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About Postural Orthostatic Tachycardia Syndrome (POTS)
Postural Orthostatic Tachycardia Syndrome (POTS) is a form of dysfunction of the autonomic nervous system’s ability to regulate heart rate. With POTS, the body is not able to keep heart rate at steady and stable levels. A variety of symptoms are associated with POTS, which may include but are not limited to angina (chest pain sometimes radiating down the left arm or into the jaw); dizziness or lightheadedness that often manifests during periods of prolonged periods of walking, prolonged periods of standing in one static position, or when standing up suddenly from seated positions; syncope (fainting); chronic fatigue; tremors, exercise intolerance; hypo or hypertension, and gastric upset.
Postural Orthostatic Tachycardia Syndrome (POTS) and the Americans with Disabilities Act
The ADA does not contain a definitive list of medical conditions that constitute disabilities. Instead, the ADA defines a person with a disability as someone who (1) has a physical or mental impairment that substantially limits one or more "major life activities," (2) has a record of such an impairment, or (3) is regarded as having such an impairment. For more information about how to determine whether a person has a disability under the ADA, see How to Determine Whether a Person Has a Disability under the Americans with Disabilities Act Amendments Act (ADAAA).
Accommodating Employees with Postural Orthostatic Tachycardia Syndrome (POTS)
People with POTS may develop some of the limitations discussed below, but rarely develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people with POTS will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available should any situation or need arise. Numerous other accommodation solutions may exist.
Questions to Consider:
- What limitations is the employee experiencing?
- How do these limitations affect the employee and the employee’s job performance?
- What specific job tasks are problematic as a result of these limitations?
- What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations?
- Once accommodations are in place, would it be useful to meet with the employee to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?
- Do supervisory personnel and employees need training?
Key Accommodations
Decreased Stamina/Fatigue: Individuals with POTS can become fatigued to the extent they cannot work a full shift or perform physical aspects of their role.
- Allow frequent breaks
- Allow flexible scheduling and flexible leave
- Allow work from home
- Implement ergonomic considerations
- Eliminate physical exertion
- Permit a service animal for mobility assistance
Dizziness: Individuals with POTS may experience dizziness or lightheadedness when standing up quickly, standing in place for prolonged periods, or from prolonged walking.
- Provide chairs with armrests and locking casters so that individuals can steady themselves when standing up without worry that the chair will move
- Provide stools or chairs to allow for alternating between standing and sitting
- Allow additional rest breaks or modify when tasks are done to break up periods of prolonged walking
Gross Motor: Individuals with POTS may experience short- or long-term gross motor limitations.
- Implement ergonomic considerations
- Provide equipment: e.g., lifting devices, carts
- Permit the use of mobility aids and/or service animal
Effect of/ Receive Medical Treatment: Individuals with POTS may need time to attend medical appointments or recover from a medical treatment or procedure.
- Allow work from home
- Allow flexible scheduling and flexible leave
Safety Standards: Having POTS does not automatically mean safety hazards will exist, but there may be increased risk in certain work environments or performing certain tasks.
- Consider developing a Plan of Action
- Purchase protective equipment: fall protection, edge cushions, alerting devices, machine guards
Accommodation Ideas:
Situations and Solutions:
The following situations and solutions are real-life examples of accommodations that were made by JAN customers. Because accommodations are made on a case-by-case basis, these examples may not be effective for every workplace but give you an idea about the types of accommodations that are possible.
A healthcare case manager with POTS experienced a drop in blood pressure if she stood or walked for long durations.
When this occurred, she needed to sit down, otherwise she would black out and fall. The healthcare facility already had grab bars, which helped stabilize her, but the employer also moved her to a location in the facility to limit walking and provide her with close access to work-related equipment.
A new hire with POTS was beginning training for a hotel receptionist position.
The training program required long hours for multiple days in a row. The employee was able to perform the job tasks, but sitting for long periods in training caused her to feel dizzy. After the employee requested an accommodation, the employer staggered the training schedule to enable her to sit in the training in the mornings and job shadow in the afternoons. This enabled her to minimize symptoms and complete the training.
A state outreach coordinator with POTS experienced low blood pressure while sitting in traffic during her commute to the worksite for team meetings.
She was able to perform her job tasks from home, but meetings were held on site. After the employee fainted while driving, she requested remote meetings as a form of reasonable accommodation. The employer approved the request for monthly meetings and scheduled quarterly meetings ahead of time so the employee could arrange transportation.
A middle school teacher with POTS was experiencing extreme fatigue and was unable to stand all day long.
After engaging in an interactive process with her school principal, they agreed that a stand-lean stool would help her at the chalkboard. They also modified her schedule and placed her planning period in the middle of the day to help break up the more physically demanding job duties.
A federal employee with POTS asked for a reclining chair to raise their legs, which would help stabilize their heart rate.
The employer instead furnished an ergonomic chair that did not recline and a footrest. The employee was dissatisfied and called JAN to discuss next steps. The employee used a JAN sample template to help explain why the ergonomic chair and footrest were ineffective as a reasonable accommodation and why the reclining chair would be effective. After engaging in the interactive process and identifying the need for specific equipment, the employer provided the reclining chair.