Jim is blind and he uses JAWS as a screen reader for his computer. It's not cheap, but your state may have an occupational therapy program that will underwrite the cost. Rich says that there's a home edition for $90 a year. JAWS will read the entire screen and tell you where things are. He says he can do just about anything. There's also ORCA, which is an open-source option.
Jim also says that there are macros, called J. Dictate, that provide full navigation and control of your computer. It's made by an English company called HartGen. It does require Dragon Naturally Speaking Professional.