Reviews

“The Lefaivre Rainbow Effect is the vital piece that has been missing in the treatment of Traumatic Brain Injury. I applaud Chris Lefaivre whose professional journey led her to these remarkable discoveries. Her work is universal to all countries and healthcare systems. The book is insightful regarding areas not commonly addressed, including the role of forgiveness in healing the spirits of patients who frequently blame others, not knowing that bitterness and resentment retard recovery. The Lefaivre Rainbow Effect brilliantly uncovers and develops strategies to manage the unique stress experience for each patient and makes insightful use of the brain’s enhanced capacity to grow while pursuing pre-injury interests and motivations. Addressing the ups and downs while maneuvering inside the legal system – that often prevents healing – is helpful to survivors and caregivers alike.

The Lefaivre Rainbow Effect includes a unique concept of the traumatically induced dysfunctional family, working to maximize recovery and reduce the loss while preserving the family unit. The appropriate use of motivated participation of the TBI survivor makes this text stand out among those in the rehabilitation field. Like a cool breeze on a warm day, it gives refreshing new hope for brain healing.“

David I. Levy MD, Clinical Professor of Surgery (Neurosurgery), University of California, San Diego, Author of Gray Matter, Americas top surgeons 2015 and 2016

Dr. Levy has been a recipient of the Patient’s Choice Award in 2010, 2011 and 2012, and being voted as one of America’s Top Surgeons in 2010, 2011, 2012, 2013, 2015 and 2016.  He has been the recipient of the Best Doctor Award  2007 – 2014.

“This book transformed my understanding of traumatic brain injury (TBI) and the complexity of treatment programs. Chris Lefaivre’s portrayal of working with her clients, their families, and the treatment team is inspirational. Her insight into the role of the human spirit and the importance of motivation and hope in determining outcomes was a revelation.

This well written and accessible book is truly a must read for all health and social workers, legal professionals,  family members,  employers and indeed anyone involved in the support of traumatically brain injured individuals.

The author paints a fascinating picture of the practice of occupational therapy and treating traumatic brain injuries and shows how thoughtful approaches to therapy and support can result in extraordinary outcomes for patients. The book presents an integrated approach to treatment and care and to the business of occupational therapy. With its extensive resources and appendices it will become a standard reference for students, professionals, and families dealing with TBI.

This book could not be timelier; as we recognize the devastating effects of brain injuries in our society.“

Deborah Buszard PhD, Deputy Vice Chancellor, University of British Columbia, Canada

Deborah Buszard is Principal of UBC’s Okanagan Campus, home of the Survive and Thrive Applied Research Facility (STAR) which brings engineers, neuroscientists kinesiologists and psychologists together to develop novel protective technologies to prevent head injuries and protect humans in hazardous environments and activities such as contact sports.

“Brain injury is a most complex healthcare challenge, with its impact on all aspects of life and functioning.  In this comprehensive volume developed through decades of first-hand experience with hundreds of individuals traveling the post-brain injury journey, Chris Lefaivre puts forth a framework that truly reflects the best elements of person-centered care.  The Lefaivre Rainbow Effect is applicable across professional domains, cultural boundaries and the continuum of care.  The guidelines of the model are consistent with all rehabilitation fields, accreditation standards and the World Health Organization’s conceptualization of disability, functioning, participation and health. The approach encompasses the biopsychosocial perspective of recovery and re-adaptation, emphasizing our common humanity and the value of the hopes, dreams, habits, roles and connections that shape all of our lives.  Lefaivre reminds us that the impact of brain injury exceeds a purely neurologic injury, and instead evolves across a survivor’s contexts – as a member of a family, community, workplace, etc.  This volume encourages the brain injury rehabilitation community to value tenets of lifelong living, purposeful activity, enriched environments, reduction of stress, forgiveness of self, listening deeply to clients and families, and other core fundamentals as key components of the healing process, a process that embraces joy, balance and the unlimited potential of the human spirit.“

Tina M. Trudel PhD, Licensed Clinical Neuropsychologist;

President/Chief operating Officer, Lakeview NeuroRehabilitation Centers and Specialty Hospitals, USA; Assistant Professor of Clinical Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine; Member of the Board of Directors – Brain Injury Association of America (BIAA); Member of the Board of Directors – North American Brain Injury Society (NABIS)

“I am a personal injury lawyer who has restricted his practice primarily to brain injury litigation since the middle 1980s. I first retained Chris Lefaivre, in her role as a community occupational therapist, in approximately 1987 to assist me in identifying the future care needs of my client who had sustained a mild to moderate brain injury in a motor vehicle accident. My client had been working as a taxidermist at the time of the accident and wanted to continue in that role following his injury if that was possible. I didn’t know whether it was or wasn’t possible but my experience up to that point in time told me that there was likely little professional help available to assist him in achieving this goal. How wrong I was! It was at this time and through this client that I experienced firsthand the magic of the Lefaivre Rainbow Effect with its emphasis on first identifying, in-depth, the complete pre-accident profile of the brain injured survivor and then building on that profile to deliver an effective and very personalized rehabilitation program which Chris identified to me as the Rainbow Effect rehabilitation program. Chris advised me at the time of this retainer that she really didn’t understand taxidermy and to my surprise but as I was to learn, consistent with her program, she immediately researched this occupation so that she could better  understand  my client’s pre-accident profile and abilities in order to deliver the most effective rehabilitation going forward. I’m proud to say that my client, with the appropriate supports identified and in place, did indeed return to the practice of taxidermy, something neither he nor I could ever have contemplated without him experiencing the Lefaivre Rainbow Effect delivered so effectively by Chris. Needless to say I subsequently endorsed this approach, the Rainbow Effect, for all cases no matter the severity of the brain injury because this program will identify any and all residual functioning remaining to assist the brain injured survivor in achieving  the  maximum quality of life possible and how best to achieve this objective. From a litigation point of view there is no better way to prepare your evidence for trial than to follow the Rainbow Effect rehabilitation approach.  Whether you are a survivor, a family member, a medical /rehabilitation expert, or a lawyer, read this book –it was a game changer for me and it will be for you as well.”

David Marr Q.C. Personal Injury Lawyer, Kamloops, British Columbia, Canada

David J. Marr Q.C. graduated from the University of Manitoba in 1972 and was called to the Bar in British Columbia in 1973.  He has practiced in the field of litigation for the past 30 years.  He received his Q.C. in 1986.  David has been a member of the Trial Lawyers Association since its inception and sits on the Board as a member at large for the County of Yale and, in recent years, has been very involved in its affairs.   For the last 25 years his practice has been restricted to acting for Plaintiffs involved in motor vehicle accidents and is now primarily related to acting for brain injured claimants.  Mr. Marr was the co‑founder of the Kamloops Brain Injury Association in 1985 (approximately).  Currently he is the President of that organization.

“The Rainbow is a marvel of nature as is the brain. Not all the colors in the rainbow are real, our eyes are not quick enough to clear the margins therefore the neuroplasticity of the brain translates the colors differently for each person. All of us will see a rainbow differently dependant on how each individual brain interprets the image.

Each Rainbow is unique every brain interprets stimuli differently; this is equally true for the therapeutic approaches described in this book for traumatic brain injury (TBI) survivors.

Despite the obvious progress in the capabilities of functional MRI imaging and the continuously rising knowledge of intracerebral communication paths, it is insufficient to merely visualize the primary post traumatic organic damage.

This book fills the gap between what a radiologist can visually see on radiologic imaging and how clinicians observe the survivors brain functioning in real life, with multiple stimuli.

Through her longstanding extraordinary experience in the therapy of TBI survivors, Christine Lefaivre succeeds in transcending primary organic damage with a multi-modal therapeutic approach.

The various therapeutic levels amalgamate and ultimately form the foundation of a complex treatment approach for this patient group.

Due to the steadily rising number of patients that are frequently very young, in part due to the combat operations in Iraq and Afghanistan, this book has the potential to evolve into an interdisciplinary fundamental work for the therapy of TBI survivors.

With the interest of the patients in mind, I wish the book a wide circulation.“

Dr. Michael Starke, Radiologist, Department of Diagnostic and Interventional Radiology, Federal Armed Forces Hospital Berlin, Germany

“A complex, confused, and difficult world awaits the survivor of a serious traumatic brain injury (TBI). This complexity confronts the survivor’s health-care providers, family members, and community as well.  As a neuropsychologist I know that understanding the injury effects can be challenge enough. But aiding recovery from TBI also requires consideration of the survivor’s pre-injury environment and personality, of the shifting picture presented by recovery of function over time, and bringing together the panoply of professional services and persons that become involved. Complications are often the rule and come in many forms: medical setbacks, funding shortfalls, problematic family dynamics, and lack of availability of desired services, to name a few. Even geography can pose a formidable challenge to the recovery process when the survivor comes from an isolated rural area, and the needed services are located in urban centres.

In her book, Chris proposes a systematic approach, the Lefaivre Rainbow Effect, to deal with these complexities. Recovery from a serious brain injury typically takes several years and Chris’ book speaks to the challenges of co-ordinating a constantly evolving care plan that involves many individuals, interventions, and practical problems. The TBI survivor and his/her family are not constants either, as they adjust to the initial injury or as they move through the variable stages of recovery. The Rainbow Effect provides a multi-modal, multi-disciplinary model that stages interventions for the survivor, the family, and the community (eg. school, workplace), so that recovery is maximized. Chris highlights the role of the case manager in promoting collaboration and coordination among the various parties involved at any particular time in the recovery process.  There are important sections in the book on the interplay between legal and funding agencies with execution of a treatment plan.

I think this book will be of particular interest to occupational therapists, but it will also be valuable to professionals and non-professionals alike who are involved in assisting the TBI survivor’s difficult journey.  While some impairments may persist following serious TBI, successful recovery of function is possible in many cases. I have worked with Chris using this model, and have seen clients who initially had Glasgow Coma scores of 4-6 recover, over a period of years, to the point where they could live independently, hold employment, and have normal relationships.”

Bill de Bosch Kemper, Ph.D. Kelowna, British Columbia, Canada

“The essential underpinning and what makes the Lefaivre Rainbow Effect so therapeutically successful is the belief that an in depth understanding of the person’s life prior to the traumatic brain injury, offers the greatest value therapeutically. Further, it is the belief that this is the absolute foundation for optimal recovery.  For too long we have focused on the specific, physical malfunction and not considered the person’s historic, underlying mental health and their pre-injury role in the extended family system and society in general.

The Lefaivre Rainbow Effect teaches that it is essential that all care providers fully embrace the profound power of the human spirit.  “Light the flame that sparks the spirit” is the rallying call for service providers, utilizing the LRE approach.  Lefaivre’s model, which is to base treatment on the pre- injury tapestry of the person’s life, by using an advanced knowledge of family system’s theory, is brilliant. The approach captures the essence of the reality that having a critical understanding of how people derive self- worth can tremendously impact their ability to recover. As well, the incorporation of the unique theory of the traumatically induced dysfunctional family sets the stage for a far more complete knowledge base of how to successfully treat the TBI patient. It is this understanding that is behind the thoroughness in patient’s data collection, which is then used to prepare and execute a top notch treatment program. The LRE’s essential belief is that a human spirit is filled with hope. If that hope has been diminished all caregivers need to gently nurture it along, from the remaining historical embers to a new flame. The LRE consequently sees the family playing an absolute essential role, in the traumatic brain injured person’s recovery.

Lefaivre’s original sensitivity, apparent when she paid mindful attention to the TBI client, who was taking on the schizophrenic symptomology of the roommate when institutionalized, speaks volumes to her intuitive understanding of brain re-wiring and what is truly needed for the TBI patient’s optimal recovery. That Lefaivre had the understanding 30 years ago, that the brain recalls best in a familiar environment utilizing old, familiar, cognitive stimuli is a testament to her incredible awareness of the client’s needs, long before the current understanding of neuroplasticity. As I read Lefaivre’s work, I was astounded by her complete understanding that the best chance for functional recovery and optimal psychological benefit is when the TBI client is in their pre- injury environment, versus an institutional setting. Perhaps Dorothy from the Wizard of Oz was an inspiration to Lefaivre when she said “there’s no place like home, there’s no place like home…”

The LRE assumption that functional family members are integral to the recovery process for a TBI client, and the understanding that a family is at risk for becoming dysfunctional in the process of recovery, is the underpinning of the success of this treatment approach. Just like a builder cannot erect an apartment building starting from the second floor, without a complete understanding of the land and a well dug and constructed foundation and first floor, the TBI survivor is not optimally served without a well- documented understanding of the client’s pre injury life functioning. What a gift this text is to the world of traumatic brain injury treatment and patient care in general.“

Gaye Gould M.S.W., R.S.W. Mississauga, Ontario, Canada

“Working with clients with head injuries? Looking for inspiration or a different direction? Then look no further than Traumatic Brain Injury Rehabilitation: The Lefaivre Rainbow Effect by Christine Lefaivre. This book is held in high regard by various professionals, such as Professor David Levy, one of America’s top neurosurgeons, as well as lawyers, clinical psychologists and research scientists, and it is easy to see why. It does not focus on the medical problem or deficit model so prevalent in the past, but builds on the individual’s life before, during and after discharge, presenting the recovery process as a journey with many stages.

Lefaivre is an occupational therapist with 25 years’ clinical experience. She has a strong commitment to social justice and the belief that people with traumatic brain injuries can learn and acquire the much–needed skills that will facilitate their engagement and re–connection with life and the communities around them; and in a way that is deeply personal and meaningful for each person. The methodology that underlies The Lefaivre Rainbow Effect regards each of us as a unique being – a member of a system that interacts with other systems in a unique way.

Therapists face daily challenges to provide support and direction to this vulnerable, often compromised or neglected client group. This book helps to clarify the way forward for everyone involved in the process: client, family, health professionals and volunteers. But it delves further and deeper than previous books on brain injury rehabilitation. Particularly interesting is the incorporation of systems and family systems theories throughout the book, and the inclusion of co–morbidities and the identification of a number of high–risk family systems, such as sexual abuse, psychiatric conditions, emotional neglect, addiction issues and violence, which present unique challenges for the individual to overcome.

The book considers a team approach to be essential for successful rehabilitation: a medical system interacting successfully with the client’s personal and family systems, and with the client firmly in the driver’s seat.

In the earlier chapters, accurate history taking and assessment is stressed as is common with many approaches, but it incorporates a balanced lifestyle approach to promote health and well– being, one that involves every aspect of the client’s life even before the injury occurred. Lefaivre proposes including a pre–injury profile description of the person before the injury to guide all interventions to provide direction for therapeutic intervention.

The Lefaivre approach helps all professionals involved in the client’s care to focus on life balance at the stage of life of the client to develop a highly personalised rehabilitation programme. Lefaivre suggests that if we do not, we (as therapists) risk becoming part of the problem. Based on the individual client’s initial life balance sheet/profile, Lefaivre further suggests the transition from hospital to home can be greatly facilitated and waiting times reduced if referrals for services in the community are actioned prior to discharge.

The book contains numerous clinical suggestions and client stories, templates, handouts for families, inventories and links to download information, including a valuable PowerPoint presentation. Details of these can be found in the notes to readers section of the book. Numerous guidelines and case illustrations provide additional depth for therapists to use and modify to make the journey for the individual an even more meaningful one.

Lefaivre discusses in some detail the concept of the traumatically–induced dysfunctional family. She draws on the importance of family systems and systems theory in general, and the rules, boundaries, expectations and values that guide and shape each family. It is no surprise that some family systems face greater challenges than others and that stressful events highlight functional difficulties specific for each individual. Co–morbidities and brain injuries combine to further influence functional family systems.

The book provides extensive information on litigation processes, expert witness testimony and medical– legal report writing, business practices, time management and complex funding issues, and, in considerable detail, the use of volunteers in the recovery process. We would do well to include these aspects in our practice as we live in a world where we have to increasingly justify what and how we do things, and where litigation is increasingly becoming part of our daily and professional lives.

The book finally discusses the many and varied aspects of ethical considerations, such as sharing information, risk factors and barriers to progress.

It is a practical and detailed book full of resources for all health professionals, whether newly qualified or more experienced. It builds on recent and growing concepts of neuroplasticity and draws deeply from the individual’s life experiences before the injury occurred. Functional family members are integral to the recovery process and need to be included from the start.”

OT Insight Magazine Maramatanga Whakaora Ngangahau
OTNZ Whakaora Ngangahau Aotearoa
PO Box 10493, Wellington
P:04 473 6510

Jean Dominy, NZROT, B.Occ Therapy,

PGDip Orthopaedagocics, MSc (Psychology)

Traumatic Brain Injury (TBI) is one of the devastating neurological disabilities leading to physical, functional and socio-economical losses. It is estimated that about 1 million persons get disabled due to TBI every year in lndia and the scenario is rapidly increasing every moment. The Occupational Therapist plays a vital role in prevention, intensive care, chronic-rehabilitation, and community integration. Various neurophysiological approaches and occupational models are in practice to manage the clients with TBI globally including India.

In this 1 5-chapter book on Traumatic Brain Injury Rehabilitation author Ms. Christine Lefaivre (Clinical Assistant Professor, University of British Columbia) has methodically elucidated a new model: The Lefaivre Rainbow Effect, exclusively for the rehabilitation of TBI. Based on her vast clinical experience of 26 years with TBI patients, she has developed this model which appears to be simple and can be implemented conveniently. The core of this model is based on the principles of human spirit, forgiveness, acceptance, and hope.

Most of the concepts symbolize a colorful presentation to perceive and understand them in a unique manner. The model comprises medical as well as occupational assumptions such as brain plasticity, client centeredness, environment, adaptation, and therapeutic devices. In most of the chapters numerous case studies are highlighted that make this book effortless to appreciate and apply clinically, The role of multidisciplinary team members including the family has been also considered as an important factor. Specifically, the cognitive retraining strategies are exhaustively and practically illustrated that may be useful for the clinician working in field of TBI. The legal, ethical and insurance aspect related to persons with TBI has also been focussed in the book. The pictorial presentations of ideas, process and interaction related to the treatment is an appreciable effort of the author of this well written book.

The Lefaivle Rainbow Effect is an outcome of the substantial clinical experience; however, systemic investigation for its evidence is warranted.

In conclusion, the book may be clinically helpful for the rehabilitation of TBI clients. The concepts will enhance the understanding of TBI and related issues. The principles of the novel model may also be utilized for other neurological disabilities. The occupational therapists, co—professionals, students, family members, employer, and insurance executives may benefit a lot from this book.

Dr. Kamal Narayan Arya, MOT, PhD, Lecturer (Occupational Therapy), New Delhi, India.

Canadian Journal of Occupational Therapy
Reprints and permission:
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Traumatic Brain Injury Rehabilitation: The Lefaivre Rainbow Effect is a comprehensive, easy-to-read text that describes a client-centred approach to assessment and intervention in brain injury rehabilitation. What makes this book unique and a must-read for any clinician working in community brain injury rehabilitation is the attention to topics that are not traditionally addressed in similar texts: business practices, litigation, future care cost analyses, case management, quality statistics, and complex family dynamics.

Topics are presented from a perspective of the Lefaivre Rainbow Effect methodology, which is grounded in understanding who the client was prior to injury, the losses he or she has experienced due to brain injury, and how multidisciplinary intervention can minimize residual loss. The Lefaivre Rainbow Effect uses ‘‘small goal directed measurable steps using pre-injury information while honoring human spirit and the individuality of the patient’’ (p. 14). Case studies, chapter summaries, charts, practical strategies, and ideas for interventions are presented throughout the book. Clear, colourful diagrams, tables, and figures supplement the text and contribute to this book’s appeal.

While the author refers to the Lefaivre Rainbow Effect as being a ‘‘methodology for cognitive retraining’’ (p. 13), the text and interventions described go well beyond cognition to describe holistic person-centred interventions that are relevant for clinicians from multiple disciplines. This book will be very useful for clinicians who are new to community brain injury rehabilitation and private practice, experienced clinicians interested in a new perspective, and lawyers or insurers who wish to develop a better understanding of one approach to brain injury rehabilitation.

Canadian Journal of Occupational Therapy by Anne Hunt Post Doctoral Fellow

Lefaivre, Christine. (2015).
Traumatic brain injury rehabilitation: The Lefaivre Rainbow Effect.
Boca Raton, FL: CRC Press.
330 pp. US$55.96. ISBN: 978-1-4822-2824-3
DOI: 10.1177/0008417415616243