Pacing Your POTS

This eLearning activity uses branching scenarios and elements of gamification to help people manage their POTS-related fatigue.

Project Details

July 23, 2021
Project Type
Individuals living with POTS
Tools Used
Articulate Storyline, Twine, Inkscape, Audacity, Microsoft PowerPoint
Instructional Design, eLearning Development, Graphic Design


I built this learning experience as a means of helping people manage their POTS. Postural Orthostatic Tachycardia syndrome (POTS) is a form of dysautonomia, a disorder of the autonomic nervous system.

POTS-related symptoms can severely limit a person’s ability to function. Daily activities such as showering can become monumental tasks. Furthermore, POTS is not traceable to a single cause and symptoms can vary from person to person.

Preface of a character who has Postural Orthostatic Tachycardia Snyndrome (POTS)

While POTS is not treatable, its symptoms can be managed. In Pacing Your POTS, learners engage in a branching scenario that models pacing and encourages positive lifestyle adaptations.

My Design Process

My design process starts with my objective: Given a real-world scenario, the learner will demonstrate effective pacing to manage POTS-related fatigue & other symptoms.

After establishing my objective, I conducted research on the disorder. I gathered information from varies articles by Dysautonomia International. Members of the POTS community acted as my Subject Matter Experts (SMEs). Their anecdotes helped me identify common causes of flare-ups and methods of self-management.

Pacing Your POTS is addressed to a broad audience who face different challenges. After some deliberation, I decided to create a branching scenario about a character living with POTS. I took inspiration from Christine Miserandino’s metaphor “The Spoon Theory” and made finite energy a central theme.

To pass the scenario, you must acknowledge the character’s limitations and select actions that help conserve their energy. Inspired by Cathy Moore’s approach to “learn by doing”, you are plunged into the scenario after some character backstory.

Development & Implementation


I used the SugarCube story format in Twine to write a script for a branching scenario. I applied principles of content gamification by turning the character’s energy into a type of “health bar”. I initially planned on adding JavaScript to include a time element, but that was taken out for the sake of simplicity.  

Brancing scenario made in Twine with the SugarCube story format

Your choices have an impact on the character’s energy. The scenario outcome is dependent on their remaining energy, and automatically fails if it reaches 0. In order to symbolize the unpredictable nature of POTS, energy consumption has a set range. For example, a hot shower could demand 20~24 energy.

Demonstration of a functional HP bar in Twine


After completing the script, I developed the wireframe in Microsoft PowerPoint. I wanted to crate a layout with minimal images and lot of negative space.

Project wireframe being created in Microsoft PowerPoint

Images from Freepik were edited in Inkscape to fit the designated color scheme. Turquoise, the chosen ribbon color of dysautonomia, is a main color throughout the project.

Vector graphic being edited in Inkscape

I opted for subtle audio cues (such as heartbeats) to make consequences more impactful. Audio from Freesound was edited in Audacity. The symbolic heart next to the energy meter uses a lottie file created by Pavel Chuvak. I copied & pasted the code into an index.html file and imported into Storyline as a web object.


After completing the wireframe, I transferred it to Storyline. I created a series of variable & triggers to perform the following:

  • Influence energy levels (which influenced scenario outcome)
  • Record choices in an activity diary

Activity diaries are often used to isolate patterns and promote changes in daily behavior. At the end of the scenario, you can view the diary to reflect on your choices.

A fatigue/activity diary

I sent the prototype to a group of learners who were not familiar with POTS. They recommended that, since the project is about energy conservation, the recap should have greater emphasis on correct/incorrect choices.Thanks to their feedback, I created a hint box in the activity diary that clarifies the character’s physiological triggers.

Key Takeaways

This project was a great opportunity for me to learn more about branching scenarios and script writing. A large chunk of the project timeline was spent plotting and creating immersive dialogue.

One of the most challenging parts of the project was determining consequences and failures. As a means of conveying the importance of pacing, nearly all choices cost energy (even good ones!). I wanted to find a middle ground between authenticity and learner engagement. The POTS community was instrumental in highlighting the daily struggles of managing chronic symptoms.  

This project has helped be build confidence in my application of learning design, storytelling, and gamification. As I move forward, I hope to use my skillset to create more learning experiences that raise awareness and promote positive change.