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Have you thought about contacting Nintendo directly and asking them what options are available?  If they were somehow able to make custom controls for your friend, that would be great PR for them.  I know my opinion of Nintendo would skyrocket should they be able to do something to help your buddy out.  It certainly can't hurt to try, and I would love to see them help a quadruple amputee live a more normal (and healthy) life.

Does anyone here have contacts at Nintendo?