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0.5em;width:100%}.mw-parser-output .ambox .mbox-image{border:none;padding:2px 0 2px 0.5em;text-align:center}.mw-parser-output .ambox .mbox-imageright{border:none;padding:2px 0.5em 2px 0;text-align:center}.mw-parser-output .ambox .mbox-empty-cell{border:none;padding:0;width:1px}.mw-parser-output .ambox .mbox-image-div{width:52px}@media(min-width:720px){.mw-parser-output .ambox{margin:0 10%}}@media print{body.ns-0 .mw-parser-output .ambox{display:none!important}}</style><table class="box-Context plainlinks metadata ambox ambox-style ambox-Context" role="presentation"><tbody><tr><td class="mbox-image"><div class="mbox-image-div"><span typeof="mw:File"><span><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/f/f2/Edit-clear.svg/40px-Edit-clear.svg.png" decoding="async" width="40" height="40" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/f/f2/Edit-clear.svg/60px-Edit-clear.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/f/f2/Edit-clear.svg/80px-Edit-clear.svg.png 2x" data-file-width="48" data-file-height="48" /></span></span></div></td><td class="mbox-text"><div class="mbox-text-span">This article <b>provides insufficient context for those unfamiliar with the subject</b>.<span class="hide-when-compact"> Please help <a class="external text" href="https://en.wikipedia.org/w/index.php?title=Visual_reinforcement_audiometry&action=edit">improve the article</a> by <a href="/wiki/Wikipedia:Writing_better_articles#Provide_context_for_the_reader" title="Wikipedia:Writing better articles">providing more context for the reader</a>.</span> <span class="date-container"><i>(<span class="date">November 2014</span>)</i></span><span class="hide-when-compact"><i> (<small><a href="/wiki/Help:Maintenance_template_removal" title="Help:Maintenance template removal">Learn how and when to remove this message</a></small>)</i></span></div></td></tr></tbody></table> <p><b>Visual reinforcement audiometry</b> (<b>VRA</b>) is a key behavioural test for evaluating hearing in young children.<sup id="cite_ref-1" class="reference"><a href="#cite_note-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-2" class="reference"><a href="#cite_note-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> First introduced by Liden and Kankkunen in 1969, VRA is a good indicator of how responsive a child is to sound and speech and whether the child is developing awareness to sound as expected. Performed by an <a href="/wiki/Audiologist" class="mw-redirect" title="Audiologist">audiologist</a>, VRA is the preferred behavioral technique for children that are 6 – 24 months of age. Using classic operant conditioning, a stimulus is presented, which is followed by a 90 degree head turn from midline by the child, resulting in the child being reinforced with an animation.<sup id="cite_ref-3" class="reference"><a href="#cite_note-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> The child is typically seated in a high chair or on a parent's lap while facing forward. A loud speaker or two are situated at 45 or 90 degrees from the child. As the auditory stimulus is presented, the child will naturally search for the sound source, resulting in a head turn and reinforcement is followed shortly after through an animated toy or video next to the speaker where the auditory stimulus was presented.<sup id="cite_ref-4" class="reference"><a href="#cite_note-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> Using VRA, an <a href="/wiki/Audiologist" class="mw-redirect" title="Audiologist">audiologist</a> can obtain minimal hearing thresholds ranging in frequencies from 250 Hz - 8000 Hz using speakers, headphones, inserts earphones or through a bone conduction transducer and plot them on an <a href="/wiki/Audiogram" title="Audiogram">audiogram</a>. The results from the <a href="/wiki/Audiogram" title="Audiogram">audiogram</a>, paired with other objective measures such as a <a href="/wiki/Tympanogram" class="mw-redirect" title="Tympanogram">Tympanogram</a>, <a href="/wiki/Otoacoustic_emissions" class="mw-redirect" title="Otoacoustic emissions">Otoacoustic emissions</a> testing and/or <a href="/wiki/Auditory_Brainstem_Response" class="mw-redirect" title="Auditory Brainstem Response">Auditory Brainstem Response</a> testing can provide further insight into the child's auditory hearing status as well as future treatment plans if deemed necessary. VRA works well until about 18–24 months of age. Above 18–24 months of age, children need more interesting tasks to hold their attention, which is when audiologists introduce <a href="/wiki/Conditioned_Play_Audiometry" class="mw-redirect" title="Conditioned Play Audiometry">Conditioned Play Audiometry</a>. </p><p>Conditioned orientation reflex (COR) is a variant of VRA where more than one sound is used. The key difference between COR and VRA is that COR is dependent on the child to have the ability to detect and localize the sound, whereas VRA only requires the child to have a head turn response after the auditory stimulus is presented, they do not need to accurately localize the sound as well. </p> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Visual_reinforcement_audiometry&action=edit&section=1" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap"><ol class="references"> <li id="cite_note-1"><span class="mw-cite-backlink"><b><a href="#cite_ref-1">^</a></b></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite class="citation web cs1"><a rel="nofollow" class="external text" href="http://www.chadkids.org/audiology/audiology_hearing_tests.html">"Hearing Tests for Children | Pediatric Audiology | Children's Hospital at Dartmouth-Hitchcock (CHaD)"</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Hearing+Tests+for+Children+%26%23124%3B+Pediatric+Audiology+%26%23124%3B+Children%27s+Hospital+at+Dartmouth-Hitchcock+%28CHaD%29&rft_id=http%3A%2F%2Fwww.chadkids.org%2Faudiology%2Faudiology_hearing_tests.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+reinforcement+audiometry" class="Z3988"></span></span> </li> <li id="cite_note-2"><span class="mw-cite-backlink"><b><a href="#cite_ref-2">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://web.archive.org/web/20141129124704/http://www.womenandinfants.org/newbornhealth/upload/VRA-and-PLAY-AUDIOMETRY.pdf">"Archived copy"</a> <span class="cs1-format">(PDF)</span>. Archived from <a rel="nofollow" class="external text" href="http://www.womenandinfants.org/newbornhealth/upload/VRA-and-PLAY-AUDIOMETRY.pdf">the original</a> <span class="cs1-format">(PDF)</span> on 2014-11-29<span class="reference-accessdate">. Retrieved <span class="nowrap">2014-11-16</span></span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Archived+copy&rft_id=http%3A%2F%2Fwww.womenandinfants.org%2Fnewbornhealth%2Fupload%2FVRA-and-PLAY-AUDIOMETRY.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+reinforcement+audiometry" class="Z3988"></span><span class="cs1-maint citation-comment"><code class="cs1-code">{{<a href="/wiki/Template:Cite_web" title="Template:Cite web">cite web</a>}}</code>: CS1 maint: archived copy as title (<a href="/wiki/Category:CS1_maint:_archived_copy_as_title" title="Category:CS1 maint: archived copy as title">link</a>)</span></span> </li> <li id="cite_note-3"><span class="mw-cite-backlink"><b><a href="#cite_ref-3">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFSinnottPisoniAslin1983" class="citation journal cs1">Sinnott, Joan M.; Pisoni, David B.; Aslin, Richard N. (January 1983). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3523360">"A comparison of pure tone auditory thresholds in human infants and adults"</a>. <i>Infant Behavior and Development</i>. <b>6</b> (1): 3–17. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2FS0163-6383%2883%2980003-4">10.1016/S0163-6383(83)80003-4</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3523360">3523360</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/23255836">23255836</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Infant+Behavior+and+Development&rft.atitle=A+comparison+of+pure+tone+auditory+thresholds+in+human+infants+and+adults&rft.volume=6&rft.issue=1&rft.pages=3-17&rft.date=1983-01&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3523360%23id-name%3DPMC&rft_id=info%3Apmid%2F23255836&rft_id=info%3Adoi%2F10.1016%2FS0163-6383%2883%2980003-4&rft.aulast=Sinnott&rft.aufirst=Joan+M.&rft.au=Pisoni%2C+David+B.&rft.au=Aslin%2C+Richard+N.&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3523360&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVisual+reinforcement+audiometry" class="Z3988"></span></span> </li> <li id="cite_note-4"><span class="mw-cite-backlink"><b><a href="#cite_ref-4">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFSabo1999" class="citation journal cs1">Sabo, Diane (June 1999). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172161">"The audio logic Assessment of the Young Pediatric Patient: The Clinic"</a>. <i>Trends in Hearing</i>. <b>4</b> (2): 51–60. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1177%2F108471389900400205">10.1177/108471389900400205</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172161">4172161</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/25425888">25425888</a>.</cite><span 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href="/wiki/Template:Hearing_and_balance" title="Template:Hearing and balance"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Hearing_and_balance" title="Template talk:Hearing and balance"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Hearing_and_balance" title="Special:EditPage/Template:Hearing and balance"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Disorders_of_hearing_and_balance" style="font-size:114%;margin:0 4em">Disorders of <a href="/wiki/Hearing" title="Hearing">hearing</a> and <a href="/wiki/Balance_(ability)" title="Balance (ability)">balance</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Hearing" title="Hearing">Hearing</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Symptoms</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hearing_loss" title="Hearing loss">Hearing loss</a></li> <li>Excessive response <ul><li><a href="/wiki/Tinnitus" title="Tinnitus">Tinnitus</a></li> <li><a href="/wiki/Hyperacusis" title="Hyperacusis">Hyperacusis</a></li> <li><a href="/wiki/Phonophobia" title="Phonophobia">Phonophobia</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Disease</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Loss" scope="row" class="navbox-group" style="width:1%">Loss</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Conductive_hearing_loss" title="Conductive hearing loss">Conductive hearing loss</a> <ul><li><a href="/wiki/Otosclerosis" title="Otosclerosis">Otosclerosis</a></li> <li><a href="/wiki/Superior_canal_dehiscence_syndrome" title="Superior canal dehiscence syndrome">Superior canal dehiscence</a></li></ul></li> <li><a href="/wiki/Sensorineural_hearing_loss" title="Sensorineural hearing loss">Sensorineural hearing loss</a> <ul><li><a href="/wiki/Presbycusis" title="Presbycusis">Presbycusis</a></li> <li><a href="/wiki/Cortical_deafness" title="Cortical deafness">Cortical deafness</a></li></ul></li> <li><a href="/wiki/Nonsyndromic_deafness" title="Nonsyndromic deafness">Nonsyndromic deafness</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Deafblindness" title="Deafblindness">Deafblindness</a> <ul><li><a href="/wiki/Wolfram_syndrome" title="Wolfram syndrome">Wolfram syndrome</a></li> <li><a href="/wiki/Usher_syndrome" title="Usher syndrome">Usher syndrome</a></li></ul></li> <li><a href="/wiki/Auditory_processing_disorder" title="Auditory processing disorder">Auditory processing disorder</a></li> <li><a href="/wiki/Spatial_hearing_loss" title="Spatial hearing loss">Spatial hearing loss</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Tests</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hearing_test" title="Hearing test">Hearing test</a></li> <li><a href="/wiki/Rinne_test" title="Rinne test">Rinne test</a></li> <li><a href="/wiki/Tone_decay_test" title="Tone decay test">Tone decay test</a></li> <li><a href="/wiki/Weber_test" title="Weber test">Weber test</a></li> <li><a href="/wiki/Audiometry" title="Audiometry">Audiometry</a> <ul><li><a href="/wiki/Pure_tone_audiometry" class="mw-redirect" title="Pure tone audiometry">pure tone</a></li> <li><a class="mw-selflink selflink">visual reinforcement</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Balance_(ability)" title="Balance (ability)">Balance</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Symptoms</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Vertigo" title="Vertigo">Vertigo</a></li> <li><a href="/wiki/Nystagmus" title="Nystagmus">nystagmus</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Disease</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Balance_disorder" title="Balance disorder">Balance disorder</a></li> <li>Peripheral <ul><li><a href="/wiki/M%C3%A9ni%C3%A8re%27s_disease" title="Ménière's disease">Ménière's disease</a></li> <li><a href="/wiki/Benign_paroxysmal_positional_vertigo" title="Benign paroxysmal positional vertigo">Benign paroxysmal positional vertigo</a></li> <li><a href="/wiki/Labyrinthitis" title="Labyrinthitis">Labyrinthitis</a></li> <li><a href="/wiki/Labyrinthine_fistula" title="Labyrinthine fistula">Labyrinthine fistula</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Tests</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Dix%E2%80%93Hallpike_test" title="Dix–Hallpike test">Dix–Hallpike test</a></li> <li><a href="/wiki/Unterberger_test" title="Unterberger test">Unterberger test</a></li> <li><a href="/wiki/Romberg%27s_test" title="Romberg's test">Romberg's test</a></li> <li><a href="/wiki/Vestibulo%E2%80%93ocular_reflex" title="Vestibulo–ocular reflex">Vestibulo–ocular reflex</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table></div>    </div><noscript><img src="https://login.wikimedia.org/wiki/Special:CentralAutoLogin/start?type=1x1&useformat=desktop" alt="" width="1" height="1" style="border: none; position: absolute;"></noscript> <div class="printfooter" data-nosnippet="">Retrieved from "<a dir="ltr" href="https://en.wikipedia.org/w/index.php?title=Visual_reinforcement_audiometry&oldid=1000359267">https://en.wikipedia.org/w/index.php?title=Visual_reinforcement_audiometry&oldid=1000359267</a>"</div></div> <div id="catlinks" class="catlinks" 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