If all else fails, there are a small number of individuals and organisations that may be able to build you a tailor made controller. This is normally the most expensive route to take, unless you can find a charity to help.
Please feel free to e-mail for help on anything that is unclear.

Accessible GameBase (UK)

Funded by SpecialEffect.org.uk, the Accessible GameBase strives to support all people in overcoming the barriers they may face when trying to play video games.

OneSwitch.org.uk (UK)

Switch adaptation service for games consoles and toys. Free advice on accessible controllers that may suit and D.I.Y. guides and assistance.

Acidmods (USA)

A console hacking community, who have made some major adaptations to standard controllers.

The pictured Xbox 360 joypad has had four face buttons and a thumb-stick switched. Contact through AcidMods or via this AbleGamers forum post.

BenHeck.com (USA)

Talented hard-ware hacker, who may be able to take on an accessible controller project for you at a price.

From Broadened Horizons (USA)

Also known as Gimp Gear. Tailor build gaming controllers that may suit with a large variety.

From Brydo.com (USA)

Tailor designed arcade sticks with an artistic flair. Very limited production.

From Evil Controllers (USA)

A joypad modification service. Go to the Modded Controllers section, then to the "Build Your Own Bundle" to see what is presently available.

From Kokoto Step (Japan)

A Japanese organisation building tailor made controllers from a range of stock parts.

LEPMIS (UK)

Highly qualified and competent engineer with a long back ground in creating specialised controls for disabled people.

MERU (UK)

MERU is a charity based in Epsom, Surrey, from where they provide services to clients in London and the South East.

They also offer an Information and Advice Service for parents and therapists nationwide, alongside selling some of their own in-house designed accessibility products.

From RJ Cooper (USA)

With a proven track record of accessibility adaptations, RJ Cooper may be able to help.

From Ultimarc (UK)

A Printed Circuit Board (PCB) with screw terminals for simple connection to switches and other digital controls.

Compatible with PCs, Playstation one, PS2, Xbox, Dreamcast and Wii with limitations. Highly recommended and used with the C-SID.

From LizardLick and GamingNow

Available as a full D.I.Y. kit or as a pre-assembled PCB with screw terminals for simple connection to switches and other digital controls.

Compatible with PCs and PS3. Using the multi-console version, Xbox, PS2 and Gamecube compatibility is possible, although a donor controller cable must be wired into the PCB. See Instructables for more.

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Related Accessible Gaming LINKS

D.I.Y. guides - Various switch adapted equipment and helpful links.

Game-Accessibility forums - Helpful forums for disabled gamers.

Build Your Own Arcade Controls - Very useful lively forum.

Enabled Cyber Gamers - Project aimed at disabled gamers in Singapore.