Head Positioning: matching product to client need, part 3: the i2i
Michelle L. Lange, OTR/L, ABDA, ATP/SMS
The i2i head, neck, and shoulders positioning system has a great backstory. Leslie Fitzsimmons, an Occupational Therapist in NJ, was frustrated that existing head supports were not meeting the needs of some of her clients. So, being a good therapist, she went into the back room and built one! Her prototype worked and she eventually approached Stealth Products who brought this to market. Why the name i2i? Because the client can now keep their head upright and look at others – eye to eye. Awesome!
The i2i has a very unique design and can be customized to meet an individual’s needs. This head support provides significant support at the suboccipital shelf without contact with the occipital area, though a separate occipital pad can be added. The support then continues on either side of the neck and anterior to the trunk in two ‘arms.’ Finally, a chin prompt fits between these arms.
So, when it is appropriate to consider the i2i as an option for a client? This unique head support has several clinical indicators:
- Lack of contact with the occiput: as the i2i does not directly contact the occipital area (unless a pad is added), this design works well for clients who tend to extend in response to contact with this area.
- Encourages midline: the 2 arms, in combination with the lateral contact at either side of the neck, encourage a midline position for clients who rotate or laterally flex the neck.
- Prevents Hooking: the 2 arms also prevent ‘hooking.’ Some of our clients tend to drop their head forward and lift the head and laterally flex, sometimes getting stuck between the bottom of the head support and the top of the back. This looks pretty scary and teams are anxious to address the issue.
- Minimizes Neck Hyperextension: the height of the posterior portion of the i2i can be customized. A higher profile option (shown above) provides significant support at the suboccipital area, limiting neck hyperextension.
- Encourages an Upright Head Position: the chin prompt encourages the client to keep their head up. When the client’s chin contacts the prompt, the client is cued to lift the head.
Christopher was using a Stealth Products Comfort Plus head support. He was positioned in neck lateral flexion and rotation. This was impacting his vision, breathing and swallow.
Here is Christopher trying an i2i. His head is now in neutral alignment, without neck lateral flexion or rotation. His visual field is greatly improved, he is in optimal alignment for swallow and breathing, and just look at that smile!
Many clients who meet the clinical criteria for the i2i may also benefit from the Ultra (see our blog on the Ultra). It is often appropriate to try both options to see which meets an individual’s needs the best.
The i2i must be flipped back to transfer the client in and out of the seating system due to the anterior arms. Flip-back mounting hardware is available. Stealth also offers a version of the i2i with arms that pivot to the sides, easing transfers. This video demonstrates how to adjust this head support, as well as tips for transferring someone in and out of their seating system when using the i2i.
Check out our case study of Max who uses an i2i with short arms.
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