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Many individuals with severe and multiple disabilities do not have an access pathway that enables them to interface with their environment because they are not afforded a binary switch that they can reliably control. While recent research has focused on the self-regulation of central signals of the autonomic nervous system (ANS) to create braincomputer interfaces (BCIs) for these individuals, there has been less focus on the peripheral signals of the ANS as an access pathway. An appraisal of the literature in the areas of biofeedback, polygraphy and mental exercises uncovered considerable evidence that peripheral ANS signals can be voluntarily controlled and thus have the potential to be used as an access pathway by the target population. However, the issues of speed, metabolic noise and pathological change must be addressed before peripheral ANS signals can be used as either a complementary or alternative access pathway to existing brain computer interfaces.