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Discover Flex VRA — a modern Visual Reinforcement Audiometry system designed for pediatric clinics. Flexible, clinician-led, and trusted in 1000+ clinics worldwide. Flex Visual Reinforcement Audiometry Starting at $2,450 Discover Flex VRA Get A Quote Video Toy Custom Content I absolutely love the Flex VRA system. Complete game changer. Kelly Jobe, Au.D., Stephen F. Austin Univserity A modern VRA system that scales from basic reinforcement to advanced testing workflows. Simple by design. Flexible by choice. Flex Toy Simple VRA thoughtfully updated. Engagement through variation. Starting at $1,250 Discover Flex Toy Get A Quote We love this system. The nurses even commented on how modern and engaging it is compared to our older system. Audiologists @ Texas Children's Hospital, Houston, TX Flex Window Cover Visual control for sound booths. Keeps the visual environment controlled during testing. $800 Discover Flex Window Cover Get A Quote Accurate sound where it matters. Flex Speaker A reliable speaker option commonly used in VRA testing environments. $650 Discover Flex Speaker Get A Quote What's New For the Flex VRA System? Smarter hardware. More flexible setups. Expanded software tools. Expanded wireless compatibility across VRA components Improved durability and mounting options New software features including Targeted Content and House Rules See Full Details Used by leading pediatric clinics

Learn how to select a reliable, flexible VRA system for pediatric audiology. Flex VRA supports integration, visual reinforcers, & seamless clinic workflows. Not all VRA systems are designed the same. As pediatric hearing evaluations have evolved, the expectations for VRA equipment have changed, as well. Clinics now look for systems that are reliable, flexible, and easy to use while supporting consistent patient responses. Here are the key factors to consider when selecting a VRA system. 1. Reliability and Timing A VRA system must respond instantly when the clinician triggers a reinforcer. Any lag or delay makes the test harder and can disrupt the child’s attention. Software driven systems tend to offer faster activation times compared to older mechanical VRA boxes. For instance, Flex VRA utilizes a paired zoned 433 MHz radio frequency wireless transmission protocol to send signal from the remote control to the reinforcer. This means that the lag time between button press to activation would be similar to that of a lag time of a wireless keyboard to your computer...instantaneous. Moreover, because each system's transmission is zoned between paired reinforcers, there is no overlap from other systems or interference from any higher frequency RF signals. 2. Quality of Visual Reinforcers Children respond best to bright, engaging, but not overstimulating content. Look for a VRA system that allows you to customize content and adjust how exciting the reinforcer should present. Features like House Rules in Flex VRA let you control how the center monitor behaves so you get clearer head turns, and more focus on the left and right reinforcers. 3. Integration With Audiology Equipment The best VRA equipment connects smoothly with your audiometer, remote, or clinic workflow. Consider whether the system supports: • Remote control activation • Audiometer integration • PC or software-based triggering Seamless integration allows clinicians to stay focused on the patient instead of the equipment. And Flex VRA includes all three of those options with every Flex VRA shipped at no extra cost . 4. Durability and Build Quality VRA equipment is used daily in pediatric settings. Look for a system designed to withstand constant use, movement between rooms, and long clinical schedules. 5. Versatility and Future Features Clinics benefit from VRA systems that grow with them. Software based systems often release updates, new reinforcers, and feature improvements that extend the life of the system without requiring new hardware. 6. Support and Service Make sure the company behind your VRA system offers reliable support. Pediatric audiology depends on smooth daily operation, so access to fast assistance matters. By evaluating these factors, clinics can choose VRA equipment that improves workflow, supports accurate Visual Reinforcement Audiometry, and creates a better experience for both the child and family. Choosing the Right VRA System for Your Clinic

Enhance VRA testing with the Flex Screen—Flex VRA's remote-controlled privacy screen for distraction-free audiology sessions. Custom sizes available. Block distractions. Improve results. Better visual control for more consistent pediatric testing. Get the Brochure Installation Guide Flex Cover configurations FLEX-WINDOWCOVER Electric rolling cover 3 ft x 3 ft Magnetic mounts Wireless remote control USB C charging cable $800 FLEX-DOORCOVER Electric rolling cover 6 ft x 18 in Magnetic mounts Wireless remote control USB C charging cable $800 International customers: Prices shown are in USD and exclude shipping, duties, and taxes. Pricing does not include the cost of shipping, applicable taxes, and installation. Sold through authorized distributors . We believe pricing transparency saves clinicians time. You can read more about why we post prices online here. Includes Includes Operator's Side Patient Side Be heard, not seen. Visual control during pediatric testing. Battery-powered window cover for placement anywhere No tools required — install in seconds Custom sizing for individual booths Rechargeable motor for long-term, hassle-free use Wireless control from anywhere in the booth Simple Installation Specifications Wireless Communication Protocol 433 MHz Radio Frequency Power Internal Battery Battery Life 6-12 Months depending on use Charging Power USB C Dimensions Window: 3ft x 3ft, Door: 5 ft x 18 in Warranty Period 2 years

Learn about what Visual Reinforcement is and why it is so important in audologic testing. Visual Reinforcement Audiometry (VRA) What is it and how does it work? Visual Reinforcement Audiometry (VRA) is a behavioral hearing test used to evaluate hearing sensitivity in infants and young children, typically between 6 months and 2–3 years of age, by conditioning a head-turn response to sound using visual reinforcement. Rather than asking a child to respond verbally or press a button, VRA relies on a natural behavioral response. When a child hears a sound, they learn that turning toward it results in something visually interesting. Over time, that association allows clinicians to estimate hearing thresholds based on consistent responses. VRA is most often used with children between approximately 6 months and 2 to 3 years of age, although developmental level is often a more important factor than age alone. Why is VRA used in pediatric audiology ? Standard hearing tests require cooperation, instruction following, and sustained attention. For very young children, that expectation simply is not realistic. Visual Reinforcement Audiometry was developed to bridge that gap. By pairing sound with visual reinforcement, clinicians can collect meaningful hearing information during a critical window for speech and language development. For many children, VRA provides the first reliable behavioral data in the diagnostic process. How Visual Reinforcement Audiometry Works At its core, VRA is a conditioning task. A sound is presented, typically through speakers or earphones. When the child responds appropriately, a visual reinforcer is activated. Over repeated trials, the child learns that responding to sound leads to a visual reward. From there, the clinician can adjust stimulus levels and frequencies to estimate hearing sensitivity. VRA being performed at the University of North Carolina A Typical VRA Session includes: Presentation of calibrated auditory stimuli Conditioning the child to associate sound with visual reinforcement Observing head turns or eye movements toward the sound source Reinforcing correct responses Gradually reducing stimulus levels to identify response thresholds The process is flexible and adapts to the child’s attention span and engagement on a given day. Types of VRA Testing Sound-field VRA Sound-field testing uses speakers positioned to the left and right of the child. This approach measures the response of the better-hearing ear and is commonly used early in the evaluation process. Ear-Specific VRA When a child tolerates earphones or insert phones, ear-specific information can be obtained. This allows clinicians to evaluate each ear independently and is preferred whenever possible. Below is a real-world example of visual reinforcement audiometry performed in a pediatric clinic. Equipment used in Visual Reinforcement Audiometry Visual reinforcement may take different forms: Animated or video-based displays Mechanical or illuminated toys Modern VRA systems often allow clinicians to choose or adjust reinforcement types based on the child’s age, preferences, or attention level. A VRA setup typically includes: An audiometer Speakers or earphones Visual reinforcers positioned to the left and right A control interface or remote Appropriate cabling and accessories Many newer systems use software-based control, allowing clinicians to customize how reinforcement behaves during a session rather than relying on fixed hardware responses. Does VRA Require Calibration? Yes and no. The actual VRA reinforcers do not require any formal calibration because they are not putting out any kind of calibrated stimuli utilized for testing hearing threshold. They are simply the reward stimulus for after the patient has heard oand recognized a calibrated stimuli from the audiometer. It is important to remember that although the VRA does not require acoustic calibration, consistent placement and predictable behavior are important to reliable testing. With that said, in order to properly perform VRA testing, a calibrated audiometer is required to ensure accurate threshold detection. Benefits of Visual Reinforcement Audiometery VRA allows clinicians to: Obtain behavioral hearing information in very young children Perform testing in a non-invasive, child-friendly way Estimate frequency-specific thresholds Adapt testing strategies based on engagement and development For many pediatric patients, VRA represents the most practical balance between accuracy and cooperation. Limitations to keep in mind Like all behavioral tests, VRA has limitations. Results depend on the child’s attention, motivation, and conditioning. Sound-field testing does not provide ear-specific data, and fatigue or loss of interest can limit session length. For these reasons, clinicians often combine VRA with other test methods using combinations systems and emphasize flexible system design. For patients who struggle with traditional visual reinforcement audiometry, VROCA testing offers an operant, visually reinforced alternative. When VRA is the preferred approach Visual Reinforcement Audiometry is typically used when: A child is too young for conditioned play audiometry Behavioral observation alone is insufficient Behavioral data is needed to cross-check objective results Ear-specific thresholds are possible but not guaranteed Professional organizations such as the American Academy of Audiology and the American Speech-Language-Hearing Association recognize VRA as a standard behavioral assessment method in pediatric audiology. Choosing a VRA System When evaluating VRA equipment, clinicians often look beyond basic functionality. Considerations commonly include: Ease of setup and room integration Flexibility of reinforcement options Compatibility with existing audiometers Consistency and reliability during testing Ability to adapt to different patient behaviors Systems that allow customization during the session can reduce frustration and improve efficiency for both clinicians and families. In Summary Visual Reinforcement Audiometry plays a critical role in pediatric hearing assessment. By pairing sound with visual reinforcement, VRA allows clinicians to collect meaningful behavioral data during early stages of development when traditional testing is not possible. As VRA technology continues to evolve, modern systems increasingly focus on flexibility, adaptability, and clinician control, all with the goal of improving test reliability and the overall experience for children and parents alike. FAQ Review What age is visual reinforcement audiometry used for? Visual reinforcement audiometry is typically used for infants and young children between approximately 6 months and 2.5 years of age. It is most effective once a child is developmentally able to localize sound and turn their head toward a visual stimulus. The exact age range may vary depending on the child’s developmental level and attention skills. How does visual reinforcement audiometry work? During visual reinforcement audiometry, a child is conditioned to turn toward a visual stimulus, such as a lighted display or animated image, when a sound is presented. When the child correctly responds to the sound, the visual reinforcement is activated as a reward. Clinicians observe these head-turn responses to determine hearing sensitivity across frequencies and ears. Is visual reinforcement audiometry reliable? Yes, visual reinforcement audiometry is considered a reliable and widely accepted behavioral hearing test when performed correctly. Reliability depends on factors such as patient engagement, clinician experience, and proper test setup. VRA is commonly used in pediatric audiology as part of comprehensive hearing assessment. How long does a VRA hearing test take? A typical visual reinforcement audiometry session lasts 15 to 30 minutes, depending on the child’s cooperation and the information being gathered. Testing may be shorter or longer based on attention span, age, and whether additional assessments are needed. Breaks are often incorporated to maintain engagement. What is the difference between VRA and play audiometry? Visual reinforcement audiometry is generally used for younger children and relies on head-turn responses reinforced by visual stimuli. Play audiometry is used for older toddlers and preschool-aged children who can perform a task, such as placing a block in a bucket, when they hear a sound. Both are behavioral tests, but they are matched to different developmental stages.

Flex Mobile is a complete portable VRA system designed for mobile audiology, outreach clinics, and shared testing environments. Transparent pricing available. Designed for Portable VRA Testing Flex Mobile is a fully featured portable VRA system built for mobile audiology programs, outreach clinics, and shared testing environments. It delivers the same Flex VRA experience clinicians rely on, in a compact kit designed to move with your practice. Built for mobile audiology. Flex Mobile VRA System A portable VRA system designed for mobile audiology. FLEX-MOBILE A complete, ready-to-use Flex VRA kit, including: Single Center Monitor 2 Remote Controls Flex PC Carrying Case Table Top Stand $2,950 International customers: Prices shown are in USD and exclude shipping, duties, and taxes. Pricing does not include the cost of shipping, applicable taxes, and installation. Sold through authorized distributors . We believe pricing transparency saves clinicians time. You can read more about why we post prices online here . Get A Quote for Flex Mobile Brochure Maintains children’s attention better than other VRA systems I've used. Brandi Murphey, Au.D. Owner, West Texas Mobile Audiology Set it down. Power on. Test. Dynamic SRT Pictured Words Board An SRT board that moves and has sound in response to touch! Watch Demo Diagrams Application Display diagrams of the ear for counseling or upload your own images! Zoned Wireless Remote Control for Mobile VRA Simplifed in design with increased functionality Response Time (from button press to activation): instantaneous (.5 ms) Battery: 2 AAA Batteries Battery Life: 1-1.5 years Number of Remotes that can pair to each system: 2 Number of Remotes that come with each system: 2 Frequently Asked Questions about Flex Mobile How would I activate the reinforcer in a mobile environment? Flex Mobile can be activated using the included wireless remote controls or directly from the Flex PC. What is the weight and dimensions of the fully packed Flex Mobile VRA case? Designed to be easy to transport and store, the case is 13" (L) x 4" (W) x 10" (H) and weights approximately 7 pounds fully loaded. Do I need to charge it before use? Flex Mobile is powered via a standard wall outlet to ensure uninterrupted, consistent performance during testing. Are there any features in Flex VRA that I wouldn't get in Flex Mobile? Flex Mobile includes the full Flex VRA feature set, including all applications, CPA games, and hardware controls. The only difference is the portable mounting and carrying configuration.

Flex Cover is a wireless privacy screen for audiology sound booths, helping reduce visual distractions during pediatric VRA testing with simple installation and custom sizing. Button Flex Speaker $650 a pair International customers: Prices shown are in USD and exclude shipping, duties, and taxes. Pricing does not include the cost of shipping, applicable taxes, and installation. Sold through authorized distributors . We believe pricing transparency saves clinicians time. You can read more about why we post prices online here. Brochure Installation Guide High Performance Audiometry Speakers Passive Speakers Magnetic backing for easy placement and installation Included speaker adapters for all amplified audiometers Included tape measure to ensure consistent height placement Low profile mounting (no brackets needed) 30 meters of speaker cable included Designed to fit for corner mount or flat mount Mount. Secure. Align. Wire. Connect. A clean, repeatable speaker installation every time. Flex Speaker Installation Walkthrough Compatibility Out Of The Box Taking the guess work out of audiometer connections Flex Speaker ships with the needed adapters to connect speaker wire to the GSI Audiostar Pro and Interacoustics EVO Interacoustics EVO Speaker Adapter (2 1/4" mono to terminal) GSI Audiostar Pro Speaker Adapter (5 pin DIN to terminal) Designed For Audiology Purpose-built to match Flex VRA dimensions, creating a clean, intentional sound booth environment. Integrated with Flex VRA monitor Side-profile, flush-mounted Front view, clean clinical install

Get in touch with Flex VRA for questions on audiology equipment. Our team supports clinics worldwide with reliable, modern VRA solutions for children. Questions about Flex VRA? We’re happy to help. A member of our team will respond within one business day. Submit Thanks for submitting! 100 E. Whitestone Blvd., St. 148, #160 Cedar Park, TX 78613 512-777-0016 sales@flexvra.com Find a representative near you Distribution

Peer-reviewed research and published literature referencing modern, software-enabled visual reinforcement audiometry approaches, including Flex VRA. Relevant Research and Literature If you are conducting or planning research related to visual reinforcement audiometry, conditioned play audiometry, or operant control approaches, and would like to discuss resources or technical considerations, you are welcome to get in touch . Concepts related to modern, software-enabled visual reinforcement audiometry have been referenced in published research, including: Bonino AY, Hemann A, Mood D, Kay E, Pancoast ES, Sommerfeldt KK. Visual reinforcers designed for children with developmental disabilities. Journal of Early Hearing Detection and Intervention. 2021 Apr 22;6(1):69–76. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC8061901/ This scoping review examines factors that influence the effectiveness and optimization of visual reinforcement audiometry in pediatric hearing assessment. Visram, A., Jackson, I., Almufarrij, I., Stone, M., & Munro, K. (2024). Optimisation of visual reinforcement audiometry: a scoping review. International Journal of Audiology. Optimisation of visual reinforcement audiometry: a scoping review This document presents the British Society of Audiology’s recommended procedure for visual reinforcement audiometry, outlining clinical standards for test setup, execution, and interpretation. British Society of Audiology. Recommended Procedure: Visual Reinforcement Audiometry. Visual Reinforcement Audiometry RP by the BSA, January 2024. https://www.thebsa.org.uk/wp-content/uploads/2024/01/OD104-37-BSA-RP-Visual-Reinforcement-Audiometry-v2.pdf

Learn how Flex VRA was built to improve pediatric audiology testing through clinician collaboration, real-world feedback, and modern reinforcement methods. Steve Smith with his two assistant (to the) regional managers. We build solutions for the parents of the child being tested. If we provide tools for audiologists that help give those parents answers about their child’s hearing, we’ll always have a customer. Steve Smith, Founder About Flex VRA Listening to clinicians from the start Flex VRA was built to support how pediatric audiology is practiced today, not how it was practiced years ago. From the beginning, our focus has been on helping audiologists maintain attention, reduce distraction, and adapt testing environments to the needs of each child. Founded in 2017 by Steve Smith, Flex VRA began as a response to a simple question from the field: Is there a better way to control what appears on a VRA screen during testing? That question led to a prototype that allowed clinicians to tailor content and environment in real time to improve engagement and test efficiency. The positive response from audiologists shaped what Flex would become. Each request from clinicians became an opportunity to improve. Features like user-uploaded content, audiometer integration, and expanded testing modes were added in direct response to real-world use. That approach continues to guide how Flex VRA is designed today. Built through collaboration with clinicians Today, Flex VRA supports hearing tests in over 1,000 clinics. That growth has been driven by close collaboration with audiologists and a commitment to listening, adapting, and improving. Each feature added to Flex VRA reflects real-world feedback from clinicians working with pediatric patients every day. By focusing on usability, flexibility, and engagement, Flex VRA has evolved alongside the needs of the clinics it serves. Questions about Flex VRA? If you’d like to learn more or discuss how Flex VRA fits into your clinic, we’re happy to help. Contact Flex VRA

Discover Flex VRA’s cutting-edge Visual Reinforcement Audiometry system with enhanced performance, custom content, and dynamic features. Learn more today! Designed beautifully. Built to perform. We love the new Flex VRA system and the flexibility it offers to keep children interested in the task. It has definitely improved patient engagement and reliability of results. Brooke Hammond, Au.D., Audiologist at Primary Children's Hospital, Salt Lake City, UT Flex VRA Configurations R=Right L=Left C=Center FLEX-C Single Center Monitor 2 Remote Controls Flex PC Audiometer Integration $2,450 FLEX-RLC (most popular) Point of View Demonstration Right, Left, and Center Monitor 2 Remote Controls Flex PC Audiometer Integration $6,950 FLEX COMBINATION SYSTEMS Make any combination of Left, Right and Center reinforcers using the same remote control. (Maximum of 6 reinforcers) Go To Combo Systems International customers: Prices shown are in USD and exclude shipping, duties, and taxes. Pricing does not include the cost of shipping, applicable taxes, and installation. Sold through authorized distributors . We believe pricing transparency saves clinicians time. You can read more about why we post prices online here. FLEX-RL Right and Left Monitor 2 Remote Controls Flex PC Audiometer Integration $4,750 Point of View Demonstration Flex VRA Brochure Get a Quote How Flex Works See Flex VRA in action or shedule an online demo Audiometer Integrations Included with every Flex VRA Universal Audiometer Integration Cable Directly interfaces with the GSI Audiostar Pro and the Interacoustics EVO and wirelessly activate with the Flex VRA on the audiometer keys. Flex PC Control Flex VRA with hotkeys while performing audiometric testing on a computerized audiometer Brochure Learn More The Remote Two Remote Controls Included With Every Flex VRA TOY VIDEO Display videos of cartoons of cartoons and live-animals while an activation button is held down. Display videos of toys while an activation button is held down. ACTIVATORS Left (Blue), Right (Red), and Center (Green) LIGHTS ON/OFF Turn on (top button) and off (bottom button) the 360 degree LED light bar while playing video content. LIGHTS ONLY Activate the 360 degree light bar only while an activation button is pressed down. Custom content comes standard with preloaded Hey Bear Sensory content, but any content can be loaded by the end user CUSTOM VOLUME CONTROL Volume up, down, and mute control of the VRA monitors. DISTRACT Use the VRA monitor as a focal point to keep patients still during tympanometry, otoscopy, or OAE testing. Accessories Optional Add-Ons To Enhance Workflow VROCA Button A wireless and battery-free visual reinforcement operant conditioning audiometry button $800 Learn More Screen Mirror Turn your Flex VRA into an internal booth monitor for counseling, play audiometry or otoscopy. $800 GSI Audiostar Pro Any computerized audiometer Learn More New Features Included with every Flex VRA Otoscopy View Using Screen Mirror, view your video otoscope directly on a Flex VRA screen inside of your booth. Compatible with most video Otoscopes (GSI Video Otoscope demoed). Not sure if your otoscope is compatible? Email us at sales@flexvra.com to check. Targeted Content Targeted Content is a feature in Flex VRA that lets the clinician pre-select exactly what video or stimulus will play when a specific button is pressed, before the test even begins. Instead of choosing content on the fly and hoping it connects with the child, Targeted Content flips the model. The child comes first, and the stimulus is chosen specifically for them. House Rules House Rules is a software feature in Flex VRA that lets clinicians set fixed behavior rules for a VRA monitor, most commonly the center screen, so it behaves exactly the way the audiologist wants during testing regardless of what stimuli are changed on the left and right monitors. House Rules reflects how Flex VRA approaches software driven VRA design. Instead of forcing clinicians to adapt to the system, the system adapts to how clinicians choose to run the test. Anchor 2 Conditioned Play Audiometry Games Included with every Flex VRA Anchor 1 Bubble Game "When you hear a tone, pop a bubble on the screen and see a character appear!" Watch Demo Farm Game "Pick a fruit out and feed it to one of the animals when you hear the tone." Watch Demo Bucket Game "Listen for the tone and when you hear the beep, touch one of the colored balls and drag it over into the bucket!" Watch Demo Dynamic SRT Pictured Words Board An SRT board that moves and has sound in response to touch! Watch Demo Diagrams Application Display diagrams of the ear for counseling or upload your own images! Watch Demo Who is Hey Bear Sensory? Learn More About Hey Bear! Hey Bear Sensory designs sensory-based content for children. Hey Bear has quickly gained popularity on YouTube, and within the last 10 years has amassed over 3 million subscribers, boasts approximately 2.5 billion views, and has a constant audience of thousands watching live every day. Flex VRA entered into an exclusive content licensing agreement with Hey Bear Sensory to provide the default custom content that will ship with every Flex VRA system. By combining Hey Bear's insanely popular content with the Flex VRA, we can provide the most engaging and positive VRA experience to audiologists and their patients. Play Video Play Video 01:01 Distract Mode in Visual Reinforcement Audiometry | Flex VRA Feature Explained This video explains Distract Mode within the Flex Visual Reinforcement Audiometry (VRA) system and how it can be used during pediatric hearing testing. Distract Mode allows clinicians to momentarily redirect a child’s attention during Otoacoustic Emissions, Tymanometry, or Otoscopy without changing standard VRA operation. Learn more about Flex VRA: https://www.flexvra.com Play Video Play Video 03:19 VROCA Button for Visual Reinforcement Audiometry | Wireless, Battery-Free by Flex VRA VROCA allows children to actively participate in audiometric testing by providing a simple, physical response option when a sound is heard. The button is designed to integrate with Flex VRA workflows and may be useful in specific testing scenarios where operant conditioning is preferred. This video shows a quick overview of how the VROCA Button functions during testing. Learn more at https://www.flexvra.com/vroca For details or questions, email: sales@flexvra.com Play Video Play Video 02:31 Wireless Flex PC for Visual Reinforcement Audiometry | Flex VRA Control Accessory This video demonstrates the Wireless Flex PC accessory for the Flex Visual Reinforcement Audiometry (VRA) system and how it supports remote control during pediatric hearing testing. Wireless Flex PC allows clinicians to control VRA reinforcement from a computer without physical cables or line-of-sight limitations. Wireless Flex PC integrates with the Flex VRA system to provide computer-based control of visual reinforcement stimuli, offering flexibility in booth layout and clinician positioning. It is designed to support efficient pediatric audiology workflows while maintaining familiar VRA operation. Wireless Flex PC is an optional accessory within the Flex VRA ecosystem. Learn more about Flex VRA: https://www.flexvra.com Play Video Play Video 00:51 FlexInstall

VROCA is a pediatric VRA response button designed to support consistent, child-initiated responses during visual reinforcement audiometry testing. Comparison of VRA, CPA, and VROCA testing Test Type Typical Age Patient Response Reinforcement VRA Infants, toddlers Head turn Lighted toy or animation CPA Young children Play task Game-based reward VROCA Older children, adults Operant response Visual video reinforcement Learn how VRA compares to CPA in pediatric audiology. Better engagement. Better data. By reinforcing correct responses with visual content, VROCA keeps patients engaged without over-stimulating the test environment. Clinicians gain greater confidence in responses while patients experience a clearer, more intuitive testing process. Every Flex VRA's software is built-in with VROCA functionality once a wireless and battery-free VROCA button is plugged into it. Plug and play, literally. Flex VROCA Button VROCA Audiology Testing (Visual Reinforcement Operant Conditioning Audiometry) Brochure Visual Reinforcement Operant Conditioning Audiometry (VROCA) is a behavioral hearing test used for older children and adults who are unable to reliably complete traditional VRA audiometry . Instead of requiring a simple hand raise or button press alone, VROCA combines an operant response with a visual reward, improving attention, compliance, and response accuracy. How to Conduct VROCA Testing VROCA testing combines an operant response with visual reinforcement to support attention and response reliability. Before testing begins, the patient is instructed to perform a simple action, such as pressing a response button, whenever they hear a sound. With the Flex VROCA button, that button press will automatically trigger the Flex VRA to activate. Once conditioning is established, each correct button press response triggers a brief visual reinforcer. The clinician can suppress the reinforcer at any time to ensure reinforcement occurs only when appropriate. This helps preserve the conditioning relationship and prevents accidental reinforcement during setup or repositioning. Below is an example of VROCA being conducted on a Flex VRA system. Note how when incorrect button presses are made, the VRA does not reinforce, and the patient is instructed to wait until they hear the tone. Throughout testing, reinforcement duration can be adjusted on the Flex VRA to match the patient’s attention span. Shorter reinforcement intervals help maintain focus, while longer intervals may be useful during initial conditioning or with patients who require additional engagement. In audiology, VROCA is particularly useful when traditional audiometry or conditioned play testing results in inconsistent responses, allowing clinicians to obtain more reliable behavioral thresholds with fewer repeated instructions. Features Wireless A wireless button reduces distraction during VROCA testing by eliminating cables that can interfere with posture, attention, and engagement. It also protects your Flex VRA from being pulled on by an attached cable. For pediatric patients, this supports more natural responses and improves consistency throughout the test session. Suppression Holding down the Custom button temporarily suppresses stimulus activation, giving clinicians precise control over when reinforcement is delivered. This prevents accidental or premature reinforcement and helps preserve the conditioning relationship until testing is ready to begin. Time Reinforcement duration can be customized from 2 to 10 seconds through the Flex VRA service menu, giving clinicians control over stimulus length to match patient attention span and reduce over-engagement. Frequently Asked Questions What does VROCA stand for in audiology? VROCA stands for Visual Reinforcement Operant Conditioning Audiometry. What age is VROCA used for? VROCA is typically used for older children and adults who are unable to reliably complete traditional audiometry or conditioned play testing. Is VROCA the same as VRA? No. VROCA requires an operant response, while VRA relies on a head-turn response to sound. Is VROCA appropriate for neurodivergent patients? Yes. VROCA is commonly used with patients who have attention, developmental, or sensory challenges, where traditional testing methods may be difficult to complete reliably.

Find clear answers to common audiology questions about VRA testing, calibration, and equipment. Learn how Flex VRA supports modern pediatric audiology. ! Widget Didn’t Load Check your internet and refresh this page. If that doesn’t work, contact us.