Like the great Houdini himself, the magic therapists have pulled off the seemingly impossible. Not only have they solved the riddle of 
treating a debilitating condition in children; they’ve done so through the prism of tight healthcare budgets.

Their solution involves no expensive technology or drug trials and, since it is effective in group sessions, makes maximum use of human resources. Yet the results it achieves in young people are no illusion, as shown through extensive published and peer-reviewed evidence.

“It’s a very unusual job in that I have meetings with magic circle magicians,” says Rebecca Johnson, clinical lead at the social enterprise, Breathe Arts Health Research. 

“They show me different tricks and we carefully select the ones we need,” she adds.

Breathe has been pioneering magic therapy 
in the UK and elsewhere in recent years. It is largely used in the treatment of children with hemiplegia, a weakness or paralysis affecting one side of the body, caused by an injury to 
the brain.

Tying shoelaces can be tricky with the condition

Mastering puzzles like shoelaces, buttons and zips are the minor victories that set children 
on the path towards independence.

For some young people with hemiplegia, however, such fine motor skills present huge challenges. And failure to overcome them can cause far more damage than mere day-to-day frustration.

Poor self-esteem, a negative self-image and an aversion to social situations are just some of the spiralling associated problems. 

Rebecca says: “Children struggling with buttons and other such tasks are generally very reliant on their parents or others around them, like teaching assistants.

“Bimanual therapy is a process for learning two-handed skills independently through repetition of carefully chosen, goal-specific activities; or in our case, magic tricks. It’s active learning with an intensity and repetition.”

The concept behind the Breathe Magic Programme was conjured up by a team of occupational therapists and staff at the Guy’s and St Thomas’ charity, alongside David Owen, who leads a double life as a magician and QC.

The one-time Young Magician of the Year
was interested in magic’s communicative and meditative qualities. Perhaps his mother’s career as a nurse and father’s as a surgeon also instilled a desire to help people.

He took the idea for magic as therapy to various charities alongside fellow magician Richard McDougall. After numerous knockbacks, Breathe’s MD Yvonne Farquharson collaborated with them and others who had helped to develop it, and the programme was born.

Breathe Magic involves special occupational therapists working with magicians to teach tricks which develop hand and arm function, cognitive ability, self-confidence and independence.

Young mentors who previously completed the programme may also be on hand to help the children. The 78-hour programme is delivered over a fortnight, followed by monthly therapy sessions and clinical assessments.

As with other emerging therapies, practitioners face the challenge of evidencing its value – and banishing misconceptions.

Magic therapy can make day tasks easier

Rebecca says: “People initially say ‘ooh magic, that’s nice’, but we are actually embedded in research.

“We lead on very strong data which guides
our programmes. This means we’re always adapting, but also that our outcomes are dramatic. It’s a very tight, scientifically-based programme, that’s also very exciting.”

Breathe’s approach to hemiplegia is based
on one of NICE’s recommended protocols, hand-arm bimanual intensive training
(HABIT). Adding a twist of magic avoids certain weaknesses of HABIT, however.

When HABIT 
is applied through the use of toys or games, for example, children may over-rely on their strong hand.

Only verbal cues from the therapist will remind them to revert to their assisting hand. This may lead to frustration.

With magic, certain tricks will not work unless each
hand plays its important part. Breathe estimates that at least 65% of young people with hemiplegia could benefit from intensive motor therapy. Around 44% of young hemiplegics also suffer from psychosocial morbidity, the organisation says.

Yet currently there is no NHS-wide access to intensive bimanual motor therapy. This is despite it being advocated in a recent systematic review (Novak et al., 2013) and in NICE guidelines (2012).

Research shows that Breathe’s approach leads to better and more spontaneous hand use, and greater independence in bimanual activities.

Speed in the grasp and release of items has been shown to quicken by over two minutes across various tasks. Such improvements are maintained at three-month follow-ups.

In one study, the affected hand was reported to be used in 72% of bimanual activities before a magic therapy camp.

This progressed to 93% after the camp, decreasing to 86% at follow- up. Neither age nor severity of impairment influenced progress.

A separate, independent study in 2015 provided the first evidence of brain plasticity in hemiplegia after bimanual intervention. Neuroimaging showed a 26.14% increase in the level of activation in the affected hemisphere following the intervention – and a 34.75% rise at follow-up. There are also several less scientifically tangible – but no less valuable – improvements too.

“We see a lot of really positive transference as well,” says Rebecca. “Parents have reported that their children are more con dent, their problem solving has improved and they are approaching everything with new vigour.”

Magic therapy is such a powerful potion
against hemiplegia for a number of reasons. Firstly, it makes any apathy children may feel towards high-intensity practice disappear.

Without the thrill of magic, it can be notoriously hard to motivate young people to engage in repetitive tasks such as those involved in HABIT.

Their determination is driven by clear goals – to not only learn impressive new tricks to show their friends, but to also perform them on stage at the end of their sessions.

The sleight of hand on the part of the therapists is that participants also vitally improve their motor functions and, in many cases, gain a more positive self-image.

Breathe Magic has proven success with severe hemiplegia cases, refuting previous clinical claims that HABIT is only applicable to 
mild cases. It also works in group settings – which should make it an attractive proposition to decision-makers in the cash-strapped
 NHS.

Reducing the amount of care needed 
for individual children also provides indirect resource savings. To date in the UK, Breathe’s magic therapy has been commissioned by 
a handful of CCGs, including Lambeth and Wandsworth, with which the group has service level agreements. Breathe now aims to spread its reach elsewhere in the UK.

“Our aim is to make magic therapy more accessible, less of a new, innovative thing and put it firmly into the mainstream,” says Rebecca.

Efforts are also underway to apply magic therapy to other conditions beyond hemiplegia. Pilot studies, including one at Great Ormond Street Hospital, have explored the benefits of Breathe Magic to children’s mental health. Its use in relation to stroke in adults is also being investigated.

With more research currently underway, Breathe may have yet more up its sleeve, as Rebecca says: “We’re on a mission 
to spread the word about how powerful magic therapy can be for people that haven’t had access to the programme.”