How to Set Up a VRA Room: Layout, Sightlines, and Placement

A Visual Reinforcement Audiometry (VRA) room works when the layout serves the test. A well-set room preserves the calibrated child and speaker positions, places reinforcers close to 90 degrees and near the child’s head height, gives the observing audiologist a clear frontal view of the child’s face, supports discreet communication between testers, limits distractions, and secures every unit against toppling. The exact layout always follows your room’s documented calibration, local protocol, and available space, so treat this guide as a planning framework, not a universal floor plan. Most placement specifics come from the British Society of Audiology’s 2025 recommended procedure for VRA (BSA, 2025).

Why does VRA room setup start with the calibrated test position?

Every VRA room plan starts from one fixed point: the spot where the child’s head sits during testing. The BSA recommended procedure states that the child’s head shall be at the point determined and marked during calibration of the sound field, so speakers, furniture, and equipment are planned around that mark, never the reverse (BSA, 2025).

Sound-field calibration assumes a specific geometry. The 2025 BSA procedure calls for a clearly documented layout, with marks on floors or ceilings so positions stay consistent, because any deviation may compromise calibration (BSA, 2025). Two practical rules follow. Involve your calibration or booth service provider before anyone moves a speaker, a highchair position, or large furniture in a calibrated room. And when adding equipment, plan mounting positions that stay out of the calibrated speaker paths. If a layout only works by shifting a calibrated element, that is a conversation with your calibration professional, not an installation-day decision.

Where should VRA speakers and reinforcers be placed?

The 2025 BSA recommended procedure places loudspeakers at 90 degrees azimuth to each side of the test position, at least one meter from the child’s ear, and roughly at head height. Reinforcers go as close to 90 degrees as possible and approximately level with the child’s head, adjacent to the speakers (BSA, 2025).

The 90 degree placement is not arbitrary. The BSA procedure notes that 90 degrees azimuth elicits the clearest head turn, the response the whole test depends on, and head-level placement means the child finds the reward with a lateral turn rather than craning up at a unit mounted high (BSA, 2025). Adjacent positioning does double duty: the procedure recommends it to aid conditioning to sound-field stimuli, and notes that co-location of speakers and rewards has been shown to improve response behavior. It also asks that facilities be able to move reinforcers closer to a child whose developmental or visual ability requires it, without disturbing loudspeaker calibration. That flexibility is worth designing in: the Pehratek HD Video system’s included articulating arm brackets exist for exactly this repositioning, and the Pehratek lines install plug and play, with no computer, no software, and no calibration of the reinforcer unit itself. For more on angles and heights, see our post on reinforcer placement.

How does the observing audiologist keep a clear view?

In the two-tester technique the BSA describes, Tester 1 controls stimuli and reinforcement while watching the child’s face, ideally from a separate observation room through a one-way window or on a monitor. The layout must give Tester 1 a clear frontal view while keeping Tester 1 invisible to the child (BSA, 2025).

The BSA procedure is specific: it is essential that Tester 1 is not visible to the child but can clearly view the child’s face, and gives no visual cues while observing responses (BSA, 2025). When planning, sit where Tester 1 will sit and check three things: full view of the child’s face at the calibrated position, controls reachable without leaning into view, and no glare on the window or monitor at testing light levels.

Control method shapes this sightline. A wired station fixes where Tester 1 sits; a wireless remote frees the position. Pehratek offers RF remotes, four channels and omni-directional, and IR remotes, which need line of sight to the units. The eight button SMART remote controls all units, including centering units, from one handset, so Tester 1 can hold position and observe. Layout is also an ergonomic question: an ASHA case study documented neck and shoulder discomfort from repeated reaching and unsupported postures at a poorly arranged VRA station (Trudel, 2014); see our post on VRA ergonomics.

Where do Tester 2, the parent, and other observers sit?

Tester 2 sits facing the child at a low table, keeping the child forward-facing and alert with quiet play. The parent typically holds or sits behind the child and is asked to stay quiet and not react to sounds. Other observers sit in the observation room or directly behind the parent and child (BSA, 2025).

The BSA procedure describes Tester 2 running a minimal table-top activity, chosen so the child’s gaze rests forward and slightly down, producing a clear head turn when the reinforcer activates (BSA, 2025). Plan a small, low table, a wipeable soft mat to keep play quiet, and storage that keeps toys out of the child’s sight.

Parent seating deserves deliberate planning. The BSA procedure asks parents to stay quiet and not respond to stimuli, warns both testers to watch for parental cueing, and cautions against letting the child lean back against the parent, which dulls alertness and transmits movement cues (BSA, 2025). The procedure also calls for direct, discreet communication from Tester 1 to Tester 2, for example a remote microphone system, so instructions never become an auditory distraction.

How do you reduce distractions and keep the child comfortable?

The test room should offer the child minimal distraction. The BSA procedure recommends dimmable lighting to make illuminated reinforcers stand out, adequate ventilation for comfort, quiet and cleanable play surfaces, and toys kept to the minimum needed to hold a midline, alert posture (BSA, 2025).

These are room-planning factors, not promises; no lighting scheme guarantees a better test. A recent scoping review of about 59 VRA studies found the strongest optimization evidence around reinforcer variety, short reinforcer durations, and well-timed breaks rather than room cosmetics (Visram et al., 2025). What planning does is remove avoidable problems. The BSA procedure supports fitting dimmers so an illuminated reinforcer can stand out, which it notes is particularly useful for children with visual impairment or complex additional needs, keeping the child’s forward view sparse, choosing quiet surfaces compatible with infection control, and confirming ventilation, because an uncomfortable child is less likely to respond well (BSA, 2025). When attention drifts between trials, Pehratek centering units reorient the patient’s attention back to a neutral starting position, so the next trial starts from midline.

Which mounts and cable paths work best in a VRA room?

Mount choice trades floor space against adjustability and service access. Wall mounts and flush installations save floor area, articulating arms add repositioning range, and tabletop stands move easily. Whatever the format, the BSA procedure requires reinforcer cabinets to be secured to wall or floor against toppling, with releasable fixings (BSA, 2025).

The comparison below reflects the mount formats Pehratek supplies; confirm options for your configuration before ordering.

Mount format	Footprint	Adjustment range	Service access	Watch for
Wall mount	None on floor	Fixed once installed	Good, at working height	Set height to the calibrated child position, not adult eye level
Articulating arm	None on floor	Repositions between sessions	Good, arm folds clear	Keep the swing path out of calibrated speaker paths
Tabletop stand	Uses table or shelf space	Moves easily	Easiest	Must still be secured against tipping and reaching hands
Flush or in-wall	None in room	Fixed	Requires rear or panel access	Plan booth wall penetrations with your booth vendor

Safety is the non-negotiable. The BSA procedure states that reinforcer cabinets and reward monitors shall be secured to the wall or floor to prevent injury should a cabinet topple, with fixings that release so a unit can still move closer for patients who need it (BSA, 2025). Plan cable paths at the same time: power at each mounted height, cables out of the child’s reach zone, no run crossing a door swing or speaker stand. Wireless control removes the control cable entirely, and the HD Video system’s 15.6 inch screen hangs on its included articulating arm brackets without a floor stand. Working inside a compact booth? See fitting VRA into a small sound booth.

What belongs on a VRA room pre-installation checklist?

Before installation day, confirm the room on paper: dimensions, calibration marks, speaker positions, reinforcer positions at left, right, and center, the Tester 1 sightline, power, control method, tester communication, mount fixings, cleaning, and service access. Then have a licensed audiologist and your booth or calibration technician approve the final diagram.

Work through the list in order:

1. Record room dimensions and the door swing. For reference, the BSA procedure describes a dedicated pediatric space with minimum floor dimensions of 6 m by 4 m plus a separate control room, while acknowledging single-room arrangements (BSA, 2025).
2. Locate and photograph the sound-field calibration marks and the documented child position.
3. Confirm speaker positions against the calibration record: 90 degrees azimuth, at least one meter away, near head height.
4. Mark reinforcer positions adjacent to each speaker, near the child’s head level, including any center unit.
5. Sit in the Tester 1 position and verify a clear, glare-free frontal view of the child’s face.
6. Place Tester 2’s low table and the parent chair, with observer seating behind or in the control room.
7. Confirm the tester communication method, for example a remote microphone system.
8. Choose the control method, wired, RF, or IR, and check line of sight if IR.
9. Verify power at each mounting position and route cables out of the child’s reach zone.
10. Specify mount fixings that secure every unit against toppling but release when a unit must move closer.
11. Check that surfaces and mats meet your infection control procedures.
12. Leave service access to every unit, then have a licensed audiologist and your booth or calibration technician sign off on the final diagram.

A top-down diagram built from this list is worth the hour it takes; note on the drawing that it is illustrative and the installed layout follows your room’s calibration. Planning a brand new space? Start with our new pediatric room checklist.

Frequently asked questions

Where should VRA reinforcers be placed?

The 2025 BSA recommended procedure places visual reinforcers as close to 90 degrees as possible from the child’s test position and approximately level with the child’s head, adjacent to the loudspeakers. This placement elicits the clearest head turn and supports conditioning to sound-field stimuli. Your room’s calibration and local protocol set the final positions.

How far should the speaker be from the child?

The BSA recommended procedure calls for at least one meter between the loudspeaker and the child’s ear, with speakers at 90 degrees azimuth to each side of the test position and near head height. The exact positions in any given room come from that room’s sound-field calibration, so confirm distances against the calibration record rather than measuring from scratch.

Does a VRA room need two rooms?

The BSA procedure prefers a two-room arrangement, with Tester 1 controlling stimuli and reinforcement from a separate observation room through a one-way window or a monitor view. It also acknowledges single-room arrangements. In one room, the layout must still keep Tester 1 out of the child’s view while preserving a clear frontal view of the child’s face.

Can a VRA system fit in a small booth?

Yes, in many cases. Wall mounts, articulating arm brackets, and flush installations keep the floor clear, and wireless remote control removes the need for a wired control run. The constraint is the calibrated geometry, not the equipment: the room still needs the documented child position, speaker distances, and a workable Tester 1 sightline.

Do I need to recalibrate after installing VRA equipment?

Pehratek VRA units install plug and play, with no computer, no software, and no calibration of the unit itself required. The sound field is a separate matter: if installation moved a speaker, changed the child’s test position, or placed a unit in a speaker path, involve your calibration or booth service provider before testing resumes. When mounting positions stay clear of the calibrated setup, most rooms need no change.

Planning a room, or several? Pehratek has been making VRA systems since 1979, and configuration help is part of the job. Send us your room count, a rough layout or dimensions, and your preferred control method, RF, IR, or wired, at info@pehratek.com, or browse the HD Video and 3D Toy VRA systems at pehratek.com. School districts and other public-sector buyers can purchase through BuyBoard.

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.

References

• British Society of Audiology. Recommended Procedure: Visual Reinforcement Audiometry. Version 1.2, June 2025. https://www.thebsa.org.uk/wp-content/uploads/2026/02/OD104-37-BSA-RP-Visual-Reinforcement-Audiometry-v1.2-June-2025-.pdf
• Trudel C. Ergonomic Case Study of an Audiologist Performing Visual Reinforcement Audiometry. ASHA. 2014. https://www.asha.org/articles/ergonomic-case-study-of-an-audiologist-performing-visual-reinforcement-audiometry/
• Visram AS, Jackson IR, Almufarrij I, Stone MA, Munro KJ. Optimisation of visual reinforcement audiometry: a scoping review. International Journal of Audiology. 2025;64(8):773-783. https://doi.org/10.1080/14992027.2024.2397716