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.

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.

LEPMIS (UK)

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

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 Kokoto Step (Japan)

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

From RJ Cooper (USA)

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

From Brydo.com (USA)

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

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.