How to Choose a VRA System for a Pediatric Audiology Clinic

How to Choose a VRA System for a Pediatric Audiology Clinic

Choose a Visual Reinforcement Audiometry (VRA) system by starting with the children you test and the work your staff performs, not with a feature list. Compare reinforcer choice, room fit, control method, installation, service, the downtime plan, purchase terms, and the total installed cost. Ask every vendor what is included in the quote, whether the system requires a computer or software, and how easily the clinic can change reinforcement when a child’s interest shifts mid-session. This guide walks through each of those decisions in order and ends with a 12-question checklist and a cost worksheet you can take into any vendor conversation, whether or not that vendor is Pehratek.

Why start with your patient mix?

The right VRA system depends on who your clinic tests, not on the longest feature list. Write down the developmental ages you see, your weekly visit volume, and how many children arrive with complex needs. Those three facts determine how much reinforcer variety, control flexibility, and session speed the equipment has to deliver.

Professional guidance places VRA in a fairly narrow developmental window. The American Academy of Audiology’s clinical guidance document describes VRA for children of approximately 5 to 24 months developmental age, used within a test battery and cross-checked against physiologic measures (AAA, 2020). The 2025 British Society of Audiology recommended procedure extends the practical range to around 30 months developmental age for some children (BSA, 2025). If your caseload skews toward the edges of that window, or toward children with developmental disabilities, reinforcer flexibility matters more than any single specification.

That flexibility is not a luxury. In a records review of 131,783 children receiving hearing care, Bonino and colleagues reported that about 9.8 percent had a developmental disability, and that those children were roughly four times more likely than other children to leave the clinic without an ear-specific diagnostic assessment (Bonino, Mood, and Dietrich, 2025). One caution from the same literature: do not assign a reinforcer format to a diagnosis. The AAA guidance notes that what rewards one child may not reward another (AAA, 2020), so buy range, then let the audiologist choose child by child.

How much reinforcer choice does your clinic need?

More reinforcer variety generally supports more responses per session. A 2025 scoping review in the International Journal of Audiology, covering 59 studies, reported that varied and complex visual reinforcers, short reinforcer durations, and scheduled breaks were associated with better response behavior in VRA (Visram et al., 2025). Buy the widest reinforcement range your booth and budget allow.

On the toy versus video question, the evidence is genuinely mixed. The 2025 BSA recommended procedure states that reinforcers may include toys, video images, or rotating lights, and describes the comparative evidence on animated toys versus video as mixed and inconclusive, while noting that access to varied rewards increases responses (BSA, 2025). The three head-to-head studies behind that statement are summarized in our toy versus video reinforcement evidence review, so the practical takeaway here is short: format choice is a tie on the evidence, and variety within whatever format you buy is the safer bet.

As product facts, not clinical evidence: the Pehratek XM-5000 Series 5 3D Toy system offers over 3800 combination possibilities from 10 sounds, 3 movements, and 5 colored LED patterns, so the reinforcer a child sees can keep changing across a session. The Pehratek VDS-3000 Series 3 HD Video system uses a 15.6 inch screen. Centering units, available with either format, reorient the child’s attention back to a neutral starting position between presentations, which supports the clean midline-to-head-turn response the test method relies on.

Will the system fit your booth?

Measure before you order. The 2025 BSA recommended procedure places loudspeakers and reinforcers at about 90 degrees azimuth from the child, at least 1 meter away, and approximately level with the child’s head, with positions marked on the floor or ceiling so the sound-field calibration stays valid (BSA, 2025). A system that cannot mount at those positions in your booth will fight you daily.

Walk the room with a tape measure and answer five questions. Where do the speakers and reinforcers sit relative to the child’s chair or the caregiver’s lap? Are the sightlines clean at a seated child’s head height? What actually holds the units up, and does the vendor include the mounting hardware? Where do power and cables run so they stay out of reach of small hands? And will anything about the placement move the calibrated sound-field positions your audiometer setup depends on?

Pehratek’s HD Video units ship with articulating arm brackets included, which helps when the compliant mounting position is not a flat wall. If fit is uncertain, send the vendor a room drawing with dimensions before ordering, and expect a configuration recommendation back, not a shrug. Our VRA room setup guide covers booth layout in more depth.

IR, RF, or computer control: what changes in the booth?

The control method decides how many steps sit between the audiologist seeing a head turn and the reinforcer firing. Infrared (IR) remotes need line of sight to a receiver. RF remotes work omni-directionally, without pointing. Computer and app-driven systems put a screen, software, and sometimes a pairing step in the path. Count the clicks per response before you buy.

Keep two things separate in your evaluation: the clinical method and the control plumbing. The test method itself, including conditioning, timing, and reinforcement schedules, comes from published guidance such as the 2025 BSA recommended procedure, and any control scheme can execute it. What differs between systems is speed and failure modes: a blocked line-of-sight remote, software that needs an update mid-clinic, or a dropped wireless pairing adds seconds to every trial in a test window that habituation already limits.

As product facts: Pehratek systems offer both RF remotes, with four channels and omni-directional operation, and IR remotes for line-of-sight control, and the eight-button SMART remote controls all units in the system, including the centering units, from a single handset. For a fuller treatment of when each option fits, see our IR versus RF remote comparison.

What should you ask about installation and support?

Ask every vendor the same four questions, and get the answers in writing on the quote. Who mounts the units and routes the cables? Does the system require a computer, software, or a separate calibration step to run? What happens in the first week if a unit fails? How long is the warranty, and who ships replacement parts, how fast?

Installation is where quoted systems and installed systems drift apart. Some VRA equipment requires a computer, licensed software, and a technician visit before the first patient. Pehratek systems are plug and play: no computer, no software, and no calibration step is required to operate the reinforcers, so a clinic’s own staff or its regular booth technician can typically complete the physical installation. Confirm with any vendor whether your booth installer can do the work and what remote support exists if a question comes up on mounting day.

Then plan for the bad week before it happens. Ask whether parts are available separately, whether a loaner or advance replacement is offered, and what the warranty actually covers. Pehratek backs all orders with a 90 day trial and covers US orders with a 3 year warranty. Whatever vendor you choose, a written downtime plan matters more than any brochure page; our VRA reliability and downtime post explains what to require.

What does the full installed cost include?

A VRA quote is complete only when it covers the whole installed system, not the starting configuration. A typical two-sided installation involves left and right reinforcer units, an optional centering unit, remotes and receivers, mounts and brackets, cabling, installation labor, shipping, and any required computer or software. Ask for one line-itemized total before comparing vendors.

Use this worksheet against every quote you receive:

Line item What to confirm before you sign
Left and right reinforcer units Toy, video, or both; how many independent reinforcers per side
Centering unit Included, optional, or unavailable; controlled from the same remote
Remotes and receivers IR or RF; number of handsets; spares available
Mounts and brackets Included in the box or quoted separately; fit your booth walls
Cabling and power Cable lengths for your room; outlet locations; concealment
Computer and software Required or not; license term; who maintains updates
Installation labor Who performs it; whether your booth technician qualifies
Sound-field calibration Whether placement affects it; who verifies positions after install
Shipping and lead time Quoted to your door; delivery window
Warranty, trial, and parts Length and coverage; trial terms; replacement part availability

Two line items deserve special attention because they recur. Software licenses and computer refresh cycles turn a one-time purchase into an ongoing cost, and systems with no computer requirement avoid both. Replacement parts availability determines whether a failed unit means a part order or a whole-system conversation.

The 12-question VRA buying checklist

Bring these twelve questions to every vendor conversation. A vendor who answers all twelve in writing, whoever they are, has given you a real quote. A vendor who cannot has given you a starting price.

  1. What developmental ages and complexity of need make up our caseload, and does this system’s reinforcement range match them?
  2. Does the system offer toy reinforcement, video reinforcement, or both, and can the audiologist switch during a session?
  3. How many independently controllable reinforcers are available per side?
  4. Is a centering option available to bring the child’s gaze back to midline between presentations?
  5. Will the units mount at the positions our booth layout and sound-field calibration require?
  6. What ships in the box: brackets, cables, receivers, and power supplies, or are they extras?
  7. Does the system require a computer, software, or a calibration step to operate?
  8. Is the remote IR or RF, and how many button presses does one reinforced response take?
  9. Who performs the installation, and can our own booth technician do it with remote support?
  10. What are the warranty length, the trial terms, and the stated plan if a unit fails in clinic?
  11. Are replacement parts available separately, and what is the typical turnaround?
  12. What is the full line-itemized installed cost, including shipping, mounts, labor, and any required computer or software?

Frequently asked questions

What should a VRA system include?

At minimum, a complete system includes reinforcer units for the left and right test positions, a remote control and receiver, and the mounting hardware and cabling to install them at calibrated positions. Many clinics add a centering unit to return the child’s attention to midline. Confirm on the quote which of these are included and which are extras.

Do VRA systems need a computer?

Some do and some do not. Computer or app-controlled systems require a PC or tablet, software, and updates as part of the test workflow. Pehratek systems are plug and play and operate with no computer, no software, and no calibration step. Ask any vendor to state the requirement in writing, because it changes both the installed cost and the downtime risk.

Should we choose toy, video, or both?

The published comparisons of animated toy and video reinforcement are mixed, and current British Society of Audiology guidance describes the evidence as inconclusive while noting that reinforcer variety increases responses. Practically, that favors buying range over betting on one format: either format can work, both formats together cover more children, and the audiologist should choose per child rather than per diagnosis.

Can we buy through our current equipment supplier?

Ask the manufacturer directly. Pehratek is available with most national and local distributors. Pehratek also sells direct to clinics and hospitals, and school districts and other public-sector buyers can purchase through BuyBoard Contract 804-26. If your organization requires a specific procurement path, send that requirement with your inquiry so the quote is structured correctly the first time.

What warranty and trial terms are reasonable for VRA equipment?

Look for terms long enough to cover real clinical use, not just delivery. Pehratek offers a 90 day trial on all orders and a 3 year warranty on US orders. Whatever vendor you compare, get the warranty length, what it covers, the trial terms, and the replacement-parts plan in writing before purchase, because these terms differ widely between systems.

Ready to compare configurations? Pehratek has made VRA systems since 1979, and the fastest way to a confident decision is to send us your booth dimensions or a simple room drawing. Email info@pehratek.com for a configuration recommendation, or review the HD Video and 3D Toy VRA systems at pehratek.com. School districts and public-sector buyers can purchase through BuyBoard Contract 804-26.

This article is educational content for hearing-care and procurement professionals. It is not medical advice. Product availability and specifications can change; confirm current details at pehratek.com.

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