Lowered floor with ramp conversion (lots of specialty manufacturers do this, mine is VMI), custom reduced effort (2:1 ratio) horizontal steering (like a bus, but 8 inch diameter), reduced effort gas/brake hand control (hand control is Menox, I think the reduced effort part is custom), Paravan Touch system for ignition/shifting/secondaries, tri-pin on all hand interfaces to hold my hands in place with special splints.

You can buy a van from the conversion companies pretty easy, my steering column was built by a specialty company in San Diego. All together it works very well for me.

edit: here's a picture of the setup, the steering wheel is elevated here but it normally sits right above my lap: https://imgur.com/a/qOSP5Dg