Oct. 20, 2010 -- The video is hard to watch. Rutgers University defensive back Eric LeGrand goes in head-first for a tackle and collapses on the 25 yard line, frozen from the neck down by a spinal cord injury.
LeGrand, a junior at Rutgers, is currently in the intensive care unit at Hackensack University Medical Center in New Jersey. He had emergency spinal surgery soon after the game. Rutgers announced that he was paralyzed from the neck down.
Paralysis can be a grave diagnosis, as seen in other high-profile cases. Christopher Reeve, who had become famous for his role as Superman, was paralyzed from the neck down after an equestrian injury in 1995. He remained in a wheelchair and on life support, becoming one of America's leading advocates for spinal injury research until he died in 2004.
But paralysis has brought other stories that seem to border on miracles. In 2000, Adam Taliaferro, then a freshman cornerback at Penn State, was paralyzed after making a tackle. Several doctors said that Taliaferro would never walk again. But four months later, he did just that -- and in 2001, he led his old team onto the field before a game to roaring applause from the crowd.
Taliaferro later founded the Taliaferro Foundation, a non-profit organization that offers emotional, financial and educational support to student-athletes who suffer catastrophic head or spinal injuries in sanctioned team events. Taliaferro's father has already reached out to LeGrand's family to say the foundation is there to provide any support the family may need.
"My advice to Eric is to focus on where he wants to be," said Taliaferro. "He's going to hear negative news, but he has to block that out. No one knows what he has inside him. He was playing [Division 1] football for a reason. He knows how to work hard, and he'll have the strength and tools to get through rehab."
And that rehabilitation road is a long one. As of Tuesday, doctors said there had been no change in Eric LeGrand's medical status after the spinal cord injury three days before. Even for the experts in the field, it's tough to say what's in store for him.
Spinal Cord Injury: What's Going on Inside
When an injury like LeGrand's occurs, the spine goes into a state of shock, in which it essentially shuts down. During this time, it is very difficult to tell whether the patient will be able to move again. Doctors usually know more about the injury itself after the shock to the system subsides, usually about 72 hours after the injury takes place.
Dr. Andrew Carsden, associate director of the Spine Institute at Beth Israel Medical Center in New York City, said that spinal cord injuries are broken up into two categories: complete and incomplete. Taliaferro suffered from the less damaging of the two, an incomplete spinal cord injury; he showed at least a slight amount of function after his initial injury. If a person suffers a complete spinal cord injury, he will have absolutely no movement or sensitivity, making the prognosis much more grim.
"If there is any function at all after spinal shock, doctors won't know what the recovery will be," said Carsden. "It could dramatic, or it could be a very little improvement.
"If there is absolutely no function after the spinal shock has subsided, it's not good. It's as if someone took a knife and cut the cord."
Dr. Edward Benzel, a spinal surgeon and chairman of Neurosurgery at the Cleveland Clinic, said that doctors have many things to sort out before making a definitive prognosis for patients like LeGrand. Doctors will likely assess the injury through neurologic examination to see if there is even the slightest amount of motor, movement, or sensory function.
"Aggressive examinations will take place to see if he can move or feel below the level of injury, and if there is any voluntary motion," Benzel said. "The rectum is usually one of the last areas of sensation to go. If, and only if, those are all gone can a doctor say that the prognosis is exceedingly poor. If he has any sort of sensation, he has a chance of substantial recovery."
Benzel continued, "I use this analogy in a person with a neurologic injury: There are two types of injured neurons, neurons that are dead and neurons that are stunned. Dead neurons are unable to recover, but with the stunned neurons, by creating the right environment for the spinal cord, the stunned neurons could recover and function again."
Long Road to Recovery for Paralysis Patients
Still, it's tricky to figure out which neurons are dead and which ones are stunned, Benzel said. In general, patients can see neurologic recovery up to two years after the injury, but it is mostly seen about six months after. If a patient is going to recover, the process begins within the first month. But Benzel made sure to reiterate that those are extreme generalizations, and he's seen people improve who he didn't expect to improve, and vice versa.
"It is a long road of frustration and not knowing, and we have to make sure to care for the patient's mental health during the process," said Dr. Jeffrey Kutcher, assistant professor of neurology at University of Michigan and director of Michigan Neurosport. "In rehab, doctors will start with the smallest movements, and try and support those movements with exercises that will improve the strength for bigger movements."
While spinal surgery has been researched and examined extensively over the years, some doctors say there has been an unfortunate lack of advances in the field.
Benzel said that spinal surgeons have learned to use air ventilators in patients to support their breathing and catheters to prevent kidney infections. There have been improved techniques in taking pressure off the spinal cord, but otherwise, breakthroughs and treatments have been slow.
"In my opinion, no treatments in the past few decades have been real breakthroughs," said Benzel. "We see small improvements here and there, but nothing major. I'm still hopeful that at some point there will be more opportunities for better treatment. "
But doctors and researchers are trying. Just last week, U.S. doctors began treating a new spinal cord injury patient with human embryonic stem cells. The hope is that the cells will travel to the site of the injury and help the damaged nerves regenerate.
The Fate of Contact Sports
After Ted Roosevelt broke his nose playing football at Harvard in 1906, his father, President Theodore Roosevelt, established the the NCAA, to set rules for amateur sports in the U.S. Today, the organization works to set safe regulations in a positive environment for young athletes.
Just recently, in January 2010, the NCAA tightened rules on concussions. Now, student-athletes are required to leave the game after showing concussion symptoms, and no player can continue on the field if he loses consciousness.
"Football is becoming bigger, stronger, and faster," said Dr. Jordan Metzl, associate attending physician at the Hospital for Special Surgery in New York. "We need to make it as safe as possible. When a player of this caliber gets injured in this serious of a way, a lot of people are going question the sport itself."
Metzl said he often sees parents of players ask if their kids should even play football, as concussions and other serious injuries continue to plague games at all levels.
Even the NFL is getting involved in hopes of preventing such injuries. The league announced it will now suspend players for dangerous and flagrant hits on the field, especially hits that involve helmets.
"We need to concentrate on teaching players how to hit appropriately, without using the head as the point of contact," said Kutcher, a former Division 1 football player. "We have to try to get across to football players not to lead with their heads."
But, while rules are being put into place by sports leagues, LeGrand will face the challenge of coming back. People across the country are cheering for his success, including Adam Taliaferro.
"We're here for Eric and his family if they need us," said Taliaferro. "I'm praying everything works out for him."