Occupational Therapy for POTS
Introduction
If you’re seeking occupational therapy for POTS (Postural Orthostatic Tachycardia Syndrome), we want you to be as informed as possible so we can truly partner to create the best course of treatment for YOU.
In occupational therapy, we tend to work from “menus” of evidence-based assessments and treatments. This gives us the flexibility to meet the specific needs of each patient. Below, you’ll see the assessment and treatment options your therapist may use, along with the evidence that supports them.
Please note that this page is for educational purposes and should not substitute advice from your medical provider. At the bottom of this page, you’ll find therapists near you who can support you.
Why pursue occupational therapy for POTS?
Non-pharmacological interventions are the frontline approach for treating POTS. Occupational therapy is cost-effective and safe. Through rehabilitation, patients often experience improvement in function and may be able to avoid starting medication or reduce their dosage over time.
Your multidisciplinary team may include a physician, occupational therapist, physical therapist, nurse, dietitian, and psychologist.
Occupational therapists specialize in providing holistic, personalized treatments that promote overall independence. We employ strategies to optimize function that consider physical, mental, emotional, and spiritual well-being. We’re often called everyday problem-solvers, ready to process the challenges you may not have time for in your other appointments, and we may make you wonder, “Why didn’t I think of that?”
Related Assessments
Assessments are powerful tools to help us partner in your care. They establish a clear baseline, direct our treatment efforts, and give us a reliable way to track your progress over time. Your team may select some specific measures that fit your unique situation. Here are some examples:
Overall Health Measures
Symptom Specific Measures
Overall Health Measures1,2, Symptom Specific Measures2-4, Pediatrics5
Possible Goal Areas
Therapy only works best when there is buy-in from the patient. It’s essential to collaborate with your therapist to establish treatment goals that accurately reflect what is truly important to you.
Goal Bank for Clinicians
Each goal is intended as a starting point. The functional motivation behind each goal should identified collaboratively with the client.
Client will improve energy management through implementation of pacing and energy conservation strategies with increase in usable hours of the day by at least 20% to promote (_____)
Client will identify and utilize at least 3 strategies to promote autonomic regulation and stress management and be able to verbally articulate or physically demonstrate in situations of dysregulation to support engagement in (_____)
Client will improve health-management / self-management through development of self-advocacy skills as needed for (_____)
Client and therapist will collaboratively identify 3-5 individualized strategies for pain management to promote function and participation in (_____) and client will utilize with 80% success at home and in community as demonstrated by report of increased participation.
Client will collaborate with therapist to identify and implement accommodations for work/school to maximize success in areas of challenge/ minimize symptoms of (_____) with report of symptom improvement by at least 50%.
Client will be able to name at least 3 strategies to support cognitive challenges and optimize executive function skills as needed for (_____)
Client will participate in home program on at least 3 out of 7 days across 3 weeks to promote (_____)
Treatment Interventions
After a thorough evaluation and goal-setting process, it is time to start making progress. The following are treatment interventions that can be implemented as part of a comprehensive therapy program.
Foundational POTS treatment and health management:
Hydration and sodium6
Compression7
Exercise (cardiovascular and strengthening in clinic; starting supine or reclined; and home program)8
Elevating head of bed elevation
Modification to daily activity9
Standing/ upright endurance strategies
Alternative positioning
Fatigue and energy management 9,10
Pacing
Energy conservation
Work simplification
Sleep education and management11
Sleep hygiene
Routines
Cognitive behavioral therapy for insomnia
Education using literature
Pain management 12,13
Pain neuroscience education
Coping skills and flare kit
Thought management
Distraction
Mindfulness
Mindful self-compassion
Breath training14
Mindfulness-based stress reduction15
Balance and vestibular
Cognitive function and support4,16
Sensory processing
Interoception17
Work and school accommodations18
Ergonomic positioning and work setup
Health management
Medication management
Increasing self-awareness of symptoms
Pregnancy and post-partum considerations
Mental health support and coping skills
Validation
Working toward acceptance
Self-advocacy skills19
Education
Condition pathophysiology
Exacerbating and relieving factors
Management
Co-occurring conditions as appropriate
Home program
Discharge suggestions:
Plan for continuing home exercise program
Community supports
Flare plan for setbacks
Self-management and empowerment
Home safety and falls prevention
Red flags:
Symptomatic joint hypermobility (hEDS and HSD) and monitor for hyperextension during physical activities
Mast cell activation (sensitivities to odors, perfumes, extreme temperatures, vibration, exertion, and more)
Myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS) and post-exertional malaise. Before and throughout exercise or activities involving exertion, screen using the DePaul and skilled clinical interview/observation.
Screening for other co-occurring conditions such as auto-immunity, or brain injury and referring to specialists for further evaluation.
Upper cervical instability
Education Resources for Clients
Education Resources for Clinicians
Instagram @EmilyRichOT
Dysautonomia International conferences and webinars Dysautonomia International: Dysautonomia Awareness, Dysautonomia Advocacy, Dysautonomia Advancement
DePaul Symptom Questionnaire - Post-Exertional Maliaise short form (DSQ-PEM) therapy in POTS (2022): YouTube
Occupational Therapy in the Treatment of Dysautonomia (2020): YouTube
Tools and Accommodations for Work, School, College, and Assistive Technology
Choosing a Therapist
Below, you can find occupational therapy professionals who have tagged “Postural Orthostatic Tachycardia Syndrome (POTS)” as a focus area. You can also access the “find a provider” resource from OTEmily.com or Dysautonomia International or call local therapy clinics in your area to inquire about the treatment they offer.
Although many occupational therapists do not specialize in POTS, their training is sufficient to engage a wide variety of patients in individualized interventions that help improve function, regardless of diagnosis.
You can further maximize your success and the therapist’s approach by sharing this page with them and referencing the additional continuing education options and resources provided here.
Christina Gutierrez
OT
PAM SPECIALTY HOSPITAL
San Antonio, Texas
Cancer, Chronic Conditions, Chronic Pain, Dementia, Leadership, Neurorehabilitation, Postural Orthostatic Tachycardia Syndrome (POTS), Spinal Cord Injury, Stroke, TBI
Jamie Boldig
MOT, OTR/L
Appleton, Wisconsin
Aging in Place, ADHD, Amyotrophic Lateral Sclerosis (ALS), Anxiety, Aphasia & Communication Disorders, Assistive Technology, Autism, Burns, Cancer, Cerebral Palsy, Chronic Conditions, Chronic Pain, Coaching, Cognitive Rehabilitation, Dementia, Depression & Mood Disorders, Dystonia, Ergonomics, Fitness, Feeding and Eating, Functional Neurological Disorder (FND), Grant Writing, Hand Therapy, Health Data, Health Policy, Health Promotion, Hippotherapy, Home Modifications, Insomnia & Sleep, Intellectual and Developmental Disabilities (IDD), Knowledge Translation, Lifestyle Medicine, Leadership, Medication Management, Multiple Sclerosis, Nature-based, Neurodiversity, Obsessive-Compulsive Disorder (OCD), Orthopedics & Musculoskeletal, Osteogenesis Imperfecta, Parkinson’s, Pelvic Health, Prevention, Population Health, Postural Orthostatic Tachycardia Syndrome (POTS), Rare Diseases, Rheumatic Diseases, Seating and Mobility, Spinal Cord Injury, Stroke, TBI, Trauma & PTSD, Tourette syndrome, Voice & Fluency
Andrea Gibson
MS, OTR/L
Therapy and Counseling Services
Camp Hill, Pennsylvania
ADHD, Anxiety, Autism, Cerebral Palsy, Chronic Conditions, Chronic Pain, Ehlers-Danlos Syndrome, Intellectual and Developmental Disabilities (IDD), Lifestyle Medicine, Neurodiversity, Postural Orthostatic Tachycardia Syndrome (POTS), Trauma & PTSD
Katy Owens
OTR/L, TPS
Empowered Path Occupational Therapy
Loveland, Colorado
ADHD, Anxiety, Autism, Chronic Conditions, Chronic Pain, Coaching, Cognitive Rehabilitation, Ehlers-Danlos Syndrome, Functional Neurological Disorder (FND), Health Promotion, Home Modifications, Insomnia & Sleep, Knowledge Translation, Leadership, Multiple Sclerosis, Neurodiversity, Neurorehabilitation, Prevention, Population Health, Postural Orthostatic Tachycardia Syndrome (POTS), Rheumatic Diseases, Sexuality/Intimacy, Trauma & PTSD
Emily Rich
PhD., OTR/L
Occupational Therapist
Tucson Medical Center
Tucson, Arizona
ADHD, Cancer, Chronic Conditions, Chronic Pain, Cognitive Rehabilitation, Ehlers-Danlos Syndrome, Functional Neurological Disorder (FND), Lifestyle Medicine, Neurodiversity, Parkinson’s, Postural Orthostatic Tachycardia Syndrome (POTS)
Salmin Chacha
OTR/L
Occupational Therapist
AL NOOR TRAINING CENTRE
dubai
ADHD, Augmentative and Alternative Communication, Aquatic Therapy, Aphasia & Communication Disorders, Assistive Technology, Autism, Burns, Cerebral Palsy, Chronic Conditions, Chronic Pain, CIMT, Coaching, Cognitive Rehabilitation, Dementia, Depression & Mood Disorders, Developmental Delays, Dystonia, Ehlers-Danlos Syndrome, Ergonomics, Emergency Department, Feeding and Eating, Functional Neurological Disorder (FND), Grant Writing, Hand Therapy, Health Data, ICU/Critical Care, Insomnia & Sleep, Intellectual and Developmental Disabilities (IDD), Knowledge Translation, Lifestyle Medicine, Low Vision Rehabilitation, Maternal Health, Medication Management, Mitochondrial Disorders, Multiple Sclerosis, Nature-based, Neurodiversity, Neurorehabilitation, NICU, Pelvic Health, Postural Orthostatic Tachycardia Syndrome (POTS), Rare Diseases, Rheumatic Diseases, Seating and Mobility, Sexuality/Intimacy, Spinal Cord Injury, Stroke, Swallowing & Dysphagia, TBI, Trauma & PTSD, Vestibular & Balance Rehab
Kate Holbrook
OTD, OTR/L, CBIS, CPST
Des Moines University
West Des Moines, Iowa
ADHD, Assistive Technology, Autism, Cerebral Palsy, Chronic Conditions, Coaching, Dystonia, Functional Neurological Disorder (FND), Health Policy, Health Promotion, Home Modifications, Intellectual and Developmental Disabilities (IDD), Leadership, Maternal Health, Mitochondrial Disorders, Neurodiversity, Neurorehabilitation, Osteogenesis Imperfecta, Postural Orthostatic Tachycardia Syndrome (POTS), Rare Diseases, Seating and Mobility, Social Determinants of Health, Spinal Cord Injury, Stroke, TBI, Trauma & PTSD
Stephanie Olszewski
MOT, OTR/L, CASDC
Diverge Community Services
Flat Rock, Michigan
ADHD, Anxiety, Autism, Chronic Pain, Ehlers-Danlos Syndrome, Home Modifications, Intellectual and Developmental Disabilities (IDD), Nature-based, Neurodiversity, Prevention, Postural Orthostatic Tachycardia Syndrome (POTS), Sexuality/Intimacy, TBI, Trauma & PTSD, Vestibular & Balance Rehab
Clarisa Mijares
OTR/L
South Pasadena, California
ADHD, Autism, Cerebral Palsy, CIMT, Intellectual and Developmental Disabilities (IDD), Low Vision Rehabilitation, Neurodiversity, Neurorehabilitation, NICU, Postural Orthostatic Tachycardia Syndrome (POTS), Tourette syndrome
Madison Lund
OTS
Student
Queen Creek, Arizona
Anxiety, Assistive Technology, Burns, Cancer, Cerebral Palsy, Chronic Conditions, Cognitive Rehabilitation, Ehlers-Danlos Syndrome, Ergonomics, Grant Writing, Health Data, Insomnia & Sleep, Intellectual and Developmental Disabilities (IDD), Leadership, Maternal Health, Multiple Sclerosis, Neurodiversity, Neurorehabilitation, NICU, Obsessive-Compulsive Disorder (OCD), Orthopedics & Musculoskeletal, Postural Orthostatic Tachycardia Syndrome (POTS), Rheumatic Diseases, Spinal Cord Injury, TBI, Trauma & PTSD
Jenn Hutchinson
OTD, OTR/L
EnbyOT, LLC
Hillsboro, Oregon
Aging in Place, ADHD, Amyotrophic Lateral Sclerosis (ALS), Autism, Burns, Cancer, Cerebral Palsy, Chronic Conditions, Chronic Pain, Cognitive Rehabilitation, Health Promotion, Home Modifications, Intellectual and Developmental Disabilities (IDD), Lifestyle Medicine, Low Vision Rehabilitation, Maternal Health, Multiple Sclerosis, Neurodiversity, Neurorehabilitation, Orthopedics & Musculoskeletal, Osteogenesis Imperfecta, Parkinson’s, Pelvic Health, Prevention, Postural Orthostatic Tachycardia Syndrome (POTS), Rare Diseases, Rheumatic Diseases, Sexuality/Intimacy, Social Determinants of Health, Spinal Cord Injury, Stroke, TBI, Trauma & PTSD
Lindsay Voorhees
OTR/L, CYT200
Lindsay Voorhees Wellness
Durham, North Carolina
Cancer, Chronic Conditions, Chronic Pain, Coaching, Health Promotion, Lifestyle Medicine, Multiple Sclerosis, Neurorehabilitation, Parkinson’s, Postural Orthostatic Tachycardia Syndrome (POTS), Spinal Cord Injury, Trauma & PTSD
Rachel Egan
OTR/L, MS, CHT, COMT-UE
NovaCare Rehabilitation
Blaine, Minnesota
Aquatic Therapy, Cancer, Chronic Pain, Coaching, Cognitive Rehabilitation, Dementia, Fitness, Hand Therapy, Industrial Rehabilitation, Leadership, Orthopedics & Musculoskeletal, Prevention, Postural Orthostatic Tachycardia Syndrome (POTS), Rheumatic Diseases, Stroke
Jason Kreuzman, MS, OTR/L
MS, OTR/L
Researcher
RewireOT
Ellisville, Missouri
Anxiety, Chronic Pain, Ehlers-Danlos Syndrome, Functional Neurological Disorder (FND), Neurodiversity, Neurorehabilitation, Postural Orthostatic Tachycardia Syndrome (POTS)
Madeline Dommel
OTR/L
Advanced Therapy Solutions, LLC.
Middletown, Connecticut
Aging in Place, ADHD, Anxiety, Autism, Burns, Cerebral Palsy, Chronic Conditions, Chronic Pain, Cognitive Rehabilitation, Hand Therapy, Home Modifications, Insomnia & Sleep, Intellectual and Developmental Disabilities (IDD), Low Vision Rehabilitation, Lymphedema, Maternal Health, Mitochondrial Disorders, Multiple Sclerosis, Nature-based, Neurodiversity, Neurorehabilitation, NICU, Obsessive-Compulsive Disorder (OCD), Orthopedics & Musculoskeletal, Osteogenesis Imperfecta, Parkinson’s, Pelvic Health, Prevention, Postural Orthostatic Tachycardia Syndrome (POTS), Spinal Cord Injury, Stroke, TBI, Trauma & PTSD, Tourette syndrome, Vestibular & Balance Rehab
Rachel L Hall
Certified Occupational Therapy
Occupational Therapy Assistant
Davisburg, Michigan
Aging in Place, Amyotrophic Lateral Sclerosis (ALS), Dementia, Home Modifications, Multiple Sclerosis, Neurorehabilitation, Orthopedics & Musculoskeletal, Parkinson’s, Pelvic Health, Prevention, Postural Orthostatic Tachycardia Syndrome (POTS), Seating and Mobility, Sexuality/Intimacy, Spinal Cord Injury, Stroke, TBI
Rebecca Beckley
OTD, OTR/L
Good Health Physical Therapy & Wellness
Portland, Oregon
ADHD, Anxiety, Chronic Conditions, Chronic Pain, Ehlers-Danlos Syndrome, Health Promotion, Knowledge Translation, Neurodiversity, Postural Orthostatic Tachycardia Syndrome (POTS)
Shaunna Kotka
OTD, OTR/L, CLT-LANA, CMT
Administrator
Open Grounds Inc.
Marina del Rey, California
ADHD, Anxiety, Cancer, Chronic Conditions, Chronic Pain, Cognitive Rehabilitation, Dementia, Depression & Mood Disorders, Dystonia, Ehlers-Danlos Syndrome, Fitness, Health Promotion, Home Modifications, Insomnia & Sleep, Knowledge Translation, Lymphedema, Medication Management, Neurodiversity, Neurorehabilitation, Obsessive-Compulsive Disorder (OCD), Orthopedics & Musculoskeletal, Parkinson’s, Prevention, Population Health, Postural Orthostatic Tachycardia Syndrome (POTS), Rare Diseases, Rheumatic Diseases, Social Determinants of Health, Sports Medicine & Performance, Stroke, TBI, Trauma & PTSD
Deborah Rogers
OTR/L
Holistic Healing with Deborah
Watertown, Massachusetts
ADHD, Anxiety, Chronic Conditions, Chronic Pain, Functional Neurological Disorder (FND), Neurorehabilitation, Postural Orthostatic Tachycardia Syndrome (POTS)
Melanie Byers
PA
Symbria
Mohnton, Pennsylvania
Aging in Place, Dementia, Pelvic Health, Postural Orthostatic Tachycardia Syndrome (POTS)
Carsyn Thomas
OTS
Xavier University
Cable, Ohio
ADHD, Anxiety, Autism, Chronic Conditions, Chronic Pain, Feeding and Eating, Hippotherapy, Intellectual and Developmental Disabilities (IDD), Maternal Health, Multiple Sclerosis, Nature-based, Neurodiversity, Neurorehabilitation, NICU, Obsessive-Compulsive Disorder (OCD), Orthopedics & Musculoskeletal, Postural Orthostatic Tachycardia Syndrome (POTS), Rare Diseases
Anna Addison
MSOT, OTR
Industry Professional
Prompt Health
San Francisco, California
Aging in Place, Aphasia & Communication Disorders, Burns, Cancer, Chronic Conditions, Chronic Pain, Cognitive Rehabilitation, Ergonomics, Fitness, Feeding and Eating, Health Data, Home Modifications, Leadership, Medication Management, Multiple Sclerosis, Neurorehabilitation, Orthopedics & Musculoskeletal, Parkinson’s, Postural Orthostatic Tachycardia Syndrome (POTS), Rare Diseases, Sports Medicine & Performance, Spinal Cord Injury, Stroke, TBI, Trauma & PTSD, Vestibular & Balance Rehab, Wound Care
Destiney Carmichael
OTS
Student
Xavier University
Cincinnati, Ohio
Aging in Place, ADHD, Amyotrophic Lateral Sclerosis (ALS), Anxiety, Assistive Technology, Autism, Burns, Cancer, Cerebral Palsy, Chronic Conditions, Chronic Pain, CIMT, Cognitive Rehabilitation, Dementia, Dystonia, Ehlers-Danlos Syndrome, Fitness, Feeding and Eating, Functional Neurological Disorder (FND), Home Modifications, Insomnia & Sleep, Intellectual and Developmental Disabilities (IDD), Lymphedema, Maternal Health, Multiple Sclerosis, Nature-based, Neurodiversity, Neurorehabilitation, NICU, Obsessive-Compulsive Disorder (OCD), Orthopedics & Musculoskeletal, Osteogenesis Imperfecta, Parkinson’s, Pelvic Health, Prevention, Postural Orthostatic Tachycardia Syndrome (POTS), Rare Diseases, Rheumatic Diseases, Seating and Mobility, Sexuality/Intimacy, Social Determinants of Health, Spinal Cord Injury, Stroke, TBI, Trauma & PTSD, Vestibular & Balance Rehab
Virginia Padgett
OTS
Student
Xavier University
Verona, Kentucky
ADHD, Anxiety, Autism, Cerebral Palsy, Chronic Conditions, Chronic Pain, Fitness, Feeding and Eating, Home Modifications, Insomnia & Sleep, Intellectual and Developmental Disabilities (IDD), Leadership, Nature-based, Neurodiversity, NICU, Prevention, Postural Orthostatic Tachycardia Syndrome (POTS), Seating and Mobility
Conclusion
Hopefully, this article has helped you understand what therapy for POTS rehab entails and whether you are a good candidate!
This article is regularly updated to reflect the latest research. If you have any research you would like us to consider for our next update, please drop it in the comments! Therapists who would like more fleshed-out information on POTS rehab treatment can join us as members of the OT Potential.
Contributors
Emily Rich
PhD., OTR/L
Sarah Lyon
OTR/L
Sarah Lyon, OTR/L, is the CEO of OT Potential. Sarah earned her BA from St. Olaf College and her master’s degree in occupational therapy from New York University. Her diverse clinical background spans multiple settings, including critical access, acute trauma, and state inpatient psychiatric hospitals. In 2011, she founded OT Potential to fulfill the industry's need for reliable, high-quality occupational therapy resources and continuing education.
As a recognized content creator, Sarah has collaborated with top healthcare brands like VeryWell Health, WebPT, and MedBridge. She blends her clinical expertise with a talent for creating clear, action-oriented content that empowers practitioners to excel. Passionate about elevating the OT profession, she has been featured on numerous industry podcasts. Sarah ultimately returned to her roots, running OT Potential and raising her family in her hometown of Aurora, Nebraska.
References
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Bagai K, Song Y, Ling JF, et al. Sleep disturbances and diminished quality of life in postural tachycardia syndrome. Journal of Clinical Sleep Medicine. 2011;7(2):204-210.
Pederson CL, Brook JB. Health-related quality of life and suicide risk in postural tachycardia syndrome. Clinical Autonomic Research. 2017;27(2):75-81.
Anderson JW, Lambert EA, Sari CI, et al. Cognitive function, health-related quality of life, and symptoms of depression and anxiety sensitivity are impaired in patients with the postural orthostatic tachycardia syndrome (POTS). Frontiers in Physiology. 2014;5(230).
McTate EA, Weiss KE. Psychosocial dimensions and functioning in youth with postural orthostatic tachycardia syndrome. Clinical Pediatrics. 2016;55(10):979-982.
Garland EM, Gamboa A, Nwazue VC, et al. Effect of high dietary sodium intake in patients with postural tachycardia syndrome. Journal of the American College of Cardiology. 2021;77(17):2174-2184.
Bourne KM, Sheldon RS, Hall J, et al. Compression garment reduces orthostatic tachycardia and symptoms in patients with postural orthostatic tachycardia syndrome. Journal of the American College of Cardiology. 2021;77(3):285-296.
Fu Q, Levine BD. Exercise and non-pharmacological treatment of POTS. Auton Neurosci. 2018;215:20-27.
Rich EM, Vas A, Boyette V, Hollingsworth C. Daily life experiences: Challenges, strategies, and implications for therapy in postural tachycardia syndrome (POTS). Occupational Therapy in Health Care. Published online 2020.
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Junghans-Rutelonis AN, Craner JR, Ale CM, Harbeck-Weber C, Fischer PR, Weiss KE. Youth with chronic pain and postural orthostatic tachycardia syndrome (POTS): Treatment mediators of improvement in functional disability. Journal of Clinical Psychology in Medical Settings. Published online 2018.
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Reilly CC, Floyd SV, Lee K, et al. Breathlessness and dysfunctional breathing in patients with postural orthostatic tachycardia syndrome (POTS): the impact of a physiotherapy intervention. Autonomic Neuroscience. 2020;223:102601.
Freedenberg VA, Hinds PS, Friedmann E. Mindfulness-based stress reduction and group support decrease stress in adolescents with cardiac diagnoses: a randomized two-group study. Pediatric Cardiology. 2017;38(7):1415-1425.
Ross AJ, Medow MS, Rowe PC, Stewart JM. What is brain fog? An evaluation of the symptom in postural tachycardia syndrome. Clinical Autonomic Research. 2013;23:305-311.
Critchley HD, Eccles J, Garfinkel SN. Interaction between cognition, emotion, and the autonomic nervous system. In: Handbook of Clinical Neurology. Vol 117. Elsevier; 2013:59-77.
Bourne KM, Chew DS, Stiles LE, et al. Postural orthostatic tachycardia syndrome is associated with significant employment and economic loss. Journal of Internal Medicine. 2021;290:203-212.
Rich EM, Vas A, Parsons TD, Krone R, Goodman BP. Functional status in postural tachycardia syndrome. British Journal of Occupational Therapy. 2021;1–9.
OT Potential does not endorse any treatments, procedures, products, or therapists referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking medical advice should consult their medical provider.