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.
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.
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.”
“I had to recover from life-saving neuro surgery during lockdown”
Having had a subarachnoid haemorrhage the day after full lockdown was imposed on the UK in March, Lee Atkinson faced the trauma of a lengthy recovery without seeing his family. Here, he shares his story of how he coped.
For millions of people across the country, the onset of the COVID-19 pandemic marked the start of a hugely challenging period. But for Lee Atkinson, that challenge was one of survival, after he experienced a subarachnoid haemorrhage the day after the UK went into lockdown on March 23.
Having felt unwell for about three weeks, Lee, a car garage manager, was seeking medical attention for his developing situation.
“He had been coming home from work feeling really tired and he’d had a few headaches,” recalls his wife, Petra.
“He went to the GP and they thought it was down to high blood pressure. He was even seen at the hospital for a scan and then he went back to work.
“But then I came home one morning after a night shift and found him collapsed in the bathroom.”
Lee, 47, was rushed to the Royal Preston Hospital, and underwent life-saving surgery after it was established he had experienced a haemorrhage. In the aftermath of his operation, Lee realised he had become partially paralysed and was struggling to communicate.
As the pandemic escalated, Lee was transferred out of hospital and into the Sue Ryder Neurological Care Centre Lancashire. The purpose-built centre had only recently opened its doors after an 18-month construction project to bring it to life, and fast-tracked its ability to welcome patients to help relieve pressure on the hospital and other local partners.
“I went into Sue Ryder on a stretcher on April 30, and at that point I was paralysed on my left hand side and my speech wasn’t great. I couldn’t use my left arm,” remembers Lee, a father of two.
“But over a period of time, they helped me get back on my feet, but they were very cautious with me.
“I had a set timetable over the week so everything was planned for me. It was really good for me to have that structure because I was in a bad place to start with. I was quite depressed but they really helped me through that.
“I was wanting to push to walk and they were being cautious because I had a period where I still had a hole in my skull from the operation. They leave it like that for about three months and you have to wear a helmet.
“I still have that helmet – all the Sue Ryder staff signed it for me. We really appreciate what they did. I was really lucky to be moved there.”
Due to the stringent restrictions on visiting imposed as a result of COVID-19, Petra was only allowed to visit her husband once in hospital, and with the pandemic escalating quickly, the opportunity for in-person visits was not possible at Sue Ryder, to protect the centre and its residents from the deadly virus.
However, keen to offer families the opportunity to be together however possible, visiting ‘of sorts’ was enabled by the team.
“After a week or so they let me and the kids go and visit him through the window, just to be able to do that meant a lot to us because we had not seen him for so long,” says Petra.
“Then, after a little while, Lee got better with his phone and was able to Facetime us. The staff were always happy to help with anything like that.
“It was obviously all new for the staff too, because usually the families would be really involved in someone’s care, but because of COVID, we weren’t able to be there.”
But while Lee was parted from his family, he was making strong progress in his recovery, buoyed by the thought of going home and working with the centre’s occupational therapy team to make that happen.
“We really didn’t know if he was going to walk again but the physio team were fantastic and some of the assistants who helped with the cognitive treatment were great,” recalls Petra.
“The staff really catered to his needs. They were so understanding about what he liked to eat and let him eat when he wanted to. They even got him involved in some games. They were just fantastic.”
On August 28, five long months after Lee’s life-saving surgery, he was able to return home, with the assistance of the Sue Ryder occupational therapy team. He is now supported by the local community team for ongoing rehabilitation.
“They arranged for Lee to have an overnight stay before he was discharged so we could make sure everything was in place that we needed,” recalls Petra.
“I went and picked him up and it gave me a chance to talk to them about things I was worried about. It really has changed our lives. It has changed everything. We were just a normal family before this.”
Lee’s recovery continues, but he is grateful for the support of the team at Sue Ryder Neurological Care Centre Lancashire during such a traumatic time for him, and particularly without the ability to see his family.
“I found it really helpful at Sue Ryder because while I was going through a really stressful time in my life, they were really great helping me to get through it,” adds Lee.
“I was just lucky that they were able to open when they did.”
How art unlocked a new future for brain injury survivor
Artist and art therapist Carl Arroyo, from therapy provider Chroma, shares the story of brain injury survivor Ricky, whose interest in tattoo art began a path towards a life with more possibilities.
I’ve been an art therapist for more than a decade now, and it’s an incredible way of drawing people out and allowing them to express themselves.
I started working with Ricky (not his real name) in the Spring of 2020, about a year and a half after his injury. He already had a multidisciplinary team around him, and it was felt that he needed something else to support him in adjusting to his experience and his injuries.
To be honest, Ricky wasn’t particularly interested in art as a whole, but he had a specific desire to design some tattoos based on his experience of his injury.
And that’s very much one of the skills that you have to have as an art therapist; that means of making a connection at some level and seeing where it takes you.
Tattoos are culturally acceptable and accessible – most towns have got tattoo parlours – so people of a certain generation find them appealing, and that certainly was the case with Ricky.
Initially, it was all about reflection, talking about the artwork, what that might relate to and then towards the end, we were looking at where he wanted to go and what he could do with his life.
And through all this was threaded the idea was that he was going to take the design he produced to a tattoo parlour and have it made into a tattoo.
One of the fascinating things that came through the design process was how he was relating it to his life, his injuries, and also his new place in the world.
His design was a skull with a crown on it, which was significant to Ricky both physically and emotionally. For example, as part of his immediate treatment following his accident, he had to have the top of his skull removed, because the brain was so swollen.
He was telling me about having this plate and the materials that they were using, and from that we had the idea to place a crown on there. And then that segued into talking about what the crown represents, in terms of Ricky being in charge of his own kingdom, and how his injury had changed how people viewed him.
One of the aspects of his injury he found hardest to deal with was being the centre of attention, surrounded by carers all the time, because in his life, in his family, he’d never had that attention. He’d not been listened to.
While he found it frustrating at times, paradoxically he came to accept that he was a king of this world and the attention was on him. The idea of the crown allowed Ricky to focus on some of the less tangible effects of his condition.
In the end, we had about 15 sessions, but, with lockdown, we were never able to meet physically and, sadly, by the time we could, he’d somewhat disengaged from the process.
However, prior to that, he was getting to the point where he could see that, if he wanted to create this new life, he was going to have to be more assertive and actually start asking for what he wanted.
And that wasn’t going to be an easy process. That’s what art therapy does; it’s about encouraging the creative process to give the patient a voice, and helping them find ways to cope with their new way of life.
Pioneering hippotherapy project delivers life-changing outcomes
A pioneering physiotherapy service for children and young people which engages them in rehab through horse riding has marked its 10th anniversary.
The Children’s Therapeutic Riding Service was the first of its kind in Scotland, and remains the largest hippotherapy service in the country. Hippotherapy is a specialist horseback form of physiotherapy, which can deliver life-changing consequences to children with disabilities, including brain injuries.
The service, delivered free of charge, attracts young people from across Scotland to its base in Muirfield and has helped hundreds of families during its time in operation.
As well as live animals, there is also a mechanical horse called Oreo, which responds to hand and leg movements like a real horse and is linked to a screen to give riders a technology-led virtual experience. The use of Oreo has been particularly important in enabling sessions to continue during the COVID-19 pandemic.
The Children’s Therapeutic Riding Service was founded by Susan Law, from Muirfield Riding Therapy (MRT) and NHS Lothian physiotherapist Heather Falconer, marking a groundbreaking partnership between the two organisations to deliver hippotherapy.
“I knew instinctively, from my years spent volunteering at MRT, that riding was of huge benefit but through meeting Heather and seeing her work, I could see how, through this physiotherapy service, we could help to change the lives of young people and their families,” Susan tells NR Times.
“If you have a child with a disability, it can be very isolating. Now, to see the difference engaging with our horses makes really gives a warm, fuzzy feeling. It’s very rewarding.
“Through our very specialist, physiotherapy-led service, we can accommodate rides for children with even severe disabilities.
“By securing National Lottery funding 10 years ago, we have been able to develop our hippotherapy service, which remains the largest in Scotland. We look forward to continuing our work into the future.”
Co-founder Heather explains the concept of their hippotherapy offering.
“Children are referred when their NHS Lothian physiotherapist believes hippotherapy to be the most effective form of physiotherapy for them,” she says.
“The children present with a huge array of challenges, including difficulties with mobility, balance, muscle tone, strength, coordination, body awareness and symmetry. Hippotherapy provides a means to address all of these issues and more.
“Hippotherapy uses the movement, warmth and rhythm of the horse as a therapy tool. As a horse walks, every step challenges its rider’s balance. This activates and strengthens the muscles of the trunk and pelvis.
“A 3-dimensional movement is transferred to the rider’s pelvis which mirrors the movement of a normal rhythmic human walking pattern, and gives experience of a normal walking pattern. The warmth of the horse and a gentle rolling gait can relax tight muscles, while a more choppy movement can increase low muscle tone.
“It is great fun, both for me and for the children I work with, for them it doesn’t feel like therapy, but delivers consistently amazing results.
“It is also much easier to connect with a child and for them to trust me using the ponies or Oreo as an intermediary. It is a 3-way therapeutic relationship, 4-way if you count the volunteer key workers too.”
Charlie Kay, aged 13, has been using the service throughout its time in operation.
“The best part about the riding service is that Charlie sees it as more of a hobby than a therapy session. He has seen a real knock-on effect in mobility and his walking is so much better,” explains Melanie, Charlie’s mum.
“As the riding engages his core he is sitting up better and straighter. Not only is it great for his physical health, but Charlie also enjoys the social aspect of speaking to all the volunteers and staff.
“Not only are the sessions helpful to Charlie, I find I get great advice joining with other parents in the viewing gallery. I am very grateful to have the opportunity for us both to use this incredible service.”
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