The power of magic is being used to help children and young people with hemiplegia recover motor function, boost confidence and live more independently.
Hemiplegia is a relatively rare condition that causes weakness or paralysis in one side of the body. In the majority of cases, the condition is present from birth.
Traditional methods of therapy rely on repetitive exercises that often fail to keep young people engaged, but interweaving arts such as magic into therapy could be the way forward.
The London-based not-for-profit social enterprise, Breathe Arts Health Research, is the only organisation in the UK delivering group-based magic therapy.
The Breathe Magic Intensive Therapy programme was established in 2010 and has since established itself as a leader in the arts and health space.
It builds on the theories of the American neuroscientist, Dr Andrew Gordon, who developed a form of therapy known as hand-arm bimanual intensive training (HABIT) in the mid-2000s.
Close-up magic embeds the principles of bimanual intensive therapy which aim to promote two-handed actions and interplays through various activities. In the case of Breathe’s Magic Intensive Therapy programme, these involve close-up magic tricks.
With a yearly cohort of up to 16 young people, the Breathe Magic Therapy programme continues to operate within a niche, but awareness is growing.
As NHS services look to put greater emphasis on social prescribing, art therapy programmes like those delivered by Breathe could begin to play a greater role in healthcare services.
Last year, Breathe Arts Health Research delivered training for the World Health Organisation, sharing their expertise and experience in design, delivery and research, marking a significant milestone for arts in health.
Occupational therapist and Breathe Magic co-clinical lead, Rebecca Johnson spoke to NR Times about the holistic benefits of magic therapy, the growing body of research backing the method and how arts therapies could begin to play a more significant role in rehabilitation.
NR Times: What is it about magic that benefits patients with hemiplegia?
Rebecca Johnson: When you look at magic as a therapeutic delivery method, magic works on both communication and performance skills. With that, you need to build on your self-reflection, your self-confidence and your ability to communicate.
When you’re learning close-up magic skills, you also need the cognitive processing of information sequencing, short-term and long-term memory, and visual perceptual skills. There are a lot of skills in magic on top of the bimanual hand skills.
Magic is quite therapeutic. It’s repetitive, you have to learn it and you can build your confidence by getting lost in the process of learning the magic. You can give your child a hobby or leisure interest that naturally delivers that therapy, promotes their hand skills and also helps them connect with other children and young people.
What does recent research say about magic therapy?
There is so much research coming out on the benefits of upper limb motor learning programmes. I think the big shift in the last 15 years is that originally people thought constraint-induced movement therapy [therapy involving constraining movements of the less-affected arm] was the best way to develop hand skills.
Whereas actually, the bimanual intensive therapy world has proven it’s just as robust and we get just as good results, if not better transference into daily activities of using two hands.
There have been lots of studies on other magic theme programmes, showing that bimanual intensive therapy really does work and when combined with goal-oriented therapy with children and young children with hemiplegia can have really significant gains in a short period of time.
Developing programmes that integrate intensive therapy and motivational aspects are highly beneficial to ensure mechanisms for change. That was key in cementing what we saw in clinical practice and taking it forward in the 2020 study [led by UCL associate professor and Breathe board member, Dr Daisy Fancourt].
It looked at the qualitative information that families were sharing and quantified that we are seeing a change in self-esteem on top of our research from 2013 that said children are seeing a change in their upper limbs.
Research identified that 71 per cent of young people with physical disabilities experience social difficulties. The 2020 study from Dr Daisy Fancourt showed how Breathe’s magic Intensive therapy model addresses these challenges. Can you explain how?
Dr Fancourt’s study looked at quality of life changes as well as parental perceived changes over time and broke down what it was about the Breathe magic intensive therapy programme in particular that caused that. It [found] that a large quantity of these children and young people have psychosocial challenges.
We were finding that we were shaping the program to work on those communication skills and to allow them to have a safe environment to work alongside peers, explore and achieve goals, and start to think about much more goal-oriented therapy.
It is not just the magic, it is the mechanism for change and the whole environment and creation of a self-supporting community that we’re creating for them. We’ve noticed a lot of changes that I think other intensive therapy programmes can’t always offer. One-to-one therapy programmes can’t always scaffold that dynamic social interaction amongst peers.
We wanted to look at more of the changes in how the children were perceiving themselves changing as well. The study really broke down our programme and helped us reflect on that.
How have these findings influenced the development of the Breathe magic programme?
I think it’s cemented what we’ve seen in our programmes. Breathe magic is something magical because all the moving components come together to create something that’s really unique and special. That is actually really hard to quantify in research terms because there are so many variables and different elements of the programme have more of a powerful change effect on differing individuals.
For children and young people with hemiplegia over the period since the programme started, the aetiology and the mechanisms of brain injury in the children have changed, and medical care advances have meant the children have changed in their physical presentation. The demands of schooling for children and young people across the board have also changed.
Our program has started to shape itself to that. In 2020 we published the study on the psychosocial benefits of the programme specifically because what families noticed and what we noticed as a team was that we were seeing huge increases in confidence, self-belief, self-esteem and independence in daily tasks.
The children and young people on the programme want to go out and make friends and they’re presenting as more empowered
How widely available is magic therapy right now?
Intensive motor interventions and goal-oriented therapy are still very inconsistent across the UK, NHS services and other charitable services. It’s very driven by the local services’ knowledge, but even when you break it down, they’re not always delivering motor learning-based intensive therapy models as the literature advocates
The NICE guidelines advocate intensive upper limb therapy models and goal-oriented models, whether that’s through themed camps or through other models of delivering therapy, but they’re just not doing it because of either financial restrictions, staffing restrictions or general NHS challenges.
Across the UK, as far as we know, we’re the only ones delivering a peer group-based therapy model using magic as a delivery theme. There are other intensive therapy modules that local services are doing typically on a one-to-one basis or for under children age seven, but they’re not on a mass scale.
So, it is still hit and miss what children are having access to. We’re proud that we are a not-for-profit organisation that is trying to promote that this is out there for these children and young people at that pivotal age of seven to 19.
This is when they want to be getting dressed in their tie for school or learning to prepare themselves a snack before they go off to university. I think the timing of what we offer is really helpful.
Has awareness of magic therapy grown in recent years?
I think there has definitely been more growth and more people are understanding what bimanual intensive therapy is. Parents are more actively seeking out alternative therapy models outside of NHS statutory provision because everyone knows how much the services are struggling to meet that need.
I think parents are starting to become more empowered to find us and to think about how therapy needs to become part of a child’s life. They can’t just keep repeatedly going to physiotherapy or occupational therapy sessions and picking up a ball ten times. It has got to be something much more embedded in their life.
I think the individuals who are coming to the camp are acting as really good advocates and say ‘look, this is what it meant for me, this is how it supported our family and actually, you can get more out of it than just your hand skills’.
How does Breathe work with the NHS and what funding is available for the families of participants on Breathe’s magic programme?
We have really good relationships with [NHS services]. We offer staff training and work in partnership. For example, in 2018, there was a partnership with Gloucestershire CCG where they funded children and young people.
Breathe occupational therapists worked with the local NHS occupational therapists to identify suitable candidates within the area, which developed their therapists’ skills in assessing and identifying suitable future candidates.
For families, there are several funding options. There are individual funding requests through the NHS, however, these are becoming more difficult to secure post-COVID. We have also set up a charitable arm that can offer sponsorship.
Some families choose to access other funds. For example, there is short breaks funding that some families can access and we support them to fundraise or identify other local funding sources.
There are lots of different ways that we work year-round to make sure that the program is as accessible as possible for families.
What does the future look like for magic therapy and arts in health in general?
From a therapist’s perspective, the postcode lottery issue is hard to [overcome], but I think the arts in the health world has a massive role to play in delivering healthcare services.
It’s an enabling model. It’s not a disabling medical model. Arts in Health have such power and therapeutic benefit, while also helping people with additional needs – whether it’s mental health needs or physical needs – into the community.
For us, there’s a wider reach to the Breathe magic intensive therapy programme on empowering people to consider different ways of doing things and thinking outside the box when delivering medical interventions.
