behaviors represent the main attachment behaviors that people can carry out during experiences of distress. We proposed VR as a novel integrating approach to measure real attachment behaviors. The first studies on attachment behavioral system by VR showed the potentiality of this approach. To improve the assessment during the VR experience, we proposed virtual stealth assessment (VSA) as a new method. VSA could represent a valid and novel technique to measure various psychological attributes in real-time during the virtual experience. The possible use of this method in psychology could be to generate a more complete, exhaustive, and accurate individual’s psychological evaluation.