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Anoxic brain injury (ABI) is a common consequence of drowning and can cause severe neurological morbidity in survivors. Assessment of functional status and prognostication in drowning victims can be extremely challenging, both acutely and chronically. Structural neuroimaging modalities (CT and MRI) have been of limited clinical value. Here, we tested the utility of resting\u2010state functional MRI (rs\u2010fMRI) for assessing brain functional integrity in this population. Eleven children with chronic, spastic quadriplegia due to drowning\u2010induced ABI were investigated. All were comatose immediately after the injury and gradually regained consciousness, but with varying ability to communicate their cognitive state. Eleven neurotypical children matched for age and gender formed the control group. Resting\u2010state fMRI and co\u2010registered T1\u2010weighted anatomical MRI were acquired at night during drug\u2010aided sleep. Network integrity was quantified by independent components analysis (ICA), at both group\u2010 and per\u2010subject levels. Functional\u2010status assessments based on in\u2010home observations were provided by families and caregivers. Motor ICNs were grossly compromised in ABI patients both group\u2010wise and individually, concordant with their prominent motor deficits. Striking preservations of perceptual and cognitive ICNs were observed, and the degree of network preservation correlated (<jats:italic>\u03c1<\/jats:italic>\u2009=\u20090.74) with the per\u2010subject functional status assessments. Collectively, our findings indicate that rs\u2010fMRI has promise for assessing brain functional integrity in ABI and, potentially, in other disorders. Furthermore, our observations suggest that the severe motor deficits observed in this population can mask relatively intact perceptual and cognitive capabilities. <jats:italic>Hum Brain Mapp 38:4813\u20134831, 2017<\/jats:italic>. \u00a9 <jats:bold>2017 Wiley Periodicals, Inc.<\/jats:bold><\/jats:p>","DOI":"10.1002\/hbm.23745","type":"journal-article","created":{"date-parts":[[2017,7,31]],"date-time":"2017-07-31T17:02:41Z","timestamp":1501520561000},"page":"4813-4831","source":"Crossref","is-referenced-by-count":23,"title":["Functional integrity in children with anoxic brain injury from drowning"],"prefix":"10.1002","volume":"38","author":[{"given":"Mariam","family":"Ishaque","sequence":"first","affiliation":[{"name":"Research Imaging Institute, University of Texas Health Science Center at San Antonio San Antonio Texas"},{"name":"Department of Radiology University of Texas Health Science Center at San Antonio San Antonio Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janessa H.","family":"Manning","sequence":"additional","affiliation":[{"name":"Merrill Palmer Skillman Institute, Wayne State University Detroit Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary D.","family":"Woolsey","sequence":"additional","affiliation":[{"name":"Research Imaging Institute, University of Texas Health Science Center at San Antonio San Antonio Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Crystal G.","family":"Franklin","sequence":"additional","affiliation":[{"name":"Research Imaging Institute, University of Texas Health Science Center at San Antonio San Antonio Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth W.","family":"Tullis","sequence":"additional","affiliation":[{"name":"Conrad Smiles Fund San Antonio Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian 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