Abstract In treating patients with amyotrophic lateral sclerosis occupational therapists face an ever-changing disability for which they must select a wide range of assistive devices to maximize function in performance of activities of daily living. This case report emphasizes the significance of the patient’s contribution in the fabrication of equipment. The success of the feeding harness described depended as much on the process of its creation as on the enhanced function it gave the patient. The harness offered the patient a sense of hope and helpfulness in the face of a relentlessly progressive disease.