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Download brochures, manuals, quick guides, and support documents from Flex VRA. Downloads 2026 Catalog Flex Halo Brochure - Product overview and specifications Flex VRA VROCA Button Brochure -Product overview for clinic decision makers Installation and User Manual -Guide for installers and end users Brochure - Product overview and specs for clinic decision makers Installation and User Manual - Guide for installers and end users Remote Control Pairing Guide - Guide for Installers Integration Cable Pairing Guide (Audiostar Pro and EVO) - Technician Support Flex VRA Video Monitor Cleaning and Caring Guidelines- Guide for End Users Screen Mirror Brochure - Product overview and specs for clinic decision makers Installation and User Manual -Guide for installers Flex PC Download Flex PC (For use on installation of new VRA with Flex PC transmitter. Contact us if adding Flex PC on to an existing system) Brochure Installation Instructions - Installation guide for technicians and end users PC Pairing Guide Flex Integration Cable Integration Cable Pairing Guide and Setup - Guide for installers and end users Setting Up Interacoustics Suite to Work with Flex VRA - Guide for installers and end users Flex Toy Brochure - Product overview and specs for clinic decision makers Installation and User Manual -Guide for installers and end users Remote Control Pairing Guide Installation and User Manual IR (purchased before 2025) - Guide for installers and end users. Integration Cable Pairing Guide and Setup - Guide for installers and end users Flex Mobile Brochure - Product overview and specs for clinic decision makers Installation and User Manual Remote Control Pairing Guide - Guide for Installers Flex Speaker Brochure - Product overview and specs for clinic decision makers Installation and User Manual - Guide for installers and end users Installation Video Demo - Short video demo for Flex Speaker installers Flex Window Cover Brochure - Product overview and specs for clinic decision makers Installation Manual - Installation guide for technicians and end users. Remote Control Pairing Guide Video Tutorial: Installing Flex Window or Door Cover Video Tutorial: Setting Upper and Lower Limits on Window Cover

Flex Halo is a hybrid VRA reinforcer that combines video and toy stimulation in one unit. Replaces multi-unit setups. Built for pediatric audiology clinics. Where toys come to life Patent Pending First, we made VRA engaging. Now, we make it feel real. Kids are instantly drawn to it and stay engaged. Don’t take our word for it. See it in action. I used the Flex Halo system with a patient with autism where we have obtained VERY limited behavioral information and have only relied on ABRs for hearing updates. The patient conditioned to the transparent screen and we were able to obtain a speech threshold for the first time. Dr. Jenny Goehring, Au.D. Boystown Hospital The Flex Halo Effect The Flex Halo Effect A new approach to VRA Traditional VRA forces you to choose between toys, video or purchasing both. Now, you don't have to choose. Toys quickly lose their impact as children habituate quickly to the same stimulus repeatedly. Video may not provide the novelty for every child. Flex Halo combines lifelike toy and video reinforcement, so the stimulus is novel every time. Toy Video Halo Flex Halo Configurations Flex Halo isn’t an add-on. It’s a complete replacement for traditional toy and video VRA reinforcement systems. FLEXHALO-C FLEXHALO-RL FLEXHALO-RLC Point of View Demonstration Single Center Monitor 2 Remote Controls Flex PC Audiometer Integration $3,500 Right and Left Monitor 2 Remote Controls Flex PC Audiometer Integration $6,500 Right, Left, and Center Monitor 2 Remote Controls Flex PC Audiometer Integration $9,700 HYBRID Make any combination of Left, Right and Center reinforcers using the same remote control. (Maximum of 6 reinforcers) 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 Brochure The Remote Two Remote Controls Included With Every Flex VRA TOY VIDEO Display videos of cartoons and live-animals on the Flex Halo VRA display Display life-like digital toys spinning inside of the Flex Halo VRA box LIGHTS ON/OFF Turn on (top button) and off (bottom button) the 360 degree LED light bar while activating VRA stimuli 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 Flex Halo VRA. DISTRACT Use Flex Halo as a focal point to keep patients still during tympanometry, otoscopy, or OAE testing. ACTIVATORS Left (Blue), Right (Red), and Center (Green) Included With Every Flex Halo Flex PC (Computerized Audiometers) Remote Controls (2) Audiometer Integration (GSI Audiostar and Interacoustics EVO) Welcome Videos Includes built-in content to help prepare and engage pediatric patients. FREE to download here . Conditioned Play Audiometry Games Built into every Flex VRA and available for FREE to download here. Toy In The Bucket Game Toy Bubble Game The Farm Game Interactive SRT Board Watch Demo Watch Demo Watch Demo Watch Demo Optional Accessories VROCA Button A wireless and battery-free visual reinforcement operant conditioning audiometry button $800 Learn More Screen Mirror Turn Flex VRA into an internal booth monitor for counseling, play audiometry or otoscopy. $800 GSI Audiostar Pro Any computerized audiometer Learn More Specifications Display 13.3 inch Remote/Flex PC/Audiometer Integration Transmission Wireless Zoned Radio Frequency .05 Seconds (Instantaneous) Activation Latency 18 months Remote Control Battery Life Input: 100-240V 50/60Hz 1.5A MAX Output: +12V, 5A, 60W Power Specifications Dimensions 14 inch (L) x 4 inch (W) x 9.5 inch (H) Operating System Windows 10 Professional Warranty 2 Years Accessories Optional Add-Ons To Enhance Workflow

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 FLEX-RL Point of View Demonstration Single Center Monitor 2 Remote Controls Flex PC Audiometer Integration $2,450 Right and Left Monitor 2 Remote Controls Flex PC Audiometer Integration $4,750 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 VRA Brochure Get a Quote How Flex Works See Flex VRA in action or shedule an online demo 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. (No Additional Cost) Included With Every Flex VRA Flex PC (Computerized Audiometers) Remote Control (2) Audiometer Integration (GSI Audiostar Pro and Interacoustics EVO) Welcome Videos Includes built-in content to help prepare and engage pediatric patients. FREE to download here . Conditioned Play Audiometry Games Built into every Flex VRA and available for FREE to download here Toy In The Bucket Game Watch Demo Toy Bubble Game The Farm Game Interactive SRT Board Watch Demo Watch Demo Watch Demo 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 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. Specifications Display 13.3 inch Remote/Flex PC/Audiometer Integration Transmission Wireless Zoned Radio Frequency .05 Seconds (Instantaneous) Activation Latency 18 months Remote Control Battery Life Input: 100-240V 50/60Hz 1.5A MAX Output: +12V, 5A, 60W Power Specifications Dimensions 13.5 inch (L) x 2 inch (W) x 10 inch (H), 8 lbs Operating System Windows 10 Professional Warranty 2 Years

Discover Flex VRA — a modern Visual Reinforcement Audiometry system designed for pediatric clinics. Flexible, clinician-led, and trusted in 1000+ clinics worldwide. Flex Halo For years, pediatric audiologists had to choose. Toy? Video? Both? Now the choice is clear. Literally. Starting at $3,750 See it in action "I absolutely LOVE Flex VRA! Complete game-changer." Kelly Jobe, Au.D., Stephen F. Austin University Flex VRA Dynamic Video VRA Starting at $2,450 Discover Flex VRA Flex Toy Toy VRA thoughtfully updated Starting at $1,250 Discover Flex Toy Flex Toy Flex Halo Flex VRA Which VRA system is right for you? Compare Flex VRA platforms Good Traditional Toy Reinforcement Better Video, Lights, and Custom Reinforcement Best All reinforcement modes in one system Video, 3D toy, lights, and custom content Static reinforcer with changing LED light patterns on each activation Videos of animals, cartoons, toys and custom content with LED light bar High-contrast video, lifelike changing 3D toy, custom content and LED lightbar Ideal for clinics seeing a low amount of pediatric patients Ideal for any booth size Starting at $1,250 See it in action Ideal for a mix of pediatric and non-pediatric patients Ideal for any booth size or mobile Starting at $2,450 See it in action Ideal for high volume or exclusively pediatric patients Ideal for booths 6' x 6' or larger Starting at $3,750 See it in action Not sure which VRA system is right for you? You can mix up different reinforcers to accommodate your specific booth space and budget. Unsure what would be best for your clinic? Request a quick demo or Contact us to discuss . Flex Window Cover Visual control for sound booths. Keeps the visual environment controlled during testing. $800 Discover Flex Window Cover Accurate sound where it matters. Flex Speaker A reliable speaker option commonly used in VRA testing environments. $650 Discover Flex Speaker Trusted by 1000+ pediatric clinics worldwide

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 (GSI Audiostar Pro, Interacoustics EVO and Affinity) • PC or software-based triggering (Madsen Astera by Natus, MedRx Avant, Inventis) 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

Flex VRA ® is the only VRA system that directly integrates simultaneous video reinforcement and traditional toy reinforcement with the GSI AudioStar Pro and Interacoustics EVO audiometers . Simultaneous Video And Toy Control Included with Every Flex VRA® System No additional integration modules required Why This Matters Most audiometers only provide a limited number of VRA control buttons. Flex VRA® is the only platform that combines both video and toy reinforcement into a single audiometer-controlled workflow. Clinicians can instantly transition between reinforcement types using remote toggling, allowing greater flexibility based on patient attention and testing needs. GSI (Grason-Stadler) Audiostar Pro Flex VRA® enables direct control of both video reinforcement and toy reinforcement simultaneously with remote toggling. Using the dedicated VRA control buttons above the attenuator dial and a remote control, clinicians can operate up to six reinforcers directly from the audiometer, creating a seamless pediatric testing workflow. This exclusive Flex VRA® integration was designed specifically for modern pediatric audiology workflows using the GSI AudioStar Pro. Interacoustics EVO Flex VRA® directly integrates with Interacoustics EVO, providing native control of simultaneous video and toy reinforcement during VRA testing through the use of remote toggling. Clinicians can operate left and right toy and video reinforcement configurations directly within Interacoustics Suite, allowing a fully integrated pediatric audiology workflow. Only Flex VRA® combines simultaneous video VRA and traditional toy VRA into a single integrated audiometer-controlled platform.

Flex VRA Software Version 3.1 Update Estimated update time: 10-15 minutes Download PDF Instructions What’s New in Version 3.1 Animated pediatric welcome videos Bubble Game Farm Game Ball in the Bucket Game Additional pediatric engagement enhancements Software Update Instructions Before beginning the update process, please make sure you have your new remote controls and update USB drive ready. Step 1 Remove any hardware or accessories connected to the bottom of the monitor so that all USB ports are available. Step 2 Locate one of the black USB receivers included with your new remote controls and insert it into an open USB port on the monitor. Step 3 Press and hold your finger on the top left corner of the screen for approximately three seconds, then release. If the Service Menu does not appear: Tap the screen once to open the on-screen menu Select Setup Step 4 Inside the Setup menu, locate and select the Service button, then confirm the selection. If you do not see a Service button: Press the Toy button on your new remote control to enter Service Mode Step 5 The monitor should now display a black Windows desktop screen. Insert the update USB drive into one of the USB ports on the bottom of the monitor. Step 6 Windows File Explorer should open automatically. If it does not: Select the folder icon on the taskbar at the bottom of the screen If the taskbar is not visible: Swipe upward from the bottom of the screen to reveal it Step 7 In Windows File Explorer, locate and open the D: drive. Step 8 Inside the D: drive, locate the file named Install. Press and hold your finger on the Install file for approximately three seconds, then release and select: Run as Administrator Step 9 A dialog box will appear asking whether this monitor is configured as a: Left Monitor Center Monitor Right Monitor Select the appropriate option for your setup. Step 10 The update process will now begin and may take approximately 10 to 15 minutes to complete. During this time: Do not press any buttons on the new remote controls Do not disconnect power Do not remove the USB drive Once the update is complete, the system will automatically reboot back into Flex VRA. Video Tutorial Watch the complete video walkthrough here: https://www.youtube.com/watch?v=WgeEm9-heIw Need Assistance? For additional support, please contact Flex VRA. https://www.flexvra.com

The site exists to show Flex VRA customers how to select the appropriate boot device on older Flex VRA systems. Flex VRA Tech Note: Not booting to proper boot device Download Tech Note Overview Issue Flex VRA turning on to a black screen that says the VRA cannot find the proper boot device. Cause The VRA is not booting to the correct boot device and it cannot find the correct Solid State Drive to launch the operating system. Resolution Confirm the user is using a Generation 2 remote control by having them identify the QR code on the bottom of the remote. Have them turn the device off by pressing the silver power button under the left-hand side of the screen behind the screen bezel. Find the “Toy” button on the remote control (the VRA sees this button as an ESC key). Press the power button again to turn the monitor on and immediately start tapping the “Toy” button until they see a blue and gray BIOS screen. Use the red right arrow on the remote control to navigate to “Boot” in the menu. Use the lights off button (icon on the bottom of the white circle on the remote control) to arrow down to “Boot Option 1”. Press the center green circle on the remote control (ENTER) to see your boot options and scroll to the “Windows Boot Manager” device and press the green circle again. Arrow over to Save and Exit and press the green circle button on the remote control to reboot. Note: If you do not see an option for “Boot Manager Device”, there is an issue with SSD card and it would need to be replaced. Please contact Flex VRA directly to coordinate a resolution.

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

Flex Speaker is a passive audiology sound field speaker designed for pediatric hearing testing, VRA, and audiometer-based sound booth environments. Compatible with leading audiometers. Audiology Sound Field Speakers for VRA and Audiometers Flex Speaker is a high-performance passive speaker system designed for sound field testing and sized to match the Flex VRA systems . Brochure Installation Guide $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. High-Performance Audiology Sound Field Speakers Flex Speaker is a passive audiology sound field speaker designed specifically for pediatric hearing testing, visual reinforcement audiometry (VRA) , and audiometer-based sound booth environments. Unlike general-purpose speakers, Flex Speaker is purpose-built for clean installation, repeatable placement, and compatibility with common clinical audiometers including GSI Audiostar Pro and Interacoustics EVO . Features include: Passive sound field speakers for clinical audiology Magnetic backing for fast booth installation Includes audiometer speaker adapters Includes tape measure for consistent speaker positioning Low-profile mounting with no brackets required Compatible with amplified audiometers Designed for corner or flat-wall placement Mount. Secure. Align. Wire. Connect. Install cleanly and maintain consistent speaker positioning across audiology testing environments. Audiology Sound Field Speaker Installation Walkthrough Seamless Audiometer Integration Includes speaker adapters for common clinical audiometers used in pediatric audiology and sound field testing. Interacoustics EVO Speaker Adapter (2 1/4" mono to terminal) GSI Audiostar Pro Speaker Adapter (5 pin DIN to terminal) Designed for Pediatric Audiology & Sound Field Testing Purpose-built for pediatric sound booths, VRA testing , and clean audiometer speaker integration. Integrated pediatric VRA setup Side-profile, flush-mounted Front view, clean clinical install Frequently Asked Questions What are sound field speakers used for in audiology? Sound field speakers are used in pediatric audiology and hearing testing environments to present tones, speech, or stimuli through speakers rather than headphones or insert earphones. They are commonly used for visual reinforcement audiometry (VRA) and other pediatric sound field testing procedures. Which audiometers are compatible with Flex Speaker? Flex Speaker is a passive audiology sound field speaker compatible with amplified audiometers that support wired speaker connections, including systems like the Interacoustics Equinox and Otometrics Astera. Included adapters support the GSI Audiostar Pro and Interacoustics EVO. If your audiometer does not have an internal amplifier for sound field testing, a dedicated amplifier can be purchased from Flex VRA through your local distributor . Not sure if your audiometer needs amplification? Ask us! Does the Flex Speaker have to be magnetically mounted? No. In fact, we recommend that at least one screw is used to secure the speaker to the soundbooth wall for long term placement. Each Flex speaker has up to 4 predrilled mounting holes in the cabinet to allow for low-profile and secure mounting. Does the Flex Speaker require calibration? Yes. Calibration by a certified audiometric technician (such as e3 Diagnostics) is recommended to ensure accurate sound field testing performance within your clinical environment. What are the dimensions of the Flex Speaker? 13.5 inches (W) x 5 inches (W) x 15 inches (H)

Privacy policy for flexvra.com. We will not ever share or sell any data shared with flexvra.com. Privacy Policy Flex VRA (“Flex VRA,” “we,” “us,” or “our”) values your privacy. This Privacy Policy explains what information we collect when you visit our website (the “Site”), contact us, or purchase our products and services, how we use it, and the choices you have. 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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.