For four hours a day, five days a week, Ken Smith toils at a workbench in a dusty basement, applying physics, handcrafts and a touch of psychology to the project at hand--making legs.
Smith fashions artificial limbs out of plastic, metal and rubber as part of his program in orthotics and prosthetics at Cal State Dominguez Hills in Carson. It's the only undergraduate degree program of its kind in California and one of only three bachelor's level prosthetics programs in the nation.
Previously, Smith ran a construction business.
"It's easier to use your mind than your brawn," Smith said as he fidgeted with the adjustments on a leg.
Smith needs both the dexterity to build the legs and the clinical expertise to make sure they fit, as well as the empathy to work well with patients.
"There are people out there that have the hand skills but don't have the people skills," Smith said.
Prosthetists fill a doctor's prescription the same way a pharmacist fills a drug order, but doctors expect prosthetists to make suggestions about which artificial knee, limb or foot would work best for each patient.
Smith is one of several students who designed prosthetic legs for Matt Baughman, 21, who acts as a patient. Baughman and several others are paid to come to class three times a semester to be measured and fitted for limbs, giving the students a chance to practice their craft.
When the class is over, the legs are generally disassembled and the parts reused.
Last week, the professional patients made their final visit to Dominguez Hills, modeling the new legs while students discussed techniques for fabricating the pieces and answered questions from instructors.
Some students, such as Smith, whizzed through the process and presented a functioning artificial limb. Others haven't yet finished their limbs.
Some students take advantage of carbon graphite supports and high-tech metals that flex and add spring to a patient's step. Another new design uses a suction seal to hold the prosthetic device on the patient, providing more stability and keeping water out.
Fitted with the newest technology, people with artificial limbs run marathons, swim and play football, basketball and other sports. Prosthetists take the patient's activity level into consideration when they choose from the 125 prosthetic knees and dozens of feet available in the marketplace.
The first step in making an artificial leg is to create a plaster cast of the patient's residual limb. From that, a "check socket" is made of clear plastic. When the patient tries on the check socket, the prosthetist can see against the transparent surface those points were the skin is pinched by excessive pressure.
After assembly of the final socket, knee joint, foot and ankle, the prosthetist adjusts the leg again. Often it's covered with foam that is colored and shaped to match the patient's other limb. Last week, the emphasis was on the function of the students' projects. As the patients walked back and forth, instructors observed the motion and gait of each leg.
It takes practitioners about three weeks to make a below-the-knee prosthesis, which costs $2,500 to $6,000, and about six weeks to make an above-the-knee model, which costs $4,000 to $12,000.
On average, patients replace their prosthetic devices every three to five years, often using the same prosthetist.
"This is a lifetime relationship," said Scott Hornbeak, the director of the program at Dominguez Hills.
Each of the 12 students will complete five semesters in the classroom and then spend 3,800 hours in a formal internship--half in prosthetics, or the replacement of body parts, and half in orthotics, which is the bracing of body parts.
To get certification, students must pass exams that test general knowledge, technical expertise and patient management.
About 3,000 are currently certified by the American Board for Certification in Orthotics and Prosthetics, based in Alexandria, Va.
But even before becoming accredited, the students' work is in demand.
"There's no such thing as an out-of-work (prosthetist)," said Ed Ayyappa, a Dominguez Hills instructor. Fresh out of school and uncertified, practitioners earn $28,000 to $40,000, Ayyappa said.
Joining a relatively unknown profession does come with a disadvantage, though.
"The word prosthetist will get you some raised eyebrows," said Dana Glidden, who added that she follows it with a quick explanation: "I'm in school to make artificial limbs and braces."