Podcast
Questions and Answers
Reinforcers should be located within a moveable cabinet obscured by smoked ______ screen.
Reinforcers should be located within a moveable cabinet obscured by smoked ______ screen.
Perspex
Loudspeakers shall be positioned at ______ relative to the test position to each side.
Loudspeakers shall be positioned at ______ relative to the test position to each side.
90° azimuth
Reinforcers should be located approximately level with the child’s head at a distance of ______ m.
Reinforcers should be located approximately level with the child’s head at a distance of ______ m.
1−2
A younger infant (age 5–12 months) should be seated on the parent’s knee, gently supported at the ______ and facing forward.
A younger infant (age 5–12 months) should be seated on the parent’s knee, gently supported at the ______ and facing forward.
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It is recommended to have at least two independently controllable toys provided for each side of testing to vary the ______.
It is recommended to have at least two independently controllable toys provided for each side of testing to vary the ______.
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The infant may be placed in a secure ‘high ______’ for proper positioning during assessment.
The infant may be placed in a secure ‘high ______’ for proper positioning during assessment.
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Tester 2 is positioned on the opposite side of the table facing the child, with a supply of suitable ______ close at hand.
Tester 2 is positioned on the opposite side of the table facing the child, with a supply of suitable ______ close at hand.
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Good two-way ______ between testers is an essential requirement for the test.
Good two-way ______ between testers is an essential requirement for the test.
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When using soundfield stimuli, hearing protection (muffs and/or ______) shall be available for parents and observers.
When using soundfield stimuli, hearing protection (muffs and/or ______) shall be available for parents and observers.
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To keep the child's interest, it is recommended to vary the stimulus type with options like warble tones and narrow band ______.
To keep the child's interest, it is recommended to vary the stimulus type with options like warble tones and narrow band ______.
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Study Notes
VRA (Visual Reinforcement Audiometry) Overview
- Target age: 6-36 months.
- Uses illuminated and animated toys as reinforcers.
Reinforcer Setup
- Reinforcers should be stored in a moveable cabinet with a smoked Perspex screen, preventing visibility until illuminated.
- A switch in the observation room controls toy animation and brightness.
- At least two toys should be independently controllable on each testing side to vary rewards.
Loudspeaker Positioning
- Loudspeakers positioned at a 90° angle from the child, 1 meter away, to ensure efficient sound delivery.
- Positioning at ear level enables better conditioning and accurate Minimum Response Level (MRL) establishment.
Reinforcer Positioning
- Reinforcers should ideally be at 90° azimuth for clearer head-turn elicitation.
- Placed 1-2 meters away and at the child’s head level, allowing for immediate association with sound stimuli.
- Proximity between loudspeaker and reinforcers enhances conditioning, but should not interfere with soundfield calibration.
Child and Tester Positioning
- Infants (5-12 months) seated on a parent’s knee or a secure high chair; older children on a low chair.
- The child must be positioned at a predetermined calibration point with an engaging activity table in front.
- Tester 2 sits opposite the child with suitable toys within reach for engagement.
Tester Positioning and Communication
- Tester 1 needs a clear view of both the child and Tester 2’s actions.
- Audiometer and reinforcer control box should be easily accessible for Tester 1.
- Effective two-way communication between testers is critical; use of discreet communication systems recommended.
Hearing Protection
- Hearing protection (muffs/plugs) shall be available for parents, observers, and testers.
- Essential for those suspecting severe or profound hearing loss to ensure safety during sound field stimuli.
Stimuli Types
- Varied stimuli should be used to maintain the child's interest, including warble tones and narrow band noise (NBN).
Stimulus Delivery Methods
- Supra-aural earphones can collapse the ear canal and are cumbersome, while insert earphones provide better direct sound delivery.
- Insert earphones reduce transcranial transmission of sound but are unsuitable for infected or obstructed ears.
Subject Preparation Procedures
- Parents and child sit in the testing room; history taking helps the child settle.
- Assess child’s alertness; adapt testing timing based on restlessness.
- Check developmental and visual status; ensure proper head control to respond.
Conditioning and Test Procedure
- Stage 1 (Conditioning): Noise + visual reinforcement prompts head turn (classical conditioning).
- Stage 2 (Testing): Noise prompts head turn or no reinforcement if the head doesn’t turn (operant conditioning).
- Conditioning trials may be needed for consistent head turns; begin with a 2-kHz stimulus at 60-70 dB HL.
Measurement of Minimum Response Levels
- Suitable table-top activities maintain the child’s forward position and alertness.
- Avoid cues linked to stimulus presentation to prevent false responses.
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Description
This quiz covers the principles and practices of Visual Reinforcement Audiometry (VRA) for children aged 6-36 months in the context of paediatric audiology. It focuses on observation techniques and the use of visual reinforcers like illuminated and animated toys. Participants will explore the setup and execution of VRA assessments.
