Occupational Therapy for POTS • OT Potential

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.

A quick note on why to pursue occupational therapy for POTS

Nonpharmacological 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?”

Therapist-recommended assessments for POTS

As you can see below, a POTS rehab evaluation can focus on multiple areas.

In addition to informing treatment at the beginning of your therapy journey, assessments provide a point of comparison to track your progress and response to treatment over time. (Without an accurate and thorough baseline, it can be hard to tell how much the interventions are helping!) As such, your therapist may perform certain assessments at various intervals over the course of therapy.

Canadian Occupational Performance Measure (COPM)¹
MALMO POTS Score
Sleep
- Sleep log
- MOS Sleep Problems Index²
Sensory Profile
Interoception
Rand-36^2,3
Cognition⁴
- Weekly calendar planning activity
- Comprehensive trail-making test
- Stroop color-word
- Cognitive self-efficacy questionnaire
Fatigue
- Fatigue severity scale³
- Modified fatigue impact scale
Pediatrics
- Functional disability inventory⁵
- Center for epidemiologic studies depression scale for children⁵
Postural alignment and breathing assessment
Gait speed (e.g., 10 Meter Walk Test)
6-Meter Walk Test (note: screen for PEM first)
Range of Motion and Manual Muscle Testing
Grip and pinch strength
Beighton score if suspect joint hypermobility
Quality of life (e.g., Rand-36 or WHOqol-bref)

Setting goals for POTS rehab

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.

Therapy treatment interventions for POTS

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.

Possible treatment interventions

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 support^4,16
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

Choosing a therapist for POTS rehab

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.

Show as:List Map

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 Club.

Article by

Emily Rich, PhD, OTRL, is a researcher, clinical specialist, and course instructor focusing on postural orthostatic tachycardia syndrome (POTS), Ehlers-Danlos syndromes (EDS)/hypermobility spectrum disorders, Parkinson’s disease, cancer rehab, and various chronic illnesses.

Reviewed by

Sarah Lyon, OTR/L, is the CEO of OT Potential and is on a mission to bridge the gap between research and real occupational therapy practice.

References

Here’s the science backing the assessments and treatment outlined above.

References:

Oetjen L, Johannsen A, Bean J, et al. The goals and outcomes of adolescent and young adults with POTS attending an intensive Interdisciplinary Treatment Program. Occupational Therapy In Health Care. 2022;38(3):768-782.
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.
Strassheim V, Welford J, Ballantine R, Newton JL. Managing fatigue in postural tachycardia syndrome (PoTS): The newcastle approach. Autonomic Neuroscience: Basic and Clinical. 2018;215:56-61.
Miglis MG, Barwick F. Sleep disorders in patients with postural tachycardia syndrome: A review of the literature and guide for clinicians. Autonomic Neuroscience: Basic and Clinical. 2018;215:62-69.
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.
Kempert H, Benore E, Heines R. Physical and occupational therapy outcomes: Adolescents’ change in functional abilities using objective measures and self-report. Scandinavian Journal of Pain. 2017;14(1):60-66.
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.

Additional Resources

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.