Two years ago, Patty Phommanyvong was a healthy 17-year-old. Now she will never walk or talk again. She was injured while cheerleading -- an athletic activity some say is now among the most dangerous for young girls.
Then she suffered an accident that stopped her breathing. Her parents claim that her school's defibrillator failed and the 45 minutes she went without oxygen left her with a brain injury that caused permanent paralysis. Today, Phommanyvong can only communicate by blinking.
One blink means yes. Twice means no. Maybe is multiple blinks.
Cheerleading has long been an iconic American pastime, and it is now more popular than ever. By one estimate, 3 million young people cheer, more than 400,000 at the high school level. And cheerleaders are no longer only on the sidelines -- many cheer competitively.
The degree of difficulty of cheer stunts has exploded. So too has the number of accidents.
Cheerleading emergency room visits have increased almost sixfold over the past three decades. There were nearly 30,000 in 2008, according to the Consumer Product Safety Commission.
The numbers are all the more disturbing because some states don't even recognize cheerleading as a sport. That means there are no uniform safety measures and training methods.
Kori Johnson is the cheerleading coach at Costa Mesa High School in Southern California. She says the cheerleaders have had to step up the degree of difficulty over the years.
"The girls, they want to be the best," said Johnson. "They want to try harder stunts. So every year when we see new stunts we try them."
Cheerleading as Competition
Costa Mesa High boasts a championship cheer squad.
Squad members say people who don't think cheerleading is a sport should just try it.
"They should be open-minded about it," one cheerleader said. "We throw people. Like our bases are lifting like people up in the air."
"It's like bench-pressing a person," a second cheerleader said.
A third cheerleader said not everyone could keep up.
"We had the water polo boys stunt with us last year and they like, quit, after like an hour," she said. "They said it was really intense."
'It's Scary. It's Scary.'
Johnson is an experienced coach with safety training and cheer certifications. She says the key to avoiding major injuries is teaching stunts step by step.
"I would never ask them to do a stunt that they're not capable of doing and trying," said Johnson. "So we make sure they have all the basic stunting and it's like stairs. We move up the ladder."
But as many parents already know, injuries are now simply a part of cheerleading.
"It's scary. It's scary," said Lynne Castro, the mother of a Costa Mesa cheerleader. But Castro said cheerleading was too important to her daughter to stop even after she suffered a serious injury. "You see other sports figures that have injuries and they just get on with it, you know. You fix it, you rehabilitate properly, and you move forward."
But there's no coming back from some of the injuries cheerleaders now risk. An injury is deemed catastrophic if it causes permanent spinal injury and paralysis. There were 73 of these injuries in cheerleading, including two deaths, between 1982 and 2008. In the same time period, there were only nine catastrophic injuries in gymnastics, four in basketball and two in soccer.
In 2008, 20-year-old Lauren Chang died during a cheer competition in Massachusetts when an accidental kick to the chest caused her lungs to collapse.
"Lauren died doing what she loved, cheering and being with her friends," said Nancy Chang, her mother, soon after the accident. "We hope her death will shed light on the inherent risks of cheerleading and we hope that additional safeguards are taken."
"It's a national epidemic," said Kimberly Archie, who started the National Cheer Safety Foundation to campaign for more safety practices in cheerleading. "I think we should be extremely concerned as a nation. ... [It's] a self-regulated industry that hasn't done a good job. If I was going to give them a report card, they'd get an F in safety."
Cheerleading is big business. Uniform sales alone are a multi-million-dollar industry. And there are thousands of cheer events all year across the nation, with competitors from ages 3 to 23. There are cheerleading all-star teams that do not cheer for any school but compete against one another.
"We don't want the kids to be hurt. We want the kids to be safe," said Tammy Van Vleet, who runs the Golden State Spirit Association, which trains cheerleading coaches and runs competitions in California. "It's our priority to make sure we provide that environment. ... Since about 1999, the degree of difficulty in cheerleading has just exploded. And we're seeing elite-level gymnasts on these cheerleading squads. And not just one athlete on the floor but 35 at a time, and [the] acrobatics and stunts that they are doing, you know, have not been matched."
That's why Van Vleet keeps two EMTs on site at major cheerleading exhibitions. But there are no uniform regulations that require such safety measures.
'What Is Safe?'
Jim Lord is executive director of the American Association of Cheerleading Coaches and Administrators, the largest cheerleading organization in the country. "Nightline" asked him whether cheerleading is safe.
"That's a great question for any sport or athletics, is, 'What is safe?'" Lord said. "There's something that says, 'Well, these are cheerleaders so they shouldn't be hurt, they shouldn't have any risks, they should be on the sidelines and they shouldn't be doing anything' -- when a lot of girls have selected this as their favorite athletic activity. And so I think there's that stigma, I think that goes along with it, for some reason."
Lord says that recognizing cheerleading as a sport would not increase safety and would only complicate managing an activity that is still not primarily competitive for most cheer squads.
"You can minimize the chance of having an injury, and what that comes down to [is] having a coach that's qualified," said Lord. "There's always going to be risk there, our job is to minimize that risk, especially from the catastrophic type of injury."
But Archie charges that the current system of recommended safety and training measures does not protect kids. Many cheer coaches only have to pass an open-book test to gain a safety certification.
Lord believes that cheerleading is not as dangerous as the injury statistics indicate. He says that cheerleading may look more dangerous than mainstream sports because there's no cheering season. Many cheerleaders practice all year, which means extended exposure to injury.
Still, critics believe that until cheerleading is recognized as a sport, safety will suffer.
If change is coming, it is too late for the Phommanyvongs. They are suing their daughter's school, claiming that the school did not respond properly to her injury. The school declined to comment for this story.
"Too far," said Patty Phommanyvong's father, Say Phommanyvong. "They went too far. They should do step-by-step."
"Maybe we can change," said her mother, Vilay. "So I don't want it to happen to another kid."