20Q: Adaptive Equipment Pioneer

Fred Sammons, 20Q- Adaptive Equipment Pioneer

Fred Sammons is one of the early pioneers in occupational therapy. He has been an occupational therapist for over 60 years. During that time, he has been an innovator in designing. manufacturing, and distributing adaptive equipment for people with disabilities while collaborating with occupational therapists and clients to identify needs and to generate product ideas. At the age 90, Fred Sammons continues to give to the profession through grants, scholarships, and donations that support research, education, and clinical programs. He is an active contributor to AMBUCS, Inc., where he collaborates to develop designs for adapted bicycles and tricycles (AmTrykes) for children with disabilities.

On a personal note, I have known Fred for many years, and he remains one of the most beloved individuals in the occupational therapy community.

Welcome, Fred!

 

Franklin Stein, PhD, OTR/L, FAOTA
Contributing Editor

Salute to OT Leaders Series

20Q: Adaptive Equipment Pioneer

PhD (HON), OT, FAOTA

History

1.  Where did you spend your childhood? 

I grew up on a farm in northwest Pennsylvania near the city of Erie. The farm had horses and dairy cows. I was the youngest of three boys in the family, and we shared the farm chores including tapping maple trees to collect the sap and make maple syrup in early spring.

2. What was your education prior to becoming an occupational therapist?

I attended a two-room elementary school near Wattsburg, Pennsylvania.  The farmhouse where I grew up was about a mile walk to the high school. I graduated with 33 classmates in 1946. During high school, I was very busy with farm chores, but I was involved with the school newspaper and yearbook. After graduating from high school, I attended the State Teachers College in California, PA. where I took courses in 11 different industrial arts subjects such as woodworking, photography, power tools, machine shop, sheet metal, plastics, and mechanical drawing. I graduated from college in 1950 with a B.A. degree in Industrial Arts. After graduating from college, I taught mechanical drawing at a high school in Follansbee, West Virginia. 

Career

3. How did your background as an industrial arts teacher influence your career as an occupational therapist?

In the 1950s, the primary duties of an occupational therapist were to apply arts and crafts in a purposeful and meaningful way to help individuals with disabilities to gain function and to return to their community. Thus, my experience in learning and teaching industrial arts in high school prepared me for becoming an occupational therapist. 

I was also a homeroom teacher for 25 boys who were slow learners. I prepared the boys for the day’s activities. 

4.  How did your army service prepare you for becoming an occupational therapist?

I was drafted into the US Army in 1951 where I spent two years. While in the army, I worked in a chemical warfare unit developing armaments. During weekend and evenings, I ran a hobby shop on the army grounds where soldiers, during their off hours, could engage in arts and crafts like woodworking, leather tooling, paint by number kits, ceramics, and other arts and crafts. Soldiers and family members came to the hobby shop to take part in the arts and craft projects. It was also a positive experience for the soldiers and increased their morale. This experience in the hobby shop helped me to develop skills in fabricating furniture, maintaining equipment, and keeping inventories. 

6. Why did you decide to go to Richmond Professional Institute (RPI) to become an occupational therapist?

I selected the Richmond Professional Institute of the College of William and Mary in Richmond, VA to study for a career in occupational therapy. It is now the Virginia Commonwealth University. In 1953, college students, with a B.S. degree, were enrolled in an 18-month certificate program in occupational therapy. The classes were intense and taught me what an occupational therapist needed to know. The fieldwork was the same as regular occupational therapy students. Military veterans were fortunate to be eligible for the GI Bill which financed their education. I completed 11 months of fieldwork in psychiatry at St. Elizabeth’s Hospital in D.C., the Woodrow Wilson Rehabilitation Center in Fishersville, VA, the Richmond, VA Hospital for TB, and the Children’s Hospital in Richmond, VA. During the first Thanksgiving weekend at RPI, I married Mary Lou. As a registered nurse, Mary Lou was able to find temporary employment during my fieldwork placements.

7.  What were your experiences at the Rehabilitation Institute of Chicago?

After receiving my certificate in occupational therapy in 1955, I accepted a position at the newly formed Rehabilitation Institute of Chicago (RIC). RIC was modeled after the Howard Rusk Institute of Rehabilitation Medicine in New York which was the first institution to train physicians to be physiatrists. Mary Britton, the sole occupational therapist at RIC, recruited me from RPI while I was still a student. This was on the recommendation of Elizabeth Messick, the program director of occupational therapy at RPI. When I started at RIC, the facility was being renovated from a printing plant. The remodeling of the structure coincided with the development of the rehabilitation hospital. I spent five very productive years at RIC serving in many roles from staff therapist to department head. Using my skills, I fabricated therapy equipment, designed therapeutic games, and placed weights on looms and a printing press to increase resistive force. A meat packing company in the stockyards of Chicago and a plumbing company referred cases to RIC through the companies' physicians. I gained valuable experience at RIC in administration and teamwork.

8. What were your job experiences at the Northwestern University Prosthetic and Research and Education Center?

In 1960, I accepted a new position at the Northwestern University Prosthetic Research and Education Center in Chicago. The mission was to do intensive research in prosthetics and to provide training for the intern physicians in orthopedics and physical and occupational therapists and prosthetists who were there for advanced training in prosthetics. I was a research associate working on prosthetic upper extremity harnessing and control systems and taught classes. I worked with individuals with amputations such as farmers who had accidents and children who lost their limbs because of thalidomide. The director of the center, Colin MacLauren, proposed starting an organization of rehabilitation engineers and therapists which eventually became the Rehabilitation Engineering and Assistive Technology Society of North America, or RESNA. I was very active in the organization. I worked at RIC and at the Veteran’s Administration/Northwestern University Prosthetic Research Unit until 1965 when I started a full-time business.

On a personal note, my wife Mary Lou contacted polio in 1956. I took care of her and my children at that time. I used a Hoyer lift for transferring her in and out of bed and a folding ramp to get in and out of our Volkswagen bus. I also developed a special wheelchair for her and adaptive equipment for everyday activities such as a “reacher” for opening the dryer as well as adaptations for the VW bus to allow her to use her wheelchair while driving.

Adaptive Devices

9. How did you begin your business of designing of adaptive devices?

My part-time hobby business, in my basement during nights and weekends, lasted ten years. During this time, I invented, designed, and fabricated many adaptive devices for helping individuals with disabilities to be independent in their everyday activities such as in eating, dressing, grooming, and toileting. I later incorporated this into a part-time business and expanded into a larger space. I began hiring workers for this business and obtained legal and business advice

When I came to Chicago, I became an active member of the Illinois Occupational Therapy Association. I took on committee assignments and worked with local occupational therapists. I was sensitive to the needs of individuals with disabilities as well as listening to occupational therapists who discussed their problems in rehabilitation. My background knowledge in industrial arts, my occupational therapy education, my army experience in running a hobby shop, and my strong work ethic that was developed working on a farm in my youth helped me to begin a business. In addition, I listened to others to discover the pressing needs of people with disabilities. My business model essentially was to find out what was needed in rehabilitation and to test and try out solutions that worked. In other words, I used a pragmatic approach to problem-solving along with my persistence and dedication. I never patented any of my inventive devices. Since the adaptive equipment was very inexpensive to fabricate, I felt that the expense of obtaining a patent, which is about $10,000, was not worth the cost. I also felt that anyone who wanted to copy my devices was welcome to do so. My goal was to invent and manufacture low-cost devices and a low-cost delivery system to make the products widely available. The flyers I printed were edited using occupational therapy language and were sent to therapists and students. They were originally black and white on newsprint

10. What were the first adaptive devices that you designed?

One of the first adaptive devices that I fabricated was a simple button hook that enabled individuals with poor fine motor coordination and strength, such as in severe arthritis or cerebral palsy, to be able to dress. The button hooks were wire loops designed to widen and open a buttonhole to enable those with poor dexterity or with only one hand to be independent with these fasteners. This was an example of a simple and inexpensive solution to a complex problem. The button hooks cost only $1 for the consumer. Based on this invention, I formed a company called the Button King Enterprises, later B/K Enterprises. I also developed a “spork” which was a combination spoon and fork for individuals having difficulty using eating utensils. I also made one the size of a soup spoon. Another invention was adding a cutting edge on a fork.  As the business grew, I turned my attention to other areas such as wheelchair lap trays and a Velcro hook and loop closure. I developed devices to help individuals with an amputation to eat food from a plate using scoops and plate guides. I also developed "reachers”, shoe horns, elastic shoelaces, laptops for wheelchairs, splinting material using Velcro (widely used in universal cuffs), night splints for individuals who had a stroke, and devices to make it easier for people with disabilities to use a typewriter.

11. How did you first market these devices?

I first marketed my adaptive devices at the 1959 American Occupational Therapy Association Annual Meeting. Since the conference was being held in Chicago, I was on the conference committee and was appointed to be in charge of the commercial exhibits. This was a first for AOTA to have as many as 20 exhibitors. These exhibitors were mainly arts and crafts companies. At the exhibit, I published a 2-page mimeograph advertisement of the button hook and other simple devices. I was a pioneer in displaying self-help products at the AOTA annual conference. I also marketed these early adaptive equipment devices through mail advertisements. I obtained a list of all the rehabilitation departments where occupational therapists worked from AOTA and used this list to contact occupational therapists either by mail, telephone or by personal visits.  When there was a dramatic increase in my business, I decided to do it full-time. I was very conservative about obtaining credit from banks. The company grew at a very rapid pace and moved to a new building every five years. This would include new shelving, storage systems, and telephone and computer equipment. Velcro hooks and loop closures were key parts in the manufacture of adaptive equipment and splints.

12.  What were some of the specific adaptive devices you designed, fabricated, and distributed?

Besides the button hook and button extender, which were very successful in the areas of dressing, I developed zipper pulls that used nylon fishlines to swivel and pull easily in men’s trousers. I developed elastic shoelaces, long-handled shoehorns, sock aids, dressing sticks, and lace locks, to be used as a one-handed activity. Velcro straps were also used for those with limited muscle strength and people with amputations. As far as eating aids, I designed, fabricated, and sold vinyl coated spoons that were easily molded to make offset spoons or forks. Rocker knives made in Japan were a popular item. I also used an epoxy putty material for shaping utensils to fit the shape of the patient’s hand while eating. Lightweight utensils were fabricated for people with arthritis who had weakened hand strength, and weighted utensils were fabricated for people with tremors, like Parkinson’s disease. Other very successful products were scoop dishes and plate guards which prevented food from coming off the plate. Reachers, universal cuffs, long-handled hair brushes and combs, suction-cupped brushes for cleaning one’s dentures, and adaptations for electric razors were some other items. All of the adaptive aids that I developed and marketed were practical, could be easily used, were inexpensive, and were safe to use. In general, these devices were small and could be sent through UPS.

13. How did you collaborate with other occupational therapists in designing new adaptive devices?

I collaborated with occupational therapists working in physical rehabilitation departments. This was essential to my success. I traveled extensively to occupational therapy departments and asked occupational therapists what they needed most in helping their patients with activities of daily living. I also asked, "Do you have any complaints about any of the devices that are being used?" Later on, some of these same therapists complained that I stole their ideas. I always felt the devices were open to everyone, and that there was no patent or restriction in fabricating a similar device. I developed a successful business by working hard, developing personal relationships, and being responsive to the needs of patients and the requests from therapists.

I also visited occupational therapy educational programs and gave free lectures on adaptive devices. Once, I visited the University of Alabama program at Birmingham’s Spain Rehabilitation Center. I was consulting on a patient with a head injury who could not pronate his wrist so that he could feed himself. On the spot, I adapted a spoon that was bent so that the patient did not need to pronate the wrist to eat. 

14. Your company was successful in the United States. Were you able to extend your business to an international market?

Our company was never very successful internationally. For example, in Great Britain, all of our products had to be approved by the National Health Service which delayed the process of marketing our products. Another point is that the British eat in a different style by turning their fork over and loading the food on the back side of the fork. We did not have an adaptive device that met their specific needs for eating. In Japan, we discovered that our products were not appropriate since the Japanese mainly eat with chopsticks. The Germans and Swiss were not receptive to our rehabilitation products since they had their own products. The Norwegians and Swedes felt that the products we manufactured were not very attractive. In addition, the African market was closed to us because the products were too expensive for the average consumer of rehabilitation devices. Other barriers were the shipping and customs regulations in the foreign countries. These procedures were time-consuming and prevented us from marketing our products overseas.

AMBUCS

15. What is your involvement in AMBUCS?

AMBUCS, which stands for the American Business Clubs, is a not-for-profit charity that has provided scholarships for students in occupational therapy, physical therapy, and speech pathology. AMBUCS invited me to be on an advisory committee to explore a variety of options for hand and foot-powered tricycles to provide therapy for children. A physical therapist from Texas was invited by the advisory committee to discuss the needs of children with motor disabilities. She expressed the need for a hand and foot tricycle to provide exercise for the children. Picking up on this, one member of the advisory committee had a machine shop and started making custom designed tricycles for children with motor disabilities. Soon the word got out and the demand was overwhelming. This encouraged the “Ambility” Advisory Committee of AMBUCS to take on the project in Texas. A factory in Kansas began manufacturing a “standardized” tricycle that fitted 4 to 6-year olds. They later developed a larger tricycle for children 7 to 11 years old. The “Greenbucs” chapter of AMBUCS took on a project to buy 25 tricycles from Toys"R" Us and convert them to hand and foot drives as a research study. The tricycles were successfully reconverted to therapy trikes for two to four-year-olds. The Kettler Company in Germany, who already manufactured tricycles, agreed to manufacture a large quantity of the new models. The new model of tricycle was very successful and sold very well. The next stage of the development of the tricycle came when The Gomier Company, from Taiwan, a manufacturer of tricycles, reached out to AMBUCS and offered to share ideas and to manufacture a hand and foot-powered tricycle. This has turned out to be a very successful venture. I have been associated with AMBUCS for 30 years and have served on a number of projects in collaboration with therapists in designing and manufacturing products for individuals with disabilities.

Most Important Contribution

16. What would you consider your most important contribution to the occupational therapy profession?

I became an occupational therapist during the 1950’s and 60’s when the federal government was supporting the rehabilitation professions through scholarships. The legislation required hospitals and health facilities to provide occupational therapy, physical therapy, and speech pathology. Occupational therapy, as a profession, expanded rapidly, and I was able to develop a mail order business that provided self-help gadgets and adaptive equipment that practitioners and patients were requesting. By collaborating closely with occupational therapists and being sensitive to the needs of patients, I was able to develop a successful enterprise that filled an important need in the profession. My most important contribution to the profession was bringing adaptive equipment to the hospitals and clinics to help patients to be more independent in the areas of activities of daily living. The products that I invented, manufactured, and distributed were practical, easy to use, and inexpensive. By being an occupational therapist and businessman, I was able to make that leap or connection so that I kept in touch with trends in clinical practice. I can say with modesty that the "Fred Sammons" name became identified with the design and manufacture of ADL devices that were made widely available to the profession.

Advice to Young Entrepreneurs

17. What advice would you give young entrepreneurs who want to start a business related to occupational therapy?

It is known that 20% of small businesses fail in their first year, 50% of small business fail after five years in business, and finally, only 30% of small business owners will survive their 10th year in business.

• Do not buy or lease space before you start your business. It is a good idea to start small with limited expectations. For example, I started my business in my basement while I was still employed by RIC. It is a good idea to start your enterprise in your own home or apartment, rental property, garage, or basement.
• Do not invest in expensive stationery. Use FedEx press or UPS stores to copy or create business brochures or catalogs.
• Invest in a post office box that keeps your address confidential. You can also use an e-mail address or separate telephone number from your residential phone. It is important at the beginning of a business to separate your personal assets from business assets.
• Start small with modest expectations. Remember as the business expands you can use the income or profits to enlarge the enterprise.
• In designing a new product for consumers, the product must be something that another person needs or must have. For example, button hooks were needed by the client who was unable to fasten buttons. Do informal market research to find out what consumers with disabilities need to become independent and what needs are identified by the occupational therapists.
• Do not seek a patent which is used to protect inventions and intellectual properties. It is very expensive costing from $15,000 to $20,000. The money for the lawyer and patent registration will put the small business into a hole. As an entrepreneur, I have never patented any of my adaptive devices. On the other hand, you should copyright all your work with a letter "C" plus date which indicates that you will register and patent the adaptive device in the future when it pays financially.
• It is a good idea for your new business to be registered with a local governmental agency and to report the business to the Better Business Bureau and local Chamber of Commerce so that you can get a bank account.
• If you set up a new business, be sure to learn everything you can about the potential clients such as the ADL needs of individuals with disabilities and the interventions currently used. In other words, you need to be an expert in the business.
• In developing a business model or plan, think short term regarding space, expenses, personnel, marketing, clients served, and product development. A business evolves, and as such, the owner of the business has to be flexible to change when circumstances demand it.
• Do preliminary planning regarding client referrals. Be sure that you have referring agencies such as hospitals, physicians, and other occupational therapists before investing “a ton of money in the business”.
• Establish good relationships with consulting and collaborating occupational therapists. The heart of a good business is establishing an honest relationship with your clients.
• A good idea is to take a short course in running a business. I took a weekend course at the University of Michigan from a professor at the business school. Local colleges and universities offer courses for starting a business which can be very helpful.
• Another resource is to contact SCORE which is a 501(c)(3) nonprofit organization that provides free confidential business mentoring services to prospective and established small business owners in the United States. More than 10,000 volunteers provide these services, and all volunteers are active or retired business executives and entrepreneurs.
• In selecting a lawyer for your business, interview a number of lawyers and select the one who you feel compatible with personally and understands the purpose of occupational therapy. The lawyer should be familiar with good business practices and has a good record of ethical dealings.
• When the business has started to establish itself in the community, hire a CPA accountant. In the beginning, I hired a part-time bookkeeper with post-polio syndrome who was in a wheelchair.
• Every business should have liability insurance, and hopefully, there will never be a claim against the business. I have never had anyone successfully sue me for product liability, but it is like any insurance policy as it provides ease of mind.
• Keep personal assets like one’s house and car separate from the business so that it cannot be used as business assets in case of a bankruptcy.

18. What are the pressing needs and trends in designing assistive technology today?

Recently, I received an advertisement for an electronic spoon that senses tremors and tries to counteract it. The cost is $900 and with accessories extra. This is much different than the devices that I first developed that cost very little to the consumer. However, if a nursing home could own the spoon and schedule it for many feedings it might be economical. Another electronic device adjusts the angle of the eating utensil and costs a “mere” $300. My personal rule of thumb for designing adaptive equipment is that it must work, be robust and durable, and be affordable to the consumer. In determining the cost of the device, other factors must be considered such as how much inventory to stock, the cost of distributing and shipping the product, and advertising and marketing. For example, when I started my business I could afford to hire occupational therapists who did not have any business education or business experience. Today, I see a trend in hiring people who have advanced degrees in marketing but little knowledge of occupational therapy. There is also a trend for drugstore chains to sell adaptive equipment that is not custom designed and may or may not be effective. On the other hand, when I started my business, occupational therapists who worked for me tried to custom fit the adaptive device to the needs of the patient rather than creating a universal device that fit all patients. From time to time, I get mail order brochures with all kinds of adaptive devices that advertise quick and easy solutions to complex problems. All I can say is that the consumer of rehabilitation devices should be well informed and a bit suspicious of modern-day hucksters!

Future Thoughts

19. What are the influences of robotics and artificial intelligence (AI) on the future of occupational therapy?

There are occupational therapists who are working with engineers in devising adaptive equipment for those individuals with severe disabilities. For example, Dr. Roger Smith, at the University of Wisconsin-Milwaukee, works extensively with engineering students in artificial intelligence and robotics. RESNA is a good resource to find out what the trends are in AI, robotics, and assistive devices.

20. What are future areas of practice in occupational therapy?

For over 100 years, many occupational therapists have been working in the margins of rehabilitation. The practice of occupational therapy continues to expand in so many areas such as home assessments for aging in place, vision rehabilitation, driver assessment and rehabilitation, health and wellness, and neonatal care. For this reason, we reach out into the margins of clinical practice and do things that are related to what we think might work better than traditional occupational therapy. As a result occupational therapists are always in flux in making minor and major changes in our domain of clinical practice. I look back at my own experiences when I was working in the 1950s in RIC. During this time, I traveled to New York City to take a course in vocational evaluation at New York University. This enabled me to develop evaluations for my rehabilitation patients. However, no one wanted my services because I was too far outside the typical occupational therapy domain of practice. That was 1958. Today, I have two occupational therapy friends who work for the state of Michigan. One teaches retailers ergonomic practices in preventing work injuries, and the other occupational therapist works with clients in their home by providing ergonomic solutions to home safety such as shower bars and raised toilet seats.

I trained in college to be a high school industrial arts teacher so that I was prepared to teach 11 different vocational trades in high school. I was educated in occupational therapy to work in mental health, pediatrics, and rehabilitation. I could have been an occupational therapist in any one of these clinical areas, but my major career turned out to be an entrepreneurial business of designing, marketing, and selling adaptive devices. My personal experience demonstrates that our occupational therapy education prepares us for many aspects of the profession. Where we wind up in our careers will depend upon many factors that may lead us in other directions. We have to be flexible and respond to the needs of society.

I think the future areas of clinical practice in occupational therapy will be outside the traditional areas that are taught in occupational therapy curriculums and will be based on changes in society, opportunities, and what we can do as occupational therapists in helping individuals who are disadvantaged and disabled to be as independent and self-reliant as possible.

Summary

Fred is a pioneer in inventing, fabricating, marketing, and selling self-help devices that are practical, easy to use, inexpensive and serve the needs of patients with disabilities. Fred is successful as a businessman because he combines an optimistic and friendly attitude in his relations with his customers, is knowledgeable and sensitive to the needs of patients, and maintains a strong work ethic. Fred is a model for those occupational therapists who are interested in combining their professional education with a business model. For more information on Fred’s contribution to the profession, go to the Fred Sammons Archive Project Resource.