I don't know why, but I've often thought about the situation the Josh finds himself in. IE - having to find a different way of building software if I couldn't use a keyboard and mouse due to medical condition.

The solution I always imagine is paying someone or having my employer pay someone to strong style pair program with me. Perhaps a student, junior developer or even someone unfamiliar with software development entirely.

For those unfamiliar with strong style, this rule sums it up: "For an idea to go from your head into the computer it MUST go through someone else's hands". Like the standard driver / navigator pair programming technique but with the navigator never touching the keyboard.

In the case of someone completely unfamiliar with software development I imagine that there would initially be a dramatic high / low skill gradient between us, with the person essentially transcribing. However given the intensity of the practise I think this gradient would level out quite quickly.