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Why Wireless Reliability Matters in Visual Reinforcement Audiometry A Visual Reinforcement Audiometry (VRA) system is only as effective as its ability to deliver reinforcement exactly when the audiologist needs it. During a pediatric hearing evaluation, timing is everything. Whether presenting an animated video or activating a toy, even a brief delay or missed command can interrupt conditioning and affect test reliability. That's why Flex VRA was engineered to provide the most dependable wireless communication possible for clinical Visual Reinforcement Audiometry. 433 MHz USB Receiver for Flex VRA Not Wi-Fi. Not Bluetooth. Unlike many consumer wireless devices, Flex VRA does not rely on Wi-Fi or Bluetooth for remote communication. Instead, Flex VRA uses a paired zoned 433 MHz radio frequency protocol, allowing every remote and receiver to communicate exclusively with one another while preventing interference from neighboring systems. This offers several important advantages in hospitals, clinics, and universities where wireless environments are often crowded. Typical Wireless Technologies Technology Frequency Bluetooth 2.4 GHz Wi-Fi 2.4 GHz / 5 GHz / 6 GHz Flex VRA RF Control 433 MHz By operating on an entirely different frequency, Flex VRA avoids competing with: Hospital Wi-Fi networks Bluetooth keyboards and mice Wireless headphones Mobile phones Tablets Smart watches Other common 2.4 GHz devices Why 433 MHz? Wireless Remote Control Lower-frequency radio waves behave differently than higher-frequency wireless technologies. Compared to 2.4 GHz Bluetooth or Wi-Fi, 433 MHz signals generally penetrate walls more effectively, travel through windows and doors more reliably, experience less attenuation through common building materials and are less affected by congestion from nearby wireless devices For adjoining audiology booths, this provides excellent reliability without depending on the quality of the building's network infrastructure. Individually Paired Systems Every Flex VRA system is individually paired. This means your remote communicates only with its assigned receiver. Benefits include: No accidental activation of neighboring VRA systems Reliable operation in clinics with multiple test rooms No device discovery process No Bluetooth pairing issues No dependence on network permissions Each system operates as its own dedicated wireless link. In addition to operating on a dedicated paired 433 MHz radio frequency, Flex VRA delivers near-instantaneous activation (approximately 0.05 seconds), helping clinicians reinforce correct responses without perceptible delay. Instantaneous activation for video and toy reinforcers Designed for Busy Hospitals and Audiology Clinics Modern healthcare facilities can have hundreds or even thousands of wireless devices operating simultaneously. Common sources include Wi-Fi access points, bluetooth peripherals, patient devices, medical equipment, staff laptops, tablets and mobile phones. Because Flex VRA operates independently of these wireless ecosystems, performance remains consistent regardless of Wi-Fi traffic. Even if a hospital experiences poor Wi-Fi coverage or overloaded wireless networks, the Flex VRA remote continues communicating directly with the receiver. Built for Clinical Reliability Consumer wireless technologies are designed for convenience. Medical equipment demands something different: Consistency. Visual Reinforcement Audiometry requires precise timing between the audiologist's response and the child's behavior. Every activation should occur immediately and predictably. That is why Flex VRA uses a dedicated RF communication protocol rather than relying on consumer wireless standards. Proven Around the World Flex VRA systems are used in: Children's hospitals University audiology programs ENT clinics Private practices Government facilities Diagnostic hearing centers Across these installations, our dedicated RF communication has proven exceptionally dependable in real-world clinical environments. Why We Chose RF Instead of Bluetooth While Bluetooth works well for headphones and consumer electronics, it was not our preferred choice for controlling a clinical VRA system. Dedicated 433 MHz RF provides several advantages for pediatric audiology: ✓ Independent of Wi-Fi networks ✓ Not affected by Bluetooth congestion ✓ Better penetration through common clinic construction ✓ Individually paired devices ✓ Fast response time ✓ Simple setup ✓ Reliable operation with no network infrastructure For us, the priority wasn't adding another wireless technology. It was choosing the one that gives audiologists confidence every time they press the button. The Flex VRA Difference At Flex VRA, every design decision starts with one question: Will this make testing easier and more reliable for the audiologist? Choosing a dedicated 433 MHz RF communication system was one of those decisions. It eliminates unnecessary complexity while delivering dependable wireless performance in the environments where pediatric hearing testing takes place every day. When reliability matters, simplicity often wins. Learn More About Flex VRA If you're looking for a Visual Reinforcement Audiometry System, VRA equipment, or want to learn how Flex VRA can improve pediatric hearing testing, explore our complete product lineup or contact us for a live demonstration.

The audiology industry continues to evolve, and one of the most exciting recent developments is the introduction of AudioSol, GSI's newest audiometer software platform. At Flex VRA®, we're excited to announce that the new AudioSol software integrates seamlessly with the Flex VRA system, creating a streamlined and intuitive experience for clinicians performing Visual Reinforcement Audiometry (VRA). Bringing Visual Reinforcement Audiometry System Controls Directly Into the Audiometer Workflow Traditionally, clinicians performing VRA often need to manage multiple devices and interfaces during testing. With the new AudioSol integration, Flex VRA reinforcers can be activated directly from within the audiometer software using on-screen controls or keyboard hotkeys. This means clinicians can remain focused on the patient and the test rather than switching between multiple control systems. More Than Reinforcement Activation What makes this integration particularly exciting is that it goes beyond simply triggering reinforcers. The Flex VRA system's multitouch interface can be used to quickly switch between reinforcement modes, allowing clinicians to adapt to each child's needs in real time. Available modes include: Video Mode Engaging video content designed to maintain interest and reinforce conditioned responses. Toy Mode Traditional animated reinforcement toys that remain a trusted option in pediatric audiology. Custom Content Mode Clinic-specific content, patient-preferred videos, or specialized reinforcement materials can be deployed instantly. Lights Only Mode A simple visual reinforcement option when a more minimal approach is preferred. This flexibility allows audiologists to tailor reinforcement strategies without disrupting the testing process. Designed for Modern Pediatric Audiology Every child responds differently during behavioral hearing assessments. The ability to quickly adjust reinforcement types can be valuable when maintaining engagement and obtaining reliable responses. By combining GSI's AudioSol platform with Flex VRA's flexible visual reinforcement audiometry system, clinicians gain access to a workflow that is both efficient and adaptable. A Shared Focus on Better Clinical Experiences We're always excited to see innovation that helps audiologists spend less time managing technology and more time focused on patients. The new GSI AudioSol integration demonstrates how thoughtful software design and flexible VRA technology can work together to create a smoother clinical experience. We encourage audiologists, clinic managers, and hearing healthcare professionals to take a closer look at what GSI has built with AudioSol and see how it works alongside Flex VRA. To learn more about Flex VRA®, contact our team or schedule a demonstration today.

Link to the Audiology Online course conducted by Flex VRA located at the bottom of the post. For decades, Visual Reinforcement Audiometry (VRA) has been one of the most important methods used in pediatric hearing assessment. This behavioral testing technique helps clinicians evaluate hearing sensitivity in infants and young children who are not yet able to participate in traditional hearing tests. Today, new technologies and testing strategies are helping audiologists improve patient engagement, streamline workflows, and obtain more complete diagnostic information. These advancements are transforming pediatric audiology testing and creating new opportunities for better patient outcomes. Utilizing distract mode while performing tympanometry Why Visual Reinforcement Audiometry Remains Essential Visual Reinforcement Audiometry is widely used to assess hearing in children typically between six months and two years of age. During testing, a child is conditioned to turn toward a sound source and is rewarded with a visual stimulus when a correct response occurs. The success of VRA depends heavily on maintaining a child's attention throughout the appointment. Many clinicians face challenges such as: Children becoming bored with repetitive visual reinforcers Limited variety of reinforcement options Difficulty managing multiple devices during testing Incomplete behavioral hearing thresholds As a result, audiologists are constantly searching for ways to improve the effectiveness of pediatric hearing assessment procedures. Advancements in Pediatric Audiology Testing Recent innovations have focused on simplifying the clinician experience while improving patient engagement. Modern systems now allow visual reinforcers to be selected and activated directly from the audiometer, reducing the need for additional hardware and streamlining pediatric audiology testing workflows. These improvements can help clinicians: Maintain a child's attention longer Increase the variety of visual reinforcers available during testing Reduce setup complexity Improve testing efficiency Obtain more complete hearing threshold information As technology continues to evolve, many audiologists are finding that updated reinforcement strategies can significantly enhance the overall effectiveness of Visual Reinforcement Audiometry sessions. Bridging Visual Reinforcement Audiometry and Conditioned Play Audiometry One of the biggest challenges in pediatric hearing care is transitioning children from Visual Reinforcement Audiometry to Conditioned Play Audiometry (CPA). While VRA is highly effective for younger children, older toddlers often become developmentally ready for more interactive testing methods. Conditioned Play Audiometry uses play-based responses to obtain hearing thresholds while keeping children engaged throughout the evaluation. New technologies are helping audiologists move seamlessly between VRA and CPA, allowing clinicians to adapt testing methods based on developmental readiness rather than equipment limitations. Expanding Testing Options with VROCA Another growing area of interest is VROCA (Visual Reinforcement Operant Conditioning Audiometry). VROCA combines elements of traditional visual reinforcement techniques with operant conditioning principles, creating additional opportunities for behavioral hearing assessment in pediatric populations. By incorporating VROCA into a comprehensive testing strategy, clinicians may be able to obtain valuable hearing information from children who are difficult to assess using conventional methods alone. As pediatric hearing diagnostics continue to evolve, VROCA represents an exciting extension of traditional Visual Reinforcement Audiometry techniques. Audiology Continuing Education for Modern Pediatric Testing Keeping up with advancements in pediatric audiology testing, Conditioned Play Audiometry, and VROCA requires ongoing professional development. Fortunately, high-quality audiology continuing education programs are helping clinicians stay current with emerging technology and best practices. We took part in an Audiology Online course called "New Tools and Strategies for Visual Reinforcement Audiometry." This course explores: Modern approaches to Visual Reinforcement Audiometry Strategies for improving visual reinforcement effectiveness Integration of Conditioned Play Audiometry techniques VROCA implementation strategies Workflow improvements for pediatric hearing assessment New technology designed specifically for pediatric audiology testing Audiologists seeking Audiology CEUs can access the course through AudiologyOnline: https://www.audiologyonline.com/audiology-ceus/course/new-tools-and-strategies-for-39687 The Future of Pediatric Hearing Assessment As technology advances, the future of Visual Reinforcement Audiometry, Conditioned Play Audiometry, and VROCA looks increasingly promising. New tools are making pediatric hearing assessment more engaging for children and more efficient for clinicians. For audiologists who perform pediatric audiology testing, staying informed about these developments is essential. Through quality audiology continuing education opportunities and practical innovations in VRA audiology, clinicians can continue improving outcomes for the children and families they serve.

How to Determine Whether a Child Is Ready for Conditioned Play Audiometry One of the most common decisions in pediatric hearing testing is whether to begin with Conditioned Play Audiometry (CPA) or Visual Reinforcement Audiometry (VRA). Choosing the appropriate behavioral hearing assessment can improve test efficiency, reduce frustration, and help obtain reliable hearing thresholds more quickly. While age provides a general guideline, developmental readiness is often a better predictor of whether a child is ready for CPA testing or should begin with VRA testing. We recently had the opportunity to attend a presentation by pediatric audiologist, Dr. Josephine Marriage, and she shared a simple observation that can help guide this decision...offer the child a simple inset puzzle at the beginning of the appointment and watch what happens. Simple inset puzzle used to help determine readiness for Conditioned Play Audiometry (CPA) before pediatric hearing testing. What the Puzzle Reveals The goal is not to evaluate puzzle-solving ability. Instead, the puzzle serves as a quick assessment of several skills that are important for successful CPA: Are they able to engage with a tabletop activity? Can they understand simple tasks? Do they have the attention and concentration needed for CPA? Are they willing to follow adult direction? Successful Conditioned Play Audiometry requires a child to understand a simple conditioned response, maintain attention, and participate in a structured play task. Common CPA activities include placing a block in a bucket, stacking rings, or completing a simple game whenever a sound is heard (Examples of games can be found here). Children who readily engage with a puzzle often demonstrate many of the same developmental skills required for successful CPA testing. If a child readily sits down, explores the puzzle, and begins placing pieces appropriately, they may be a good candidate for CPA. These behaviors suggest they can likely learn and perform a conditioned play task such as placing a block in a bucket or a peg in a board when a sound is heard. On the other hand, if the child shows little interest in the puzzle, struggles to engage with the activity, or is unable to participate meaningfully, beginning with VRA may be the more efficient approach. Visual Reinforcement Audiometry is often the preferred behavioral hearing test for younger children or children who are not yet developmentally ready for Conditioned Play Audiometry. During VRA testing, the child is conditioned to turn toward a sound source and receives visual reinforcement when a response is made. Beginning with VRA can often lead to more efficient testing when tabletop play tasks are not yet appropriate. Why This Matters Many clinicians have experienced spending valuable test time attempting CPA with a child who is not developmentally ready. By the time the decision is made to switch to VRA, attention and cooperation may already be declining. A simple puzzle can provide useful information within seconds and help guide the initial testing strategy. A Practical Clinical Tool This observation highlights an important principle in pediatric audiology: successful testing starts with meeting the child where they are developmentally. While no single activity can perfectly predict success with CPA or VRA, a quick puzzle assessment may help clinicians make a more informed decision and improve testing efficiency. As always, clinical judgment, developmental history, language abilities, and previous testing experiences should all be considered when selecting the most appropriate behavioral test method. Whether you are deciding between Conditioned Play Audiometry and Visual Reinforcement Audiometry, matching the testing method to the child's developmental abilities is often the key to obtaining reliable results. Simple observations, such as how a child interacts with a puzzle, can help guide the decision between CPA testing and VRA testing before the first stimulus is even presented.

All of the below videos and more are available to watch with your child before their test 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.

We’re excited to release our latest animated video that explains how pediatric speech testing is performed during a pediatric hearing test. Flex Dog demonstrating how a child would perform a speech hearing test In addition to traditional sound testing, audiologists often perform speech recognition testing using pictured words or age-appropriate speech materials. During this portion of the hearing test, the audiologist presents speech at different volume levels while asking the child to identify words or pictures they hear. This process helps determine: How well a child can hear speech How clearly spoken words are understood The softest level at which speech can be recognized Whether hearing difficulties may impact language development Our new animated video was created to help parents, caregivers, students, and clinicians better understand what happens during a pediatric hearing test and how pediatric speech testing is performed in an audiology visit. At Flex VRA, we’re committed to modernizing pediatric audiology tools through engaging, flexible, and easy-to-use VRA system technology designed for today’s clinical environments. If you'd like to access this video at a later date or download it for your own personal or professional use (free of charge), Youtube and download links are available at flexvra.com/flexdog.

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.

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 .