Breathe Magic Intensive Therapy Programme

Effectiveness of the programme on hand function and independence

Research into the programme found that Breathe Magic increased usage of the young peoples’ affected hands by 61%. This was sustained after a follow-up 3 months, regardless of age, severity of movement restriction, or nationality, (Green & Farquharson, 2013) a further study showed that 92% of young people had improvements in bimanual ability, and 75% of the young people maintained their improvement after a follow-up 6 weeks later (Myers, Green, Schertz, Shiran, Geva, et al. 2015).

Our research shows that participants had clinically significant improvements in bimanual (two-handed) motor skills and improved independence and participation in daily activities. These skills were well maintained at the 6 month follow-up assessments.

Following the programme, young people and their parents report improved movement skills and a greater ability to perform physical daily tasks at 6 months follow up and reductions in hours of care and support from parents following the young person’s participation in the programme due to their newfound independence (Fancourt, 2020).

Effectiveness of the programme on neuroplasticity of the brain in young people

Following participation in intensive Magic HABIT neuroimaging showed that there was a 26.14% increase in level of activation in the affected hemisphere from before to after the intervention (shown in beta values), and a 34.75% improvement at follow- up (Weinstein et al, 2015).

Further studies showed increased white matter integrity was detected in the corpus callosum and corticospinal tract after the 60 hours of therapy in about half of the participants. This was associated with better hand function and the improvement was maintained in bimanual independence and unimanual hand function at follow-up.

Young people with greater overall brain damage (higher radiological score and decreased cortical activation in the affected hemisphere in fMRI) had greater improvement in bimanual function post-treatment. Diffusion tensor imaging in the PLIC (posterior limb of the internal capsule) and CST (corticospinal tract) indicated more white matter damage in some participants was associated with greater improvement in bilateral function following intervention (Schertz et al, 2016). Children with ipsilateral, bilateral, and contralateral cortical spinal tract connectivity, improved equally in HABIT interventions (Friel, 2021).

Effectiveness and improvements in psychosocial development in young people

International studies recognise it is extremely difficult to motivate children to do the high-intensity practice that is required for motor learning. Magic-themed bimanual intensive therapy programmes use a novel learning medium to motivate young people to achieve their goals. Magic themed programmes have been shown to work equally with more severe hemiplegia, negating previous clinical concerns that it was only suitable for individuals with mild hemiplegia (Novak, 2013). Parents described the benefit of the non-medical approach for children’s motivation as a further mechanism of change (Fancourt, 2020).

71% of young people with hemiplegia experience mild-servere psychosocial and emotional difficulties – an important determinant of this is decreased self-esteem (Parkes, 2009). Following the programme, parents reported improvements in their child’s self-confidence, self-esteem and self-motivation. Children were keen to persevere in doing things without parental support or prompting, improved  confidence and comfort in discussing their diagnosis, and a willingness to try new things. Parents further highlighted improved optimism themselves about their child’s future and increased confidence in their child’s ability to achieve unexpected things.

Young people reported developing new friendships at the programme which helped with social integration at school, and they reported increased feelings of pride, decreased frustration, increased independence, a decrease in self-punishing behaviours and improved feelings of helpfulness and emotional regulation.

Breathe Magic Intensive Therapy Programme – Published Research 

Green, D., Schertz, M., Gordon, A.M., Moore, A., Schejter Margalit, T., Farquharson, Y., Ben Bashat, D., Weinstein, M., Lin, J.-P. and Fattal-Valevski, A. (2013), A multi-site study of functional outcomes following a themed approach to hand–arm bimanual intensive therapy for children with hemiplegia. Dev Med Child Neurol, 55: 527-533. Read it here.

Green D, & Farquharson Y (2013), The magic of movement: Integrating magic into rehabilitation for children with hemiplegia, Dev Med Child Neurol; 5(S2):19. 21.

Novak, I. (2013), A magical moment in research translation: strategies for providing high intensity bimanual therapy. Dev Med Child Neurol, 55: 491-491.  Read it here.

Fancourt, D., Wee, J. & Lorencatto, F. Identifying mechanisms of change in a magic-themed hand-arm bimanual intensive therapy programme for children with unilateral spastic cerebral palsy: a qualitative study using behaviour change theory. BMC Pediatrics, 20 (1), 363). Read it here.

Other Published Research

Contact (2020), What is hemiplegia? (Accessed 20/06/2021).

Friel KM, Ferre CL, Brandao M, Kuo H-C, Chin K, Hung Y-C, Robert MT, Flamand V H, Smorenburg A, Bleyenheuft Y, Carmel JB, Campos T & Gordon AM (2021), Improvements in Upper Extremity Function Following Intensive Training Are Independent of Corticospinal Tract Organization in Children With Unilateral Spastic Cerebral Palsy: A Clinical Randomized Trial, Frontiers in Neurology, 12(633).

Goodman R & Graham P (1996), Psychiatric problems in children with hemiplegia: cross sectional epidemiological survey, BMJ, 1996, 312(7038):1065–9.

Hines A. C, Bundy AC, Black M, Haertsch & Wallen M (2019), Upper Limb Function of Children with Unilateral Cerebral Palsy After a Magic-Themed HABIT: A Pre-Post-Study with 3- and 6-Month Follow-Up, Physical & Occupational Therapy In Pediatrics, 39:4, 404-419, DOI: 10.1080/01942638.2018.1505802

Hines A, Bundy AC, Haertsch M & Wallen M (2019), A magic-themed upper limb intervention for children with unilateral cerebral palsy: The perspectives of parents. Dev Neurorehabil. Feb;22(2):104-110.

Myers V, Green D, Schertz M, Shiran SI, Geva R, et al (2015), Brain plasticity following intensive bimanual therapy in children with hemiparesis: preliminary evidence, Neural Plast, 20;2015:798481.

National Institute of Clinical Excellence (2012 & 2016). Spasticity in Under 19’s Management: Clinical guideline [CG145]. (Accessed 20/06/2021).

Novak I (2013), A magical moment in research translation: strategies for providing high intensity bimanual therapy, Developmental Medicine & Child Neurology, 55(6), 491–491.

Novak I & Honan I (2019), Effectiveness of paediatric occupational therapy for children with disabilities: A systematic review, Australian Occupational Therapy Journal, 2019, Jun;66(3):258-273.

Novak I, McIntyre S, Morgan C, Campbell L, Dark L, Morton N, Stumbles E, Wilson SA & Goldsmith S (2013), A systematic review of interventions for children with cerebral palsy: state of the evidence. Dev Med Child Neurol. 2013 Oct;55(10):885-910.

Oskoui M, Coutinho F, Dykeman J, Jetté N & Pringsheim T (2013), An update on the prevalence of cerebral palsy: a systematic review and meta-analysis. Dev Med Child Neurol. 2013;55(6):509–19. 

Parkes J, White-Koning M, McCullough N & Colver A (2009), Psychological problems in children with hemiplegia: a European multicentre survey, Arch Dis Child, Jun;94(6):429-33.

Schertz M, Shiran S, Myers V, Weinstein M, Fattal-Valevski Artzi M, Bashat D B, Gordon A M & Green D (2016), Imaging predictors of improvement from a motor learning based intervention for children with unilateral cerebral palsy.Neurorehabilitation and Neural Repair, Vol. 30, no 7, p. 647-660.

Sellier E, Platt MJ, Andersen GL, Krägeloh-Mann I, De La Cruz J, Cans C, et al (2016), Decreasing prevalence in cerebral palsy: a multi-site European population based study, 1980 to 2003, Dev Med Child Neurol, 2016;58(1):85–92.

Spencer K, Yuen HK, Jenkins GR, Kirklin K, Griffin AR, Vogtle LK & Davis D (2020), Evaluation of a Magic Camp for Children with Hemiparesis: A Pilot Study. Occup Ther Health Care, 2020 Apr;34(2):155-170, doi: 10.1080/07380577.2020.1741055.

Weinstein M, Myers V, Green D, Schertz M, Shiran S, Geva R, Artzi M, Gordon AM, Fattal-Valevski A & Bashat DB (2015) Brain plasticity following intensive bimanual therapy in children with hemiparesis: preliminary evidence. Neural Plasticity. 2015;2015:798481. doi:10.1155/2015/798481.