As you can see, he drives an automatic with a tiptronic shifter, and he has a mechanical linkage so that he can shift with what is left of his right arm, which isn't much. Steering is done entirely with the left foot, while acceleration and braking is with the right.
Well done, sir. Well done.
Aaron Miller is the Rides editor for Supercompressor. He's fairly certain this is actually even more impressive than Alex Zanardi racing with no legs.