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All modern video entertainment systems require a coordinated, dexterous input on a control pad for gameplay. Our client was a quadriplegic and lacked the ability to interact with the games that he wished to play. We improved the interface to the video game console to maximize his achievable movement and reduce the need for unachievable movement. Since he was capable of all voice and shoulder manipulation, we re-routed button and joystick controls to accommodate them as inputs. Most of the button inputs were manifested from voice recognition because of the broad spectrum of tones and timing available. The remaining inputs were assigned to shoulder motion, including the joystick. Our primary goal is that this interface will allow most games to be played effectively.