Input Is Not Fixed: What Alternative Game Controllers Can Teach Occupational Therapy

I recently came across a project from students at Rochester Institute of Technology that got me thinking. At the Game Developers Conference, RIT students showcased a collection of alternative game controllers that were definitely not standard - they were interfaces built from oversized scissors, giant toothbrushes, physical wiring stations, and other unconventional objects. The assignment challenged students to design interactive systems that deliberately moved beyond traditional controllers like keyboards, mice, and gamepads.

At first glance, these projects are playful and experimental and I think that is part of the point. The exercise seems designed to disrupt assumptions about how humans interact with digital systems.

But the deeper idea embedded in the project is more interesting and is something I would like our future occupational therapy students to deeply integrate into their thinking:

Input is not fixed.

Once you step outside the standard paradigm of buttons and joysticks, you start to realize that almost anything can become input. Human–computer interaction does not require a keyboard or a touchscreen. It simply requires a detectable signal that can be mapped to an action.

Accordingly, movement, force, breath, gaze, any muscle activation or even environmental sensors can be input. The key insight is that interaction systems are not limited by the devices we have historically used. They are limited only by our ability to detect and translate human signals.

That observation about a sensor-first based design framework has interesting implications for fields like occupational therapy.

The Traditional Assistive Technology Framing

Within occupational therapy education, assistive technology is often taught through the lens of devices and equipment categories first. Students learn about switches, communication systems, mounting systems, environmental control units, and wheelchair interfaces. These tools are important and remain foundational to practice.

But the educational framing frequently centers on what devices exist rather than how interaction itself is designed, so the typical question centers around "Which device should we select for this person?"

This device-first approach makes sense historically. Assistive technology grew alongside specialized equipment markets and rehabilitation engineering solutions. Clinicians learned how to match clients with existing technologies. I think that this model quietly embeds a design assumption that the interaction system already exists, and the job of the clinician is to adapt the user to it.

So when someone cannot use a standard interface, the solution becomes finding a modified version of the same interface, like a switch instead of a keyboard, or eye gaze instead of manual input. That might be effective but I don't think it is the most interesting question we can ask.

The More Fundamental Question

Maybe the deeper question should be "What signals can a person reliably produce?" Once that question is answered, then we would naturally ask "How can those signals be translated into meaningful interaction?" This shift reframes assistive technology from device selection to signal translation. Instead of beginning with a device category, we begin with the human system.

These students are demonstrating that once a signal can be captured, it can be mapped to almost any output - giant scissors - whatever - but also digital actions, environmental controls, robotic movement, communication systems, or virtual environments. In other words, the real design space is not the device. The real design space is the human signal.

Why the Game Industry Keeps Exploring This Space

It seems that most creative explorations of alternative input are coming from the gaming industry, and not from health care. Games provide a unique environment for this kind of experimentation. Healthcare systems tend to prioritize reliability, regulatory compliance, and reimbursement structures. Those constraints make it difficult to experiment with unusual interfaces.

Games, by contrast, reward novelty. Designers are encouraged to push boundaries and create unusual experiences. As a result, they frequently stumble onto interaction ideas that later become relevant for accessibility.

The Pedagogical Opportunity for Occupational Therapy

Projects like the alternative controllers developed by RIT students suggest an interesting opportunity for occupational therapy education. Instead of focusing primarily on assistive technology devices, programs could spend more time teaching students to think about input design. I like the idea of helping students understand sensor technologies that can detect input signals, and then how to design interaction systems around capabilities as opposed to designing around device constraints. The focus shifts from equipment catalogs to interaction architecture.

In many ways, this aligns closely with the core philosophy of occupational therapy. The profession has always been concerned with enabling meaningful participation through the adaptation of environments and tasks. What changes is the technological landscape in which those adaptations occur. The design challenge is no longer limited to mechanical devices, or what switch we can buy from a catalog. 

Researchers in human–computer interaction have explored similar ideas under the concept of “ability-based design,” which focuses on building systems around user capabilities rather than forcing users to conform to predefined interfaces. Concepts like this may have something to teach us as we rethink how we approach assistive technology pedagogy in occupational therapy.

Interdisciplinary Collaboration as the Catalyst

One of the reasons the RIT project stands out is that it sits at the intersection of multiple disciplines: computing, game design, engineering, and human-centered design. Innovation in interaction often occurs at these boundaries. When students trained in software development collaborate with engineers working on sensors, designers exploring physical interfaces, and human scientists studying behavior and movement, new ideas about interaction begin to emerge.

For fields like occupational therapy, engaging with these interdisciplinary spaces may open new directions for both education and research. Occupational therapy students are not likely to turn into engineers or programmers (maybe some will!) but rather we can cultivate a mindset that recognizes how human capacity can be translated into interaction.

That is a lot deeper than having familiarity with the available commercial tech, and only learning how to write a justification letter to fund it!

Questioning the Defaults

Perhaps the most important lesson from projects like alternative game controllers is that many of the interaction systems we take for granted are historical artifacts rather than fundamental requirements. I have experience in the late 1980s to early 1990s setting up demonstration centers and loan closets full of adaptive keyboards, mice, and buttons that became dominant because they were convenient solutions at a particular moment in technological history. That was good stuff, back in the day, but they are not the only possible ways to interact with objects or the larger environment.

Once that assumption is questioned, the design space becomes much larger, and when the design space becomes larger, new opportunities for accessibility emerge.

So I don't think we need to abandon existing assistive technology frameworks, but we probably need to expand them. Teaching students about switches and environmental control units remains valuable but alongside those tools, we have to create room to teach how to think about human signals as input - which is more fundamental.

I think that innovation for occupational therapy in this space begins by asking whether the default interface is the only interface we should imagine. And if we want our occupational therapy doctoral educational outcomes to be differential, then we have to start teaching some of these frameworks in novel ways.