Acoustic Reflexes

The Acoustic Reflexes element simulates acoustic reflex threshold (ART) testing. For each ear it can present two conditions — ipsilateral (probe and stimulus in the same ear) and contralateral (stimulus in the opposite ear) — across a set of frequencies. The instructor designs the true reflex picture: the threshold (in dB HL) at each frequency, and whether the reflex is Normal, Elevated, or Absent. During a submission the learner raises the stimulus level, runs each presentation, watches the waveform deflect, and records the reflex threshold (and, when asked, classifies it) for every condition and frequency.

Like every Theta element, it follows the same lifecycle: Design → Settings → Testing → Scoring → Report. If you've read another element page, this one will feel familiar.

Design

The Design tab is where you set the reflex values the learner must discover. The four conditions are laid out in two cards — Right ear (red) and Left ear (blue) — each holding an Ipsilateral and a Contralateral block.

Choosing a case: template vs fixed

Whether the element is a template or uses fixed values is decided on the element card (not on this tab). A badge at the top of the Design tab tells you which mode you're in:

Enabling conditions

A condition you don't want to test stays as a dashed "not tested" block — click Enable to add it. Only enabled conditions appear in the submission. Each enabled block has quick actions in its header:

• All Normal — sets every frequency to Normal at a representative threshold.
• All Absent — marks every frequency as no reflex (threshold cleared).
• Remove — turns the condition off again.

Setting reflex values

For each frequency you set three things:

• Threshold (dB HL) — in Fixed mode, type the exact reflex threshold (step 5). Leave it blank (shown as ABS) for no reflex. In Template mode this row instead shows the expected range that will be drawn at random.
• Classification — choose Normal, Elevated, or Absent. This is both the template category and the category that gets scored.
• Scored frequencies — a row of frequency chips deciding which frequencies count for this condition. All are on by default. A frequency you switch off is still presented to the learner, it just isn't graded — useful when you want the full picture explored but only part of it assessed.

Threshold and classification are independent, so they can disagree. If a typed threshold falls in a different category than the one you selected (for example, a 110 dB threshold tagged "Normal"), the cell is flagged with an amber warning. You can keep the override — the warning is informational.

If you remove every condition, a warning appears: learners would open the element to an empty console with nothing to do.

Waveform preview

Expand Waveform preview under any condition to see, per frequency, the overlaid traces that the learner will encounter at a spread of levels around the threshold. Levels are colored by loudness, and a ✓ marks the lowest level that elicits a reflex (the measured threshold). This is a quick sanity check that the case behaves the way you intend.

Settings

The Settings tab holds the case-wide configuration that isn't part of any one condition's values.

Tested frequencies

Toggle which frequencies are presented. Available frequencies are 500 Hz, 1 kHz, 2 kHz, and 4 kHz; all four are on by default. At least one frequency must stay enabled. Adding or removing a frequency re-aligns the threshold and classification values you've already set.

Threshold boundaries

These dB values define how a saved threshold maps to a classification, plus the testable level range:

A live summary box on this tab restates the resulting Normal, Elevated, and Absent ranges using your current values — it's computed from the same rule the designer and the template generator use, so what it says is what a threshold will actually be drawn from.

These five values have to stay in order (min below max, the Elevated cutoff above the min and at or below the Absent cutoff, the Absent cutoff at or below the max, and the start level inside the range). If an edit breaks that, an amber note lists what's wrong and the value snaps back into a legal range when you leave the field.

Quick-fill from a pattern

A helper that seeds all four conditions at once from a common clinical pattern. Pick a Pattern and an Affected ear (Right, Left, or Bilateral), then Apply pattern:

After applying, you can edit any individual value back on the Design tab.

Testing

In a submission the learner works one condition at a time. The console is pinned to the bottom of the screen, with a large waveform plot above it.

The console

The console is split into three sections:

• Setup — pick the Ear (Right / Left), the Mode (Ipsilateral / Contralateral), and the Frequency. Only configured conditions are selectable; the frequency dropdown shows a ✓ next to frequencies that are already complete.
• Level — the current stimulus level in dB HL, with −/+ buttons and a slider (5 dB steps, bounded by the min/max test levels).
• Actions — Run, Save, an optional Classify reflex group, and a clipboard button for a quick peek at saved values.

Recording a result

For each condition and frequency the workflow is:

1. Set the level and press Run. The waveform draws on — a deflection means a reflex was elicited at that level; a flat trace means none. The live trace is red for the right ear and blue for the left, and the previous couple of runs stay on screen (in gray) for comparison against the dashed rest line and the amber threshold criterion line.
2. Lower or raise the level and run again until you find the lowest level that elicits a reflex — that's the threshold.
3. Press Save to record the current level as the reflex threshold. If the reflex is absent, you won't save a level.
4. When the lesson asks for it, choose a classification: Normal, Elevated, Absent, or Could not test (CNT). Outside exam mode a Suggested label based on your saved level appears as a hint, but the choice is yours. In an exam the suggestion is hidden, along with the threshold-criterion line on the plot — judging the reflex is the thing being tested.
5. If the lesson doesn't ask for a classification, a No response button sits next to Save. Use it to state that there's no reflex at any level — leaving the frequency blank is not the same answer.

A status banner under the plot summarizes the current frequency (turning green when everything required is recorded, amber while something is still missing), with a Clear link to reset that frequency. Saving or classifying automatically advances to the next not-yet-complete frequency.

What's collected

The lesson's scoring settings decide what the learner is asked to record per condition:

• If only the threshold is scored or reported, the Classify reflex group is hidden — the learner saves a level, or presses No response.
• If only the classification is scored or reported, the Save button is hidden — the learner just labels the reflex.
• If neither is configured for a condition, the threshold is collected as a fallback measurement.

A Results Summary table sits below the plot, and a gear menu (top-right) toggles it on or off. Outside exam mode it can also reveal an Answer Key — True Results table for self-checking; in exam mode the answer key is never shown. Every Run / Save / Classify / Clear action is written to the submission's action trail, so the attempt shows up in Action Analysis and counts toward the elapsed time on the report.

Scoring

Scoring compares the learner's recorded values against the designed values. The Scoring tab gives an ear × condition grid plus a global tolerance.

Threshold tolerance

A single setting — ±5, ±10, or ±15 dB (default ±10) — applied to every condition. A saved threshold counts as correct when it lands within this range of the true threshold.

Per-condition scoring

For each of the four conditions you first toggle whether it's enabled (counts at all). When enabled, two fields each get a tri-state control:

Each field can be set to Score, Report only, or Off:

• Score — counts toward the submission score.
• Report only — shown in the report for reference but not scored. See Report-only fields for how this tri-state behaves across elements.
• Off — not collected, not scored, not shown.

A Sync Ears checkbox (on by default) mirrors any change you make to one ear onto the other, so symmetric cases are quick to set up. Within an enabled, scored field, the frequencies evaluated are the ones ticked under Scored frequencies for that condition on the Design tab.

What counts as an answer

A frequency the learner never touched is not an answer, even when the designed reflex is Absent — it's scored incorrect rather than credited for a blank cell. To get credit for a designed Absent, the learner has to say so: choose Absent, or press No response on a condition that doesn't collect a classification. Could not test (CNT) is a declined measurement, so it never scores correct on either field.

Report

In the generated PDF, the ART element renders per ear. Each ear shows its Ipsilateral and Contralateral sections as a table with one row per tested frequency and four columns:

So the report always shows both sides: what the reflexes were and what the learner recorded. The scoring table further down breaks the same data out field by field (threshold and classification separately) if you need the detail.

Conditions that weren't configured show No data, and an ear with nothing tested shows No ART data. A condition switched off on the Scoring tab is left out entirely, and an element with nothing scored or reported doesn't appear on the report at all.

The same design-vs-recorded comparison is available in-app without generating a PDF: open the scoring summary, where the ART row has a Show breakdown link and a View data tab.