02/29/2012 03:01 pm ET Updated Apr 30, 2012

Ivy League Rethinks Concussions

Last year, Cornell saw an increase in reported concussions across all sports, with football once again recording the most of any team. Former Sun Sports Editor Alex Kuczynski-Brown spoke with three former players -- two of whom had their collegiate football careers ended prematurely due to concussions -- to find out how exactly the injury affected them, both academically and personally. She also sat down with medical professionals at Cornell in an effort to understand what the University -- and Ivy League in general -- is doing to combat this national issue.

On Wednesday, Oct. 20, 2010 then-freshman safety Nnamdi Abalihi collided with freshman running back Grant Gellatly during practice.

"As soon as we made contact my head just snapped back, and then from that moment on I just felt lost ... like I was still there, but not completely there," Abalihi said of the accidental collision. "I got this big headache ... they'd show us cards to run the defense and I'd look at it and sometimes I'd forget, so I'd ask the guy next to me 'Hey, what are we supposed to do?'"

Abalihi did not seek medical attention right away, electing instead to take some Tylenol later that night.

"I thought it was just a headache," he said.

The next morning, however, Abalihi's headache was so bad that he knew he had a concussion. He saw a doctor, who administered a memory test that Abalihi "did okay on ... I was slow, I wasn't really quick on it." Then came a balance test, which confirmed that he "definitely [had] bruising somewhere."

"It was the simplest thing: close your eyes, stand on two feet with your arms to your sides," Abalihi explained. "And I started wobbling. I fell a couple times, too."

After seeking input from both his doctor at home and a neurologist, Abalihi heeded their recommendation to end his football career. The concussion -- Abalihi's fifth overall -- left him struggling to do homework, and with impaired speech, balance and, at times, speed.

"I tried doing homework ... and that was bad," he said. "I could read words and stuff, but I couldn't really concentrate. Like if we had a conversation, five minutes in I'd be like 'What did we say?'"

During the month following his diagnosis, Abalihi continued to go to class, but had no required work, ultimately taking incompletes in two courses and dropping the other two. He went home for Thanksgiving Break and did not return to Cornell until the beginning of the Spring 2011 semester.

Even though his instructions while at home were to "just rest," Abalihi mentioned that was "when the symptoms got really bad."

In addition to being on medication for nausea, he also experienced dizziness and loss of appetite. Most of the time, he did nothing but sleep.

"It was good for recovery and stuff ... but it was just the worst feeing ever," Abalihi said.

Even after two months of mandated relaxation, the current sophomore admitted "It took a long time -- all second semester -- for me to actually get back to where I was before."

Upon his return to campus Abalihi still suffered periodic headaches, and the effort to regain his pre-concussion form represented a slow, painstaking process.

"I'm sharp now, again, thank God," he said. "When I first got back, I just had to re-learn reading ... I had to read really slowly. Now I've picked up the speed, but at first it was just real slow. I had to take my time."

Abalihi was just one of several Cornell football players who saw their seasons -- and careers -- cut short last year due to concussions.

In an interview with The Sun this past March, Gannett's Chief of Sports Medicine Dr. David Wentzel mentioned that Cornell's concussion numbers for the academic year 2010-11 "were up across all sports."

"By the end of [the Fall 2010] semester, we had seen more concussions in our athletes than we had the entire last year," he said, noting that in some instances those concussions were the product of alcohol-related or freak accidents.

However, Wentzel did mention that Princeton and Cornell were at the top of the Ivy League in football concussions in 2010. According to head athletic trainer Bernie DePalma, the football team regularly sees the most concussions by far of any varsity squad at Cornell.

"There's no comparison," he said, adding that other collision sports such as men's ice hockey and men's lacrosse also tend to see a fair amount of concussions, followed by contact sports like basketball, women's lacrosse and women's ice hockey at the next tier down.

DePalma said last November that while he did not know the reason behind Cornell's concussions increase, part of the 2010 offseason would be dedicated to studying video and looking at "neck strength and how to train the neck to decelerate the head during contact and collisions."

"A concussion isn't necessarily from a blow to the head -- helmets are not designed to prevent concussions," DePalma explained. "First of all, you can't prevent it with equipment because it's the brain banging against the inside of the skull, floating around in fluid, and it hits the inside of the skull, and that's what causes the concussion. So that could be from a body hit, whiplash, it could be from a direct hit, it could be from just falling."

In July, the Ivy League released a 21-page concussion report based on the findings of an ad hoc committee co-chaired by Cornell President David Skorton and Dartmouth President Jim Yong Kim.

The committee's series of recommendations, which were accepted by the presidents of all eight schools, will take effect this season and are intended to reduce the number of concussions and subconcussive hits in Ivy League football.

The new rules include the limitation of full-contact practices allowed per week to just two -- three less than the NCAA maximum. Spring practice will also see the number of permitted full-contact practices cut by one -- a 12-percent reduction from the current Ivy League limit, and a 42-percent reduction from the NCAA maximum. Another new rule limits the number of days that pads can be worn during both sessions of preseason two-a-days to just one.

According to the report, greater emphasis will also be given to teaching proper techniques for avoiding helmet hits, and educating student-athletes about the signs and symptoms of a concussion, as well as the long-term risks associated with repetitive brain trauma.

Additionally, "Officials will be directed to continue erring on the side of caution by calling penalties if a helmet or head hit might have occurred, which will in turn allow the Ivy League office to assess and determine any appropriate post-game ramifications."

The report states that beginning this season, "the Ivy League Executive Director [Robin Harris] will take appropriate but firm action in response to helmet hits, including suspension for intentional hits."

In years past, helmet-to-helmet or targeted hits resulted in an email reprimand from the executive director to the head coach, with a reminder that coaches should continue to review the importance of player safety, particularly regarding helmet hits.

According to DePalma, the Ivy League has been at the forefront of concussions research for quite some time, and back in the early 1980s was part of a group of 11 institutions that performed one of the first comprehensive studies on concussions out of the medical school at the University of Virginia.

One of the recommendations to come out of that study was the grading system for concussions, which depended on how the athlete reported his or her symptoms.

"The last couple years the NCAA and the medical profession has gotten away from the grading system, but that research back then led to what we're doing now, in a sense," DePalma said.

With the old system, an athlete who sustained a Grade 1 concussion could technically be allowed back in the game if the symptoms cleared up in 15-20 minutes.

Nowadays, "If you're diagnosed as having a concussion, you're out that day, absolutely you're not allowed to go back," DePalma explained. "Then there's eight steps to return to play and that can be three days, it could be three weeks, it could be three months, it could be a year depending on how long it takes that athlete to clear up ... and they've got to pass numerous tests to do that, including a physical test without symptoms [and] neuropsych tests without symptoms."

The summer prior to arriving at Cornell, every individual participating in a concussion-prone sport must take a baseline exam designed to test neuropsychological and neurocognitive function. In the event the athlete sustains a concussion, his or her score on the neuropsych test -- taken 24 hours after the initial diagnosis -- is then compared to the original baseline.

"We're testing those same athletes against themselves," Wentzel explained.

DePalma mentioned that athletes usually still have symptoms 24 hours after getting a concussion, and must ultimately go 24 hours symptom-free before being allowed to do anything.

"Once they do that, we start slowly -- allow them to ride a bike first," he said. "If that goes well, we'll pump it up to maybe jogging. If that goes well we may add weight-lifting, where we increase their heart rate a little bit more. If that goes well we may allow them to do sport-specific drills.

"The thing ... we're seeing more and more of is that even if you're not working out -- if you're in the weight room observing -- the pounding of the weights and the noise brings symptoms back, and that just sets you back. Now you start over again -- your 24 hours ended, you had symptoms, so now we've got to back up again."

Abalihi stated that prior to returning home for the remainder of the fall semester, he was on the sideline during a Cornell football game at Schoellkopf. The noise from the crowd and marching band affected him to the point that he had to periodically go inside to the training room and just stand there for 10-20 minutes before coming back out. The sun in particular gave Abalihi a "really bad headache" -- even with a hood over his head.

As far as multiple concussions are concerned, Wentzel stated that they are "kind of like snowflakes," in that "you won't see one exactly alike." They also do not necessarily get progressively worse.

"Sometimes you can have a severe one the first time, where they're having a lot of amnesia with it ... a second concussion may be milder, and they may recover in four days. So it really varies," Wentzel said.

Such was the case for former Cornell running back Marcus Hendren '11, who missed the remaining eight weeks of his senior season due to a concussion sustained during the Red's Homecoming game against Yale on Sept. 25.

"I cut back and headed toward the sideline," Hendren stated in an email. "I didn't have anywhere to go and instead of just running out of bounds, I lowered my head and shoulder and made contact with their safety."

Hendren had suffered three concussions prior to this one, the first of which came while playing baseball in eighth grade. That concussion left him unconscious. The next two happened during his sophomore and junior seasons of college, with a rehab period of two weeks for each.

"There are different degrees of concussions, and I think the first and the last were to a higher degree than the middle two," Hendren wrote.

According to Wentzel, "The thing that I see more with repeat concussions, where we start worrying is ... increased vulnerability: it doesn't look like a bad hit."

This proved true in the case of former free safety Ben Heller '11, who sustained a concussion every year of college with the exception of his junior season -- including two his freshman and sophomore years.

During Cornell's Oct. 9 game at Harvard, Heller collided with then-freshman teammate Brian Gee, who actually left with a concussion. Heller was able to come back, but then took a few hits during practice a couple days later.

"That night I just felt terrible," he recounted. "You never want to tell the trainer two days before [a] game ... but I had to. He held me out for that week."

Unaware at the time that he may have sustained a concussion during the initial collision, Heller explained that with some hits "you know you're out," but with others, "you're kind of like 'I'm fine, I'm good to keep going.'"

"That was like the hit at Harvard," he continued. "I finished the game and I was fine, and then I guess I was vulnerable during the week -- I took a few hits during practice, and then it just made it that much worse."

The former safety described how a lot of guys on the team will suffer a head injury but "kind of just act like nothing happened. They go back in, they get hit again, and then that's called Second impact syndrome, which is very serious. People have died from those type of injuries."

Heller was able to return to the field a week later, participating in non-contact practice after first spending four days doing "just nothing -- sleep I guess."

"A concussion is just the most frustrating injury," he said. "It's not like a sprained ankle, you can't do rehab -- it's just pretty much lay down and just hang out and don't do anything ... sleeping is the best type of rehab for a concussion."

Fortunately for Heller, none of his concussions ever affected his academic work, though the same cannot be said for some of his teammates.

"I know guys on the team who have had concussions ... and for like 2-3 weeks it was very tough [for them] to be in a room with bright lights, or have a professor on the microphone. They'd get headaches, have to leave the classroom," Heller explained. "A lot of guys on the team had it way tougher than I did with respect to schoolwork."

Hendren recalled spending hours studying for a Finance prelim, only to forget everything as soon as he finished.

"I tried to keep up with my schoolwork following those concussions, but every symptom really works against you," he wrote.

According to Hendren, he "experienced the entire spectrum of side effects from concussions over the years," and that while the headaches and difficulty concentrating are a given, "with the last concussion, I felt nauseous for four weeks anytime my heart rate increased -- walking up hills, stairs, etc."

Hendren's symptoms only lasted during the season, and once he was able to exercise again, "everything pretty much returned to normal." He has not had any problems since, but admitted that his memory was "definitely affected" during the rehab period.

"I attempted to study and could never retain any information regardless of the time spent," he said. "I often found myself forgetting a lot of small stuff like appointments, assignments, etc."

When an athlete sustains a concussion, DePalma and his staff refer him or her to the Assistant Director of Athletics for Student Services, Chris Wlosinski. She serves as a liaison between the athlete and their professors, helping to figure things out schedule-wise as far as postponing prelims and papers go.

That being said, the process is not always without complications.

While Hendren told his professors about his injury, "There is only so much they can do to accommodate for an ailment that is nonvisual."

"By that I am basically saying that although I had a doctor's note, most did not fully believe the concussion was a serious issue," he continued. "I just had to do whatever I could and accept it for what it was."

Wentzel described a situation that happened last fall, in which a professor was not going to let an athlete postpone anything.

"I had an athlete come in and sign a release so I could talk to the professor. I emailed the professor, I left a phone message ... they never returned my call," he said. However, upon realizing that Wentzel was involved, the professor allowed the student in question to delay turning in assignments.

In addition to keeping tabs on their academic well-being, Cornell's medical staff also monitors concussed athletes for depression and altered mood, according to Wentzel.

"I had a lacrosse player sent down a couple years ago, the athletic trainer was worried about him -- he was crying in the locker room after the game, and we [had] won the game," Wentzel explained. "When I started talking to him I said 'Did you get hit in the head in the game?' and he said 'Oh yeah, the first [quarter]' -- and he continued to play."

Wentzel then asked "You didn't know why you were crying?" to which he responded, "Naw, I had no idea."

After their conversation Wentzel did a concussion inventory, and not surprisingly the lacrosse player had a high symptoms score.

Speaking on his own experience, Hendren said "it was a very difficult time ... emotionally," but did not know if that was a product of the concussion, or the realization that he would never play football again.

Regarding depression, DePalma mentioned that many experts in sports-related concussions -- such as Dr. Robert Cantu and Dr. Michael Collins -- are at present concerned by the media's ongoing attempts to connect concussions to brain damage and suicide.

"Those are articles being written with no scientific basis because they haven't shown ... that concussions lead to all this stuff," DePalma said. "Right now it's anecdotal, and they're kind of speculating."

Wentzel echoed this sentiment:

"No one has proven a clear link since suicidality is such a multifaceted problem, and so many different things can lead someone to that."

DePalma acknowledged that "concussions do affect cognitive ability to do things," and that it is usually around the fourth concussion in a career that "we start to see athletes not being able to recover as quickly [and] having more problems cognitive-wise and academically ... and where they start to get very emotional and very frustrated."

It is also at about this time that Cornell's medical staff have a "serious conversation" with the player about ending their athletic career. According to DePalma, most of the time they agree that "enough's enough," as do their parents.

"The one this year was the worst, which kind of scared me," Heller said of his fifth concussion. "The headache that I had was just worse than what I experienced before. What I experienced before was [haziness and dizziness], but my head really wasn't throbbing. This time, it was throbbing."

Heller said that initially he was thinking of playing football in Canada or trying out for the NFL after his senior season.

"I'm not doing that now, but I was thinking about it," he stated. "I spoke to the trainers, I spoke to Rhett [Ticconi], who's our Director of Operations ... they told me 'You've had a lot of concussions, probably not a good idea.'"

Hendren's decision to end his collegiate football career prematurely came four weeks after the Homecoming game.

"After those four weeks, I had not progressed as quickly as I'd hoped," he wrote in an email. "It was a mutual decision between the trainers and myself."

Hendren said he made the decision after studying the long-term effects of concussions outweighing the benefits of returning to play. Even though he is now symptom-free and was able to start lifting weights/exercising with two weeks left in the season, Hendren does not regret not coming back.

"I should have run out of bounds, though," he said.

The article originally appeared in the Cornell Sun.