Presentation Notes (Cognitive Rehabilitation for Vocational Training of Primarily Ketamine

Presentation Notes (Cognitive Rehabilitation for Vocational Training of Primarily Ketamine Users: A Randomized Control Trial)

• Goal & objectives
• Brief literature review and conceptualization
• Research questions and methodology
• Summary of key results

• Discussion & conclusions

• To improve the cognitive function and vocational outcomes of youngsters who were primarily ketamine users through vocational training systems (VTS).

• To investigate if there was any significant differences among two treatment groups (virtual reality-based group /VRG, tutor-administered group/TAG) and a wait-listing control group/CG) in terms of cognitive performance, vocational outcomes and work related self-efficacy, during pre-test, post-test, 3-month and 6-month follow up.

• Ketamine was the top one psychotropic drug taken by secondary students (Li, Tam & Tam, 2010; Tsui et al., 2011).

• Cognitive problems have also been documented (Amann, 2009; Morgan 2006; Stewart 2001; Rowland et al., 2005)

• Cognitive functioning was one of the significant predictors of vocational outcomes (Diller, Copeland & Jansen, 2008; Hougue, 2010)

• Minimizing the effect on this cognitive factor was thus hypothesized to improve work rehabilitation outcomes and ultimately employability

• VR can be defined as “...a way for humans to visualize, manipulate, and interact with computers and extremely complex data.” (Aukstakalnis and Blatner, 1992).

• An advanced form of computer interface that allowed the user to “interact” with and become“immersed”within a computer generated environment.

• VR training in CR can be explained by

• EE is referred to as simulation from a complex environment

• CL refers to the learning that takes place when day-to-day problems in real-life situations are encountered (Gordon, Cantor, Ashman and Brown, 2006).

• Did VTS enhance cognitive performance in ketamine users?

• Did VTS enhance vocational outcomes in people with schizophrenia?

• Were there any significant differences between the three groups (virtual reality-based training group: VRG; tutor-administered group: TAG and control group: CG)

• After completion of the 10-session vocational-based cognitive training, the VRG would show more improvements than the TAG and that there would be no significant improvements in the CG in the following aspects:

• Use of ketamine with frequency at least twice per month over 6 months within the last 2 years and no other illicit psychotropic drug used up to once per month within the last 2 year.
• Chinese ethnicity of both genders
• Age between 15 and 30
• Under treatment and rehabilitation following abstinence
• Negative results obtained from the rapid urinary test of Ketamine
• Able and willing to provide informed consent to participate in the study

• Mental retardation
• Neurological disorder
• Physical handicaps, for example blindness
• Significant medical diseases requiring regular medication
• Poly-drug group (use ketamine with other illicit psychotropic drug such as Ectascy or methamphetamine, with frequency at least twice per month over 6 months within the last 2 years)

• The training module is divided into 3 levels:

• According Shapiro-Wilk Test of normality, the criteria for normality was not met in most of the dependent variables.

• Non-parametric alternative tests were used

• TONI3 (nonverbal intelligence)

• DVT (attention)

• RBMT (memory)

• WCST (executive functioning)

• Onsite Test (sales-related activities)

• Self-efficacy (sales-related activities)

• All the subjects at 3-month follow up were unemployed. And there were no statistically significant difference in employment status at 6-month follow up across the three groups respectively ("2= 5.875; p=0.209) though VRG had got more open employment (VRG=31.8%) than TAG (16.7%) and CG group (13.6%); part-time employment (VRG=18.2%; TAG= 0%; CG=0%), lower percentage in unemployment (VRG=50%; TAG=83.3%; CG=86.4%).

• The canonical correlation between cognitive function and work status for those successful follow ups at the 3-month and 6-month follow-ups were 0.363 and 0.477, respectively.

• When cognitive functioning was used to predict work status, the overall classification rates were 65.3% (at the 3-month follow-up) and 54.7% (at the 6-month follow-up).

1. VRG showed significant improvement in cognitive functions in respect of attention and memory across time, but not in the TAG and the CG.

• Due to greater spatial processing demand with virtual environment that could induce activity in posterior hippocampus and parahippocampal cortex (Rose et al., 2005; Lee & Rudebeck, 2010).
• Capacity of working memory may be enhanced because of the activation of the corresponding brain regions (Lee & Rudebeck, 2010; Baumann, et. al., 2003).

• Improvement in self-efficacy in the TAG was greater than that of the VRG.

• When people valued the tasks as being meaningful and useful for reaching their future goals, they were more intrinsically motivated to learn and possibly benefit more from the learning task (Expectancy-value theory, Choi et al, 2010, Fishbein and Ajzen, 1975)
• Learning, achievement performance and task engagement to perceptions of self-efficacy and task value were linked (Eccles and Wigfield, 2002).
• Perceptions of self-competency (self-efficacy), task difficulty and the relative value of a task to an individual can affect a person’s choice of whether or not to engage in a learning activity or task.

• The subjects were required to complete a work performance test in a boutique. They had to perform tasks that were very similar to those that they performed in the training scenarios.

• It was assumed that any improvements in work performance would be mainly due to the transfer effects of VR training or tutor training.

• Both the VRG and TAG showed significant improvements in the on-site tests compared to the CG, these results indicate that both treatment groups showed good generalization effects.

1. The use of VR technology in cognitive remediation showed initial promising results to improve the cognitive function, self-efficacy and work skills for ketamine users.
2. Potential use by service provider to ketamine users.

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