Well my thoughts so far are basically to replicate the existing shifter but as a thumbie. The first hurdle to overcome is the diameter of the barrel required to wrap the cable, I have had a thought though and I give you the Rohloff 'Ninja Star' shifter
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total cable pull/pull required is 96.2mm, 13 steps of 7.4mm
this would require a minimum diameter, assuming full 360 deg, of 30.7mm
scale that up a bit to allow for cable entry/exit so a 35mm diameter gives you 110mm of circumference, or your 96.2 + 13.8mm spare.
shifter body is a hockey puck style disc, about 40mm diameter, 14mm deep with an inner cable wrap disc, 10mm deep, with upper and lower cable channels and recess for cable nipple. The casing is in two halves and the inner cable wrap disc is clamped between them, there is an upper and lower cable entry/exit point aligned with each cable channel. So hockey puck with two jet nozzles poking out of the side. The inner disc/casing interface would deal with the 13 shift steps in the same way as a DT or barend shifter does. This would require approx 313 degrees of rotation for the full 96.2mm in either direction.
now here's the good bit, rather than a single lever you have a 3 or 4 spoke style lever, which slots into a splined interface in the disc centre, and bolts through to the shifter mounting bracket holding it all together. The diameter of the levers could be 60mm meaning they overhang the disc by 10mm all the way round. Or they could be longer, fatter, it could basically be an aftermarket option style thing. Choose the type of shifting 'Ninja Star' to suit your hands/thumbs. They could be orientated via the number of splines in the interface. You could even have a second shifting 'star' underneath, again optional, making it a true thumb and forefinger experience. Rather than having to move a single lever round 313 degrees you'd never need to move a lever more than 80 degrees with a 4 arm approach. If you went with an upper and lower 4 arm design the two Ninja Stars could be offset against each other to ensure a lever is always in easy reach.
this could also be mounted at a barend, using just one shifting star arm and that could be orientated in or out for preference.
the shifter mount has a hinged bracket and is 31.8mm with shims all the way down to 22.2mm. It should also be a cradle effect so the hockey puck disc could attach at 2 or 3 points providing stability and resisting twisting strain. Though this could impede the upper and lower arm combination idea.
Come on...what's not to like, offer an array of fancy anodised colours, two tone with one colour for the body and another for the star. Laser etch something like 'Ninja Death Star' onto it and flog it to MTBers worlwide