Clinical Interests

Cognitive assessment and intervention, awareness deficits after brain injury, driving and community mobility

Research Interests

Dr. Barco’s research interests focus on driving performance in older adults with various medical impairments. Her research goals are to develop ways clinicians can better assess driving performance in their clients as well as to identify interventions to prolong driving and community mobility throughout the lifespan. She collaborates closely with David Carr, MD, and Anjali Bhorade, MD, in grant-funded research studying fitness to drive in various populations including older adults with dementia, stroke, Parkinson's disease and visual disorders (glaucoma). She has developed a tool to score driving errors which is being utilized nationally and in NIH studies.

Additionally, Dr. Barco has collaborated with Eric Lenze, MD, and his research team to study the effectiveness of an innovative training based program focused on increasing motivation and therapy intensity in older adults receiving occupational and physical therapy services with the goal to improve functional outcomes (NIH R01 PI: Lenze). She is actively involved with the continuation of this research at Shirley Ryan Ability Lab with Alex Wong, PhD, with individuals who have spinal cord injuries.

Teaching Roles

Dr. Barco teaches in multiple areas including cognitive assessment, cognitive intervention and classes that relate to driving evaluation and rehabilitation. She is the co-course director of M01 642 Evaluation and Intervention: Adults and Older Adults and the course director of OT682 Translational Science in Action. In her intervention course, she provides opportunities for students to work directly with persons impacted by cognitive challenges resulting from health conditions to facilitate integration of clinical experience and classroom learning throughout the semester.


2013: Doctorate in Occupational Therapy (OTD), Washington University School of Medicine in St. Louis, Program in Occupational Therapy
1987: MS in occupational therapy, Washington University School of Medicine in St. Louis, Program in Occupational Therapy
1984: BS in occupational therapy, Washington University School of Medicine in St. Louis, Program in Occupational Therapy
1981: Bachelor in Social Work, University of Missouri-Columbia


Dr. Barco specializes in the assessment and treatment of adolescents and adults with brain injuries. Prior to joining the faculty, she was the program coordinator for the Head Injury Resource Center for 15 years (currently located Mercy Medical Center in St. Louis), and the administrative director of medical services at The Center for Head Injury Services, a not-for-profit comprehensive community integration center in St. Louis. She assisted in the development of a model of practice addressing awareness deficits after brain injury which is currently in textbooks and utilized in treatment programs today.

Dr. Barco is specialty certified by American Occupational Therapy Association in driving and community mobility and a certified driving rehabilitation specialist thru the Association for Driver Rehabilitation Specialists. Dr. Barco has performed driving assessments and interventions for more than 20 years and has been instrumental in the development of driving programs in rehabilitation facilities associated with major medical centers across Missouri. She currently provides clinical services thru Washington University Occupational Therapy Community Practice.

Selected Publications

Costello, M., Barco, P.P., Manning, K. J., O’Brien, K. E. Older adult driving performance assessed under simulated and on-road conditions. Applied Neuropsychology, published online May 15, 2022,

Barco, P. P., Wallendorf, M., Blenden, G., Rutkoski, K., Dolan, K., & Carr, D. (2021). Caregiver prediction of driving fitness in older adults with dementia. Clinical Gerontologist, 1-8. doi:10.1080/07317115.2021.1872130

Baris, E., Rodebaugh, T., Bland, M., Barco, P., Lenard, E., Lang, C.E., Miller, J.P., Yingling, M., Lenze, E.J. (2021). Executive function moderates Functional Outcomes of Engagement Strategies during Rehabilitation in Older Adults. American Journal of Physical Medicine & Rehabilitation.

Barco, P. P., Wallendorf, M., Rutkoski, K., Dolan, K., Rakus, D., Johnson, A., & Carr, D. B. (2020). Validity and Reliability of the Traffic sign Naming Test (TSNT) and Written Exam for Driving Decisions (WEDD) as measures of fitness to drive among older adults. The American journal of occupational therapy: official publication of the American Occupational Therapy Association, 74(3), 7403205090p1–7403205090p10.

Lenze, E. J., Lenard, E., Bland, M., Barco, P., Miller, J. P., Yingling, M., Lang, C. E., Morrow-Howell, N., Baum, C. M., Binder, E. F., & Rodebaugh, T. L. (2019). Effect of enhanced medical rehabilitation on functional recovery in older adults receiving skilled nursing care after acute rehabilitation: A randomized clinical trial. JAMA network open, 2(7), e198199.

Barco, P. P., Baum, C. M., Ott, B. R., Ice, S., Johnson, A., Wallendorf, M., & Carr, D. B. (2015). Driving errors in persons with dementia. Journal of the American Geriatrics Society, 63(7), 1373-1380.

Barco, PP, Carr, DB. Rutkoski, KR, Xiong, C., Roe, CM (2015). Brief Report - Inter-rater reliability of the record of driving errors (RODE), American Journal of Occupational Therapy, 69, 6902350020.

Barco PP, Wallendorf MJ, Snellgrove CA, Ott BR, Carr DB (2014). Predicting Road Test Performance in Drivers with Stroke. American Journal of Occupational Therapy, 68(2), 221-229. (Not supported by NIH funds)

Aufman EL, Bland MD, Barco PP, Carr DB, Lang CE. Predictors of Return to Driving after Stroke (2013). American Journal of Physical Medicine & Rehabilitation, 92(7), 627-634. doi:10.1097/PHM.0b013e318282bc0d

Hetland AJ, Carr DB, Wallendorf MJ, Barco PP (2014). Potentially driver impairing’ (PDI) medication use in medically impaired adults referred for driving evaluation. Annuals of Pharmacotherapy. 2014 Jan 28. [Epub ahead of print] PMID:24473491

Meuser T, Berg-Weger M, Niewoehner P, Harmon A, Kuenzie, Carr DB, & Barco PP (2012). Physician input and licensing of at-risk drivers: A review of all-inclusive medical evaluation forms in the US and Canada. Accident Analysis and Prevention, 46: 8-17. ISSN 0001-4575, 10.1016/j.aap.2011.12.009. (Not supported by NIH funds)

Ott, B. R., Papandonatos, G. D., Davis, J. D., & Barco, P. P. (2012). Naturalistic Validation of an On-Road Driving Test of Older Drivers. Human Factors, 54(4), 663-674. doi: 10.1177/0018720811435235

Carr, D.B., Barco, P.P., Wallendorf, M.J., Snellgrove, C.A., Ott, B.R (2011). Predicting road test performance in drivers with Dementia. Journal of American Geriatrics Society, 59: 2112-2117. (PMCID:PMC3228409)

Crosson B, Barco PP, Velozo CA, Bolesta MM, Werts D, and Brobeck TC (1989). Levels of awareness and compensation in post-acute head injury rehabilitation. The Journal of Head Trauma Rehabilitation, 4(3): 46-54.

Select Book Chapters and Other

Burch, K., Barco, P.P. Cognitive disabilities model: interventions for clients with dementia. (2019). In T. J. Wolf, D. Edwards, & G. Giles (Eds.), Functional Cognition (pp. 239-262). AOTA.

Barco, P. P., Gillen, G., Wolf, T.J. (2019). Cognitive intervention selection: Learning and concepts of transfer. In T. J. Wolf, D. Edwards, & G. Giles (Eds.), Functional Cognition and Occupational Therapy: A Practical Approach to Treating Individuals with Cognitive Loss (pp. 179-188). AOTA

Manning, K. J., Barco, P. P., Schultheis, M. T. (2019). Driving evaluation in older adults. In: Handbook on the Neuropsychology of Aging and Dementia (2nd ed.). Springer Science

Barco, P.P. & Dappen, MS. Occupational Therapy for Individuals with Stroke in the Outpatient Rehabilitation Setting. In: T. Wolf (ed). Stroke: Interventions to Support Occupational Performance. Neurorehabilitation in Occupational Therapy Series, Vol ll, AOTA Press, in press.

Barco, P.P., Stav, W. B., Arnold, R., & Carr, D. (2012). Cognition and community mobility. In M. J. McGuire & E. Schold Davis (Eds.). AOTA Self-paced clinical course: Driving and community mobility. Bethesda, MD: AOTA.

Carr D and Barco P. The older driver (introduction, functional assessment, interventions, medical assessment). In: Berkow R and Beers MH, eds. The Merck Manual of Medical Information, Professional Edition. Whitehouse Station, NJ: Merck Publishing Co. Whitehouse Station, NJ; 2010. Available at:

Barco PP, Crosson BC, Bolesta MM, Werts D, and Stout R. Training awareness and compensation in post acute head injury rehabilitation. In: Kreutzer JS and. Wehman PH, eds. Cognitive Rehabilitation for Persons with Traumatic Brain Injury: A Functional Approach. Baltimore, MD: Paul H. Brookes Publishing Company; 1991: 129-147.

Sandson J, Crosson B, Posner MI, Brobeck TC, Barco PP, and Velozo CA. Attentional imbalances following head injury. In: J.M. Williams JM and C.J. Long CJ, eds. Cognitive Approaches to Neuropsychology. New York, NY: Plenum; 1988: 45-49. 


2021: Named to the Honor Roll of Academy of Educators at Washington University in St. Louis, School of Medicine
2017: Roster of Fellows, American Occupational Therapy Association
2013: Jerome Ely Human Factors Article Award for best article in 2012, Volume of Human Factors: Naturalistic Validation of an On-Road Driving Test of Older Drivers
2007: Roberta Sheldon Award for Prevention and Education in Brain Injury
1997: Spirit of Excellence Award (from Brain Injury Association of Missouri)
1993: YMCA Working Women of Achievement Award

Barco, Peggy


Professor of Occupational Therapy and Medicine

Curriculum Vitae

Contact Information

Phone: (314) 286-1654
Fax: (314) 286-1601

Research Laboratory

Driving and Community Mobility Laboratory

Ranked as the Number Three OT Program in the Nation

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