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For years, pediatric audiologists have had to make a decision. Do you use toys, video, or both? Do you rely on what worked before or adapt to what children need today? With the recent release of Flex Halo, that choice becomes clear. Literally. One System. A Completely New Experience. Flex Halo is not just another reinforcer. At its core is a transparent display that brings both digital toys and video content into the same physical space, creating beautiful high-contrast videos and the illusion of lifelike toys appearing right in front of the child. It’s video VRA. It’s toy VRA. And for the first time, it’s both in one box. Flex Halo Lifelike Toy Effect Why Flex Halo Matters Traditional VRA setups have always required compromise. Different reinforcers, sometimes even different systems and more complex workflows. Flex Halo simplifies everything. Hybrid reinforcement Seamlessly switch between animated lifelike toys, brilliant high-contrast video, or custom content without changing hardware. Higher engagement The transparent display captures attention in a way static toys and standard monitors simply can’t. Designed for the Way Clinicians Actually Work Flex Halo wasn’t built in a vacuum. It was built around real clinical workflows, designed with the input of practicing pediatric audiologists, and battle tested in some of the most demanding pediatric clinics in the country resulting in: Full audiometer integration for streamlined testing Instant activation with virtually no latency Customizable content, from sensory videos to clinic-specific stimuli Independent volume control to match patient needs Flexible configurations for left, right, center, or full-room setups Everything is designed to reduce friction and give clinicians more control in the moment. A New Category of Reinforcement Flex Halo doesn’t replace traditional VRA. It enhances it. By combining physical presence with digital flexibility, it introduces something entirely new: Holographic-style reinforcement that constantly changes and easily switches between reinforcement modes. That means: More flexibility in how you test More confidence in the results you get And a better experience for both the child and the clinician Our Standard for Great VRA Has Shifted Flex VRA has always been about one idea: Give clinicians the tools to adapt to any child. Flex Halo is the next step in that mission. It’s not just a new product. It’s a new way to think about engagement, conditioning, and what’s possible in the pediatric audiology booth. Flex Halo is available now. If you’re ready to see what happens when toys and video finally work as one, it’s time to experience Flex Halo.

Getting a call from your pediatrician saying your child needs a hearing test can feel like a lot. You might not know what it involves, whether it will be uncomfortable, or what happens if the results aren't what you hoped. The good news: a pediatric hearing test is one of the gentler appointments your child will ever have. Nothing is painful. The audiologist is trained to work with kids who may not cooperate perfectly. And the whole thing is designed to feel more like a game than a medical procedure — especially for toddlers and young children. Here's exactly what to expect at a child's hearing test. Before the appointment You don't need to do much to prepare. No dietary restrictions, no special schedule changes. A few things that genuinely help: Bring your child well-rested.  This matters most for toddlers. Behavioral hearing tests require your child to respond to sounds, which takes attention. A tired or hungry toddler is harder to test reliably. Talk about it beforehand.  You don't need to over-explain. Something like: "We're going to visit a person who checks ears. You'll listen to some sounds and look at some fun things on the screen." Framing it as curious rather than scary goes a long way. In fact, we've made a fun animated video you can show your child to help ease any uncertainty or anxiety they may have before the visit! Flex Dog Shows What to Expect At A Child's Hearing Test What happens when you arrive You'll typically start in a regular exam room, where the audiologist will ask about your child's history such as if your child has a history of ear infections, family history of hearing loss, and whether you've noticed anything at home that prompted the referral. Then the audiologist will look in your child's ears with a small light (an otoscope) to check for earwax or anything visible that could affect the test. This is quick and painless. The hearing tests The specific tests depend on your child's age. Here's how it generally breaks down. Tympanometry (all ages) Almost every pediatric hearing evaluation includes tympanometry. A small probe is placed at the entrance to the ear canal and it measures how the eardrum responds to a tiny puff of air. This tells the audiologist whether there's fluid behind the eardrum, a perforation, or pressure that might be affecting hearing. It takes about 30 seconds and causes no discomfort. Visual Reinforcement Audiometry — VRA (approximately 6 months to 2.5 years) This is the test designed specifically for babies and young toddlers. Your child will sit on your lap inside a sound booth, or in a chair with you nearby. Sounds are played through speakers (or through small earphones, depending on the setup). When your child turns toward the sound, they're rewarded with something visually engaging like an animated toy, a video, a light-up display. The audiologist watches for your child to make the connection: hear a sound, look toward it, get rewarded. Once that pattern is established, they start varying the volume and pitch to map out your child's hearing range. Conditioned Play Audiometry — CPA (approximately 2.5 to 4 years) For slightly older kids, the audiologist shifts to a game. Your child puts on headphones and is taught to do something such as drop a block in a bucket or put a peg in a board every time they hear a sound. Most kids find this fun once they understand the task, and the audiologist is patient in teaching it. Our animated Flex Dog video below demonstrates this CPA test. Conventional audiometry (4 years and up) By age four or so, most children can do the same test adults do: put on headphones, raise your hand (or press a button) when you hear a tone. The audiologist tests different pitches at different volumes in each ear. What if my child won't cooperate? This is probably the question parents worry about most, and the honest answer is: it happens, and audiologists expect it. If a child can't complete one test method, it's easy to transition to another, such as from conventional audiometry to play audiometry, or even back to VRA if needed. Experienced pediatric audiologists are used to fidgety, uninterested, or anxious kids. They'll try different approaches, take breaks, and work with whatever engagement they can get. It may take more than one appointment to get a complete picture, and that's completely normal. Your job during the test is mostly to be calm and present, and most importantly, not to coach or prompt your child, since that can interfere with the results. Just sit nearby, be a steady presence, and let the audiologist do their thing. Will it hurt? No. None of the standard hearing tests are invasive and should not cause any pain or discomfort. There are no needles, no instruments placed inside the ear canal, nothing loud enough to be startling. The equipment used for insertion into the ear, such as tympanometry and OAE testing, have soft foam tips and at most, might tickle a little bit. How long does it take? A full pediatric hearing evaluation usually runs 45 minutes to an hour. If additional tests are needed or your child needs extra time to settle in, it may go a bit longer. What happens after and understanding the results The audiologist will typically share results with you before you leave. A few things to know: Not passing a screening is not the same as a diagnosis.  Not passing a hearing screening doesn't mean a baby has hearing loss, but it does mean that the baby should have a full hearing evaluation. A full evaluation gives much more precise information. Results will show the type and degree of any hearing loss.  If there is hearing loss, the audiologist can tell you which ear is affected, how significant it is, and whether it appears to be in the middle ear (often treatable) or in the inner ear. Early identification matters.  Babies identified before 3 months of age who receive intervention by 6 months can reach comparable speech and language outcomes to their peers with normal hearing.  If the test finds something, getting answers sooner rather than later is genuinely one of the most useful things you can do. A note on the technology The hearing test equipment your child's audiologist uses matters, and it's evolved significantly in recent years. Modern VRA systems, like the ones used in Flex VRA, use engaging video and animated toy stimuli specifically designed to hold a young child's attention long enough to get accurate results. The better the system holds your child's attention, the more complete the hearing picture the audiologist can get in a single visit. The short version-what to expect at a child's hearing test Your child's hearing test is not something to dread. It's a calm, game-like experience that the audiologist has done hundreds of times. Bring a rested, fed child, talk it up as an adventure, and know that whatever the results show, you'll leave with better information than you walked in with...and that's always worth having. If you have questions before the appointment, don't hesitate to call the audiology clinic directly. They're used to nervous parents, and a two-minute phone call can go a long way.

Flex Dog Animation Demonstrates VRA Testing Hearing is one of the most critical senses in a child’s early development, directly influencing speech, language, and social skills. Detecting hearing issues as early as possible can make a profound difference in a child’s growth and communication abilities. One of the most effective methods for evaluating hearing in infants and toddlers is Visual Reinforcement Audiometry (VRA). In this post, we’ll explain what VRA is, how it works, and why modern VRA systems like Flex VRA  are transforming pediatric audiology. Understanding Visual Reinforcement Audiometry Visual Reinforcement Audiometry  is a behavioral hearing test designed for children between 6 months and 3 years of age. Unlike older children or adults, infants can’t reliably respond to verbal instructions during a hearing assessment. VRA addresses this challenge by combining sound stimulation with visual rewards. During a VRA session, the audiologist presents a series of sounds through a speaker. When the child turns their head toward the sound source, they are rewarded with a visual stimulus, such as a moving toy, animated video, or light display. This positive reinforcement encourages the child to participate consistently, providing reliable and measurable results. How VRA Helps Children Early Detection of Hearing Loss VRA enables audiologists to identify hearing impairments early, often before parents notice any obvious signs. Early detection is crucial because untreated hearing loss can lead to delays in speech, language development, and even cognitive skills. Engagement and Comfort Infants and toddlers are naturally curious, but they have limited attention spans. The visual reinforcement component makes the test fun and engaging, keeping the child’s focus on the task while minimizing stress or anxiety. Reliable and Repeatable Results Because VRA relies on natural behavioral responses rather than verbal communication, the test provides accurate results even with very young children. This reliability is essential for creating tailored treatment plans, including hearing aids, cochlear implants, or speech therapy. Parental Peace of Mind Parents can see firsthand how their child reacts to sounds in a controlled environment, giving them confidence in the test results. It also helps families understand the importance of consistent hearing monitoring during early childhood. Modern VRA Systems: A Game-Changer for Pediatric Audiology Traditional VRA systems often rely on bulky equipment and limited visual stimuli, which can reduce engagement. Today, modern systems like Flex VRA combine advanced hardware with customizable software to create a flexible, child-friendly testing experience. Wireless Components:  Flexible placement of speakers and toys for any clinic setup. Customizable Visual Stimuli:  Videos and animations tailored to a child’s age or interests. Research shows  that using modern VRA systems can increase testing accuracy and engagement compared to conventional methods. Who Should Consider VRA Testing? VRA is recommended for: Infants with a family history of hearing loss Babies who failed newborn hearing screenings Children at risk of middle ear infections or other auditory issues Pediatric clinics seeking efficient, engaging hearing assessment solutions By incorporating VRA into regular checkups, audiologists and parents can proactively support a child’s auditory development. Take the Next Step with Flex VRA Modern pediatric audiology is evolving, and Flex VRA is at the forefront. Its intuitive, engaging, and reliable system  helps audiologists deliver accurate results while keeping children happy and comfortable. Ready to take your pediatric hearing assessments to the next level? Explore our Flex VRA systems today and see how modern VRA testing can make a difference for your clinic and your young patients.  Discover Flex VRA Now!

For many children, walking into a clinic for any reason can feel overwhelming, even when there's nothing to worry about. A pediatric hearing test is one of the most comfortable, fun medical experiences a child can have. But getting them to believe that before they walk in the door? That's a different story. To ease the anxiety of the child (and sometimes even the parents) we created introductory videos that explain what to expect in a hearing test that children and their parents can watch before their appointment. An adult in a lab coat using words like "exam," "clinic," and "hearing threshold" simply wouldn't work for kids, so we created a character, Flex the dog, to explain the testing process in a way that's simple, reassuring, and genuinely fun! We've uploaded these videos to our YouTube channel for easy sharing and included download links so they're accessible on any computer, tablet, or phone. Feel free to share them with any patient who could use a little extra reassurance, because a hearing test isn't something to be nervous about. It's something to look forward to! Watch both videos below or download them to share directly with families: The Listening Game : A short explainer video that demonstrates Visual Reinforcement Audiometry (VRA). Youtube Download Video Watch Flex the Dog explain how fun a hearing test can be with VRA (Visual Reinforcement Audiometry) Toy In The Bucket Game : A short explainer video that demonstrates Conditioned Play Audiometry (CPA). Youtube                        Download Video                    Download Free CPA Games

Starting in 2026, we made the decision to post our prices online. We did this because serving the audiology community is not limited to the moment a system is installed in a booth. It also includes the process clinicians go through when they are evaluating new equipment. That process takes time, and we believe it deserves clarity. We know there are multiple options available for VRA systems and accessories. We also know that Flex is not always the lowest-priced option. We are comfortable with that. We believe we offer the best overall VRA solution available today, and we are proud of the level of quality, reliability, and design we deliver at a competitive price point. If we are confident in our products and our pricing, we believe that confidence should be visible. Posting prices allows clinicians to quickly understand whether Flex fits within their budget before investing time in conversations or demos. It respects their time and supports more straightforward, productive discussions. Most importantly, this approach reflects how we prefer to do business. Transparent pricing encourages honest conversations, realistic expectations, and long-term relationships built on trust. For clinics who value that approach, we are happy to be open from the start. If you have questions about configurations, options, or what makes the most sense for your clinic, we are always happy to talk. A Note for International Customers For our international customers, please note that all published prices are listed in U.S. dollars (USD) and do not include shipping, duties, taxes, or other fees that may be associated with international purchases. These costs can vary by country and region. We are always happy to work with your local international distributor to help clarify estimated total costs or discuss logistics in advance so there are no surprises.

Visual Reinforcement Audiometry (VRA) has become an essential tool in pediatric audiology, enabling audiologists to assess hearing in infants and young children accurately. But how did VRA develop into the sophisticated systems we use today, like the Flex VRA? Understanding the history of visual reinforcement audiometry offers valuable insight into its evolution and the innovations that continue to enhance patient engagement and testing reliability. Early Beginnings of Pediatric Hearing Tests Before the introduction of VRA, audiologists primarily relied on behavioral observation audiometry (BOA)  and other basic techniques to assess hearing in children. These methods were often subjective and depended heavily on the child’s natural reactions, making it challenging to obtain consistent results. The need for a more structured and reliable approach led to the development of Visual Reinforcement Audiometry in the mid-20th century. By combining auditory stimuli with visual rewards, audiologists could encourage children to respond more consistently to sounds, improving both accuracy and reliability. The Emergence of Visual Reinforcement Audiometry The first VRA systems used simple toys or lights as visual reinforcers. When a child responded to a sound, a toy would activate, or a light would flash, creating a positive feedback loop that encouraged repeated responses. This method marked a significant advancement in pediatric audiology, allowing clinicians to gather more precise data on a child’s hearing abilities. Early systems, while effective, had limitations. The toys were often bulky, difficult to manipulate, and not particularly engaging for children, especially those with developmental differences or shorter attention spans. Advancements in Technology: Enter Modern VRA Over the decades, VRA evolved with technological innovations.  Video monitors replaced static toys, and dynamic visual content was introduced to capture children’s attention more effectively. The integration of audiovisual stimuli created a more engaging testing environment, improving participation rates and test accuracy. Modern VRA systems, like the Flex VRA , have taken these advancements even further. Flex VRA combines customizable video content with intuitive touch-screen controls, allowing audiologists to tailor each test to a child’s unique interests and attention span. The exclusive partnership with Hey Bear Sensory  provides engaging, sensory-based videos that make the testing process enjoyable for children, including those with developmental differences like Down Syndrome. Key Innovations of Flex VRA Flex VRA stands out in the history of VRA for several reasons: Customizable Content:  Audiologists can choose videos, toys, and games that match each child’s preferences. Wireless and Flexible Setup:  The system can be easily adjusted for different testing environments and patient needs. Enhanced Engagement:  Dynamic video rewards and interactive games keep children attentive, resulting in more reliable outcomes. Integration Capabilities:  Flex VRA seamlessly works with other audiology tools such as OAEs, ABR, and tympanometry. Audiologists across the country have praised Flex VRA for improving patient engagement, streamlining testing, and providing more consistent results in pediatric hearing assessments. Why Understanding the History Matters Knowing the history of visual reinforcement audiometry helps clinicians appreciate the evolution of pediatric hearing assessments and the importance of engaging modern tools. From simple toys to sophisticated digital systems, VRA has consistently aimed to make hearing tests more accurate, reliable, and enjoyable for children. Flex VRA represents the latest step in this evolution, offering a system that respects the foundations of VRA while leveraging modern technology to meet today’s audiology needs. Conclusion Visual Reinforcement Audiometry has come a long way since its inception. By understanding its history, audiologists can better appreciate the advancements that systems like Flex VRA bring to pediatric audiology. With customizable content, engaging visuals, and reliable testing features, Flex VRA continues to shape the future of pediatric hearing assessments. For more information about how Flex VRA can enhance your pediatric audiology practice, explore   Flex VRA’s products  or   contact your local representative .

In pediatric audiology, achieving reliable behavioral thresholds is often the most critical step in diagnosing hearing loss. For infants and toddlers, the method of choice is visual reinforcement audiometry (VRA). Recently, the study by Bonino et al. (2021) titled “Visual Reinforcers Designed for Children with Developmental Disabilities” has provided actionable insights for improving VRA system performance and outcomes. Understanding Visual Reinforcement Audiometry Visual reinforcement audiometry is a behavioral hearing test technique typically used for children from around 6 months to 2 years (and sometimes older). In this method, a child is conditioned to turn toward a sound source. When they respond, they are rewarded with a visual stimulus, such as a toy, video, or light. Reliable results depend on engagement and consistency. The Challenge: Testing Children with Developmental Disabilities Testing children with developmental disabilities can be particularly challenging. These children may face additional barriers, including: Sensory sensitivities Limited attention shifts Restricted interests Atypical response behaviors Difficulties with standard conditioning protocols These factors can significantly reduce the likelihood of completing a full audiogram. Breakthrough Study: Library of Visual Reinforcers Bonino developed a library of 45 themed reinforcer sets (photos/videos) selected based on common interests of children with developmental disabilities. Each set contains 20-40 unique items and is formatted for commercial VRA systems and custom slideshow setups. The library is freely downloadable under Creative Commons licensing. Key Findings & Takeaways for VRA Systems & Audiology Research Here are some key findings that can enhance VRA systems and audiology research: Tailored Reinforcers : Reinforcers designed for developmental interests may improve engagement, reduce the number of sessions, and enhance data yield (though clinical validation is pending). Flexible VRA Systems : VRA systems that allow easy switching of content/themes—and custom uploads—are better equipped to help overcome habituation and attention lapses. Open-Source Libraries : Research-backed libraries democratize access to better reinforcement materials for audiology clinics of all sizes. Future Research Directions : Future audiology research should quantify how tailored reinforcers impact completion rates, threshold reliability, session length, and cost reduction. What This Means for Clinical VRA Testing For audiologists and pediatric hearing centers, consider the following: Review Reinforcer Content : Examine the reinforcer content your VRA system uses. Does it include themes aligned to children with developmental disabilities? Modern VRA Systems : If using a modern VRA system (like Flex VRA), ensure it allows custom video uploads and rapid reinforcer changes. How Flex VRA Leverages the Research Flex VRA supports both video-based and toy-based reinforcement. It allows custom content uploads and offers a modern touch interface for ease of use. This aligns directly with the Bonino study’s emphasis on reinforcer customization and engagement. By integrating research-backed libraries and simplifying system configuration, Flex VRA positions your clinic to deliver better outcomes, particularly for populations that challenge standard VRA approaches. Conclusion: The Future of Pediatric Audiology As we move forward, the integration of tailored visual reinforcers into VRA systems will revolutionize how we approach pediatric audiology. By focusing on engagement and customization, we can improve the reliability of test results and enhance the overall experience for children undergoing hearing evaluations. By embracing these advancements, we can ensure that every child receives the best possible care and support in their hearing journey. Let’s make hearing evaluations more engaging and effective for children! For more insights on improving pediatric audiology practices, check out this study .

Disclaimer This content is provided for general educational purposes only and does not constitute billing, coding, or legal advice. CPT coding requirements, reimbursement policies, and payer guidelines may change and can vary by insurer and jurisdiction. Clinicians and practices should consult payer-specific policies, professional guidance, or qualified billing specialists to ensure accurate coding and compliance. Visual Reinforcement Audiometry is a commonly used behavioral hearing test within a pediatric VRA system, designed to measure hearing thresholds in infants and young children. Although most pediatric audiologists might be familiar with VRA testing, questions about VRA CPT codes and how to bill for VRA testing are a common question in our inbox. So, in this overvie, we'll address the most frequently asked questions about how to bill for VRA and which CPT codes are typically used. What CPT code is used for Visual Reinforcement Audiometry? The CPT code most commonly associated with visual reinforcement audiometry is 92579. This code is used for behavioral audiometric testing that relies on visual reinforcement techniques and is typically applied when testing infants or young children who are not developmentally ready for conditioned play audiometry. Is there one CPT code that covers all VRA system testing? No. There is no single CPT code that universally covers all testing performed during a VRA session. Billing for visual reinforcement audiometry is based on the testing method performed, not the VRA system or equipment used. While 92579 is often appropriate, additional audiometric CPT codes may be used depending on how thresholds are obtained and payer-specific guidance. When should CPT code 92582 be used instead of a VRA CPT code? CPT code 92582 is used for conditioned play audiometry and should only be billed when play-based testing is performed. It should not be used for visual reinforcement audiometry unless the child has transitioned developmentally to play audiometry during the session. Does soundfield versus ear-specific testing affect how to bill for VRA? In most cases, billing does not change solely based on whether testing is completed in the soundfield or with ear-specific transducers. However, documentation should clearly describe how stimuli were presented, how responses were obtained, and which behavioral method was used during visual reinforcement audiometry. What documentation is important when billing for VRA testing? Clinical documentation should include the patient’s age and developmental level, the behavioral testing method used, the reliability of responses, and any limitations encountered during testing. Clear documentation supports medical necessity and is especially important when billing for pediatric visual reinforcement audiometry. Do payer rules vary for VRA CPT codes? Yes. Reimbursement and coverage for visual reinforcement audiometry vary by insurance carrier, state Medicaid program, and individual payer policy. Practices should regularly review payer guidelines and confirm requirements such as prior authorization when applicable. Does the type of VRA system affect billing? No. CPT codes describe the clinical service performed, not the technology or reinforcement system used. Billing should always reflect the testing procedure and behavioral method rather than the specific VRA system.

In pediatric audiology, two of the most commonly used behavioral hearing tests are Visual Reinforcement Audiometry (VRA) and Conditioned Play Audiometry (CPA). Although both tests are used to evaluate hearing in children, they are designed for different developmental stages and rely on different response behaviors. Understanding the difference between VRA and CPA testing helps audiologists choose the most appropriate method and obtain reliable hearing thresholds. What Is Visual Reinforcement Audiometry (VRA)? Visual Reinforcement Audiometry (VRA) is a behavioral hearing test used primarily with infants and young toddlers, typically between 6 months and 2.5 years of age. During VRA testing: Sounds are presented through speakers or earphones The child is conditioned to turn toward the sound A visual reinforcer (video, light, or toy) is activated after a correct response VRA testing relies on natural head-turn behavior rather than instructed responses as you can see in the video below. Example of VRA testing being done with a Flex VRA version 1 When VRA is typically used Infants and toddlers under 3 years old Children who cannot follow verbal instructions Early behavioral hearing assessments Pediatric patients with short or variable attention spans Visual Reinforcement Audiometry is most effective when the reinforcement is engaging but controlled, allowing the child to stay focused without distraction. What Is Conditioned Play Audiometry (CPA)? Conditioned Play Audiometry (CPA) is a behavioral hearing test commonly used with older toddlers and preschool-aged children, generally between 2.5 and 5 years of age, depending on developmental readiness. During CPA testing: The child is taught a simple play task (such as placing a block in a container) The task is performed each time a sound is heard Responses are intentional and conditioned CPA requires the child to understand instructions and complete a specific action in response to sound. When CPA is typically used Preschool-aged children Children who can follow simple instructions Patients with longer attention spans Diagnostic or follow-up audiology evaluations Conditioned Play Audiometry can produce reliable thresholds when the child is developmentally ready. Key Differences Between VRA and CPA Feature VRA CPA Full name Visual Reinforcement Audiometry Conditioned Play Audiometry Typical age range 6 months to ~2.5 years ~2.5 to 5 years Response type Head turn toward sound Conditioned play action Instruction required Minimal Moderate Attention demands Short and variable Longer and sustained Reinforcement Visual stimulus Play-based task Clinical goal Sound detection and early thresholds Behavioral thresholds Why Developmental Readiness Is Important Choosing between VRA and CPA is not based on age alone. A child may be chronologically old enough for CPA but not developmentally ready to: Understand instructions Perform a conditioned task consistently Maintain attention throughout testing Using CPA too early can result in: Inconsistent responses Increased test time Unreliable thresholds In these cases, Visual Reinforcement Audiometry may still be the more appropriate test method. Transitioning From VRA to CPA The transition from VRA to CPA often occurs gradually. Some children may move between methods during the same appointment depending on: Fatigue Engagement level Task understanding Audiology clinics benefit from testing environments that allow flexibility between VRA and CPA, rather than forcing a single testing approach. The Role of Flexible VRA Systems in Pediatric Audiology Modern pediatric audiology clinics increasingly rely on VRA systems that support: Multiple reinforcement options Adjustable visual engagement Controlled test environments Smooth workflow transitions These capabilities allow audiologists to adapt testing methods based on the child’s developmental stage rather than strictly following age-based guidelines. Choosing Between VRA and CPA There is no single “best” pediatric hearing test. Use VRA when the child responds best to visual reinforcement and natural head-turn behavior. Use CPA when the child can follow instructions and reliably complete a conditioned task. The most accurate pediatric audiology evaluations are achieved when clinicians can adjust testing methods in real time. This includes possible utilizing a VRA system with an interactive button for VROCA testing . Summary: VRA vs CPA Visual Reinforcement Audiometry and Conditioned Play Audiometry serve different but complementary roles in pediatric hearing testing. Understanding the difference between VRA and CPA allows audiologists to: Select the appropriate test method Reduce testing time Improve reliability of results Create a better experience for children and parents

We’ve been hard at work throughout 2025 building some exciting new things at Flex. One project we’re especially excited to share in 2026 is the next generation of the Flex Toy Visual Reinforcement Audiometry System . The original goal was simple. We wanted to convert the Flex Toy to our zoned radio-frequency wireless technology to make installation easier and improve compatibility with our wireless video reinforcers. But once we opened the box and started updating internal components, it became clear that this was an opportunity to rethink Flex Toy entirely and push traditional toy VRA further. The problem with traditional toy VRA I’ll admit something up front. I’ve never been a huge fan of traditional toy VRA. At Flex, we design VRA systems to not only capture attention, but to hold  interest and genuinely delight patients and families during a hearing evaluation. The idea of lighting up the same box with the same figure inside, over and over, has always felt a bit underwhelming. So, if we were going to redesign the Flex Toy, it couldn’t just be another box that lights up a figure. It had to approach reinforcement differently. The flashing LED light bar had to go One early thought was simple: if novelty matters, maybe we change the color of the flashing light each time the toy activates. Old Flex Toy Still boring. So  we went further. We removed the traditional light bar entirely and replaced it with a dynamic light panel capable of producing different colors and  patterns on every activation. That change made an immediate difference. New Flex Toy Now, each activation produces a new light pattern dancing around the border of the toy. We placed early versions into trial sites, and the feedback was unanimous: “The kids LOVE it.” That was all the confirmation we needed to make it a permanent part of the new design. Reducing mechanical parts and breakage The original Flex Toy contained a number of moving parts, boards, speakers, and gears that were vulnerable to breakage during shipping or installation. If we were rebuilding the system, that risk had to go away. We upgraded the internal motors to a drop-resistant design, reinforced mounting for internal boards and speakers, and moved the external sound card inside the enclosure so it could not be accidentally disconnected. The result is a Flex Toy that is more durable and reliable than ever. Combined with wireless operation, the likelihood of mechanical issues is now extremely low. Rethinking power Wireless toys introduce a new challenge: power. Audiology booths are notorious for having limited outlets, and with Flex Combo systems capable of supporting up to 6 reinforcers, requiring one outlet per device simply wasn’t realistic. So we didn’t just rethink power for Flex Toy. We reworked power options across the Flex VRA system as a whole. After a lot of trial and error, it’s now possible to run up to five reinforcers  (monitors, toys, or any combination you can think of) from a single power outlet. Will that configuration be used every day? Probably not. But as someone who spent years installing systems, knowing you have flexible power options when you need them matters. The clinician may never notice, but the installation technician who’s an hour away from the nearest hardware store certainly will. Looking ahead To say we’re happy with the results of this redesign would be an understatement. Dare I say it...I’m genuinely excited about traditional toy VRA now. Thank you to the audiologists whose feedback guided each design decision, and to our distribution partners who have patiently waited for this release. We’re excited to usher in the new Flex Toy in 2026.

Adapting the VRA System to the Patient, Not the Other Way Around A modern VRA system needs to do more than just present visual reinforcement. It needs to adapt to the wide range of patients seen in pediatric audiology clinics every day. Most children respond well to standard visual reinforcement. Bright lights, engaging videos, or a familiar toy are often enough to elicit reliable head turns. But every clinician has encountered the difficult-to-test patient. The child who only engages with one specific type of stimulus, character, or motion. This is where Targeted Content in the Flex VRA system becomes valuable. The Traditional VRA System Approach Most VRA systems are designed around a one-to-many model. The system provides several different stimulus options, and the clinician cycles through them during testing to see what captures the child’s attention. This works well in the majority of cases and remains an important part of the Flex VRA workflow. The Flex remote includes four stimulus options that can be accessed instantly during testing, giving audiologists flexibility and control in real time. However, some patients do not respond to variety. They respond to specificity. When a VRA System Needs to Be More Targeted Certain patients will only engage with very specific content. A particular category of video. A familiar character. A known visual preference. In these cases, switching between multiple generic stimuli can actually reduce engagement rather than improve it. Instead of asking the child to adapt to the VRA system, it can be more effective to adapt the VRA system to the child . What Is Targeted Content in the Flex VRA System? Targeted Content allows the clinician to customize what specific content appears when pressing the Video and Custom buttons on the Flex remote before the test begins. Importantly, this does not remove flexibility during testing. The clinician still has access to all four stimulus options throughout the session. The difference is that when Video or Custom is selected, the content that appears is intentional and pre-defined. This allows the VRA system to be tailored to the patient rather than relying on trial and error during the test. Example Use Case in a Pediatric VRA System Imagine a patient coming in for testing who you already know loves trains and Paw Patrol. Before the session starts, you configure the VRA system as follows: -Video stimulus set to a category such as “Vehicles” -Custom stimulus set to Paw Patrol content that you have uploaded Now, during testing, when you activate Video or Custom, that specific content appears instantly. The testing environment is now aligned with what you already know engages that patient. Why Targeted Content Matters Will Targeted Content be used on every patient? Probably not. But for the difficult-to-test patient, the one who struggles to stay engaged or fatigues quickly, having the right stimulus at the right moment can make a meaningful difference in obtaining reliable results. A flexible VRA system should give clinicians options. A great VRA system gives them control. Targeted Content is another way the Flex VRA system helps clinicians adapt to real-world testing challenges while keeping the focus where it belongs, on the child and their family.

Hearing tests can feel intimidating for both children and parents, especially if it’s the first time. The good news is that today’s pediatric audiology technology, like Visual Reinforcement Audiometry (VRA) , makes testing more fun, engaging, and accurate than ever before. Still, a little preparation can go a long way in helping your child feel comfortable and confident during their appointment. In this guide, we’ll explain what to expect during a VRA test and share simple, effective tips to ensure a smooth experience for you and your child. What Is a Visual Reinforcement Audiometry (VRA) Test? Visual Reinforcement Audiometry  is a specialized hearing test designed for infants and toddlers, typically between 6 months and 2.5 years old. The test helps audiologists measure how your child responds to sounds at different volumes and pitches. Here’s how it works: Your child sits on your lap in a sound-treated room. Sounds are played through speakers or headphones. When your child turns their head toward the sound, they’re rewarded with a visual stimulus  like a moving toy, flashing light, or a short, fun video clip. This reinforcement encourages participation and helps the audiologist determine the quietest sounds your child can hear. With modern systems like   Flex VRA , the process is even more engaging. Instead of mechanical toys, children see bright, animated clips—such as Hey Bear Sensory videos—that capture attention and make the test feel more like play than evaluation. Why Preparation Matters Even though VRA tests  are designed to be child-friendly, unfamiliar environments and new faces can still make some children nervous. Preparing ahead of time helps reduce anxiety and ensures the most accurate results possible. A calm, cooperative child responds more consistently, allowing audiologists to gather complete and reliable hearing data in a shorter session. Tips to Prepare Your Child for a VRA Test Here are some practical ways to help your child get ready for their upcoming hearing test: 1. Talk About the Appointment in Simple Terms A few days before the test, explain to your child that they’re going to visit a “ hearing doctor ” who will play sounds and show them fun videos when they listen carefully. Keeping the explanation short, positive, and age-appropriate helps set the right tone. 2. Practice Listening Games at Home You can prepare your child by playing simple sound games. Try hiding a small bell or toy that makes noise and encourage your child to find where it’s coming from. This builds familiarity with responding to sounds just like in a VRA test. 3. Schedule the Appointment Wisely Book the test at a time when your child is usually alert and well-rested. Avoid scheduling right before nap time or meals to reduce irritability or distraction. 4. Bring Comfort Items If your child has a favorite toy, blanket, or pacifier, bring it along. Familiar objects provide comfort in a new environment and help them feel more secure during the test. 5. Avoid Ear-Blocking Accessories Before the test, remove any hats, hairbands, or earrings that might cover your child’s ears. This ensures the audiologist can place the equipment properly for accurate testing. 6. Be a Calm and Reassuring Presence Your child will likely sit on your lap during the test. Try to stay calm and positive—children easily pick up on their parents’ emotions. Smiling and encouraging them helps create a relaxed atmosphere. 7. Ask Questions Before and After the Test Don’t hesitate to ask your audiologist to explain what will happen or to share the results in clear, simple language. Pediatric audiologists are trained to work with families and will appreciate your engagement. How Flex VRA Makes the Process Easier Traditional toy-based VRA systems were effective but often limited in flexibility and appeal. Flex VRA  brings the process into the digital age with fully customizable, screen-based visual reinforcements. Using vibrant, motion-rich clips from Hey Bear Sensory , Flex VRA systems keep children focused and motivated throughout testing—resulting in faster, more reliable outcomes. Audiologists can even adjust content based on each child’s interests or developmental level, making the experience uniquely personal and engaging. Modern innovations like these help transform what could be a stressful appointment into an interactive and positive experience for families. Give Your Child a Better Hearing Test Experience At Flex VRA , we believe hearing tests should be accurate, efficient, and child-centered. Our virtual reinforcement systems are trusted by hospitals, universities, and private clinics across the U.S. for their reliability and ability to keep children engaged. Call us:  512-777-0016 Email:   sales@flexvra.com   Visit us:  100 E. Whitestone Blvd., Ste. 148, #160, Cedar Park, TX 78613 Request a quote or schedule a demo today →  and discover how Flex VRA can make pediatric audiology testing easier for your patients—and your practice.