My post won't be very helpful I'm afraid, and I know my advice won't be popular at all here, but if you are struggling you should consider trying macOS. I am not trying to sell you Apple products. It's just that accessibility features are truly well implemented in Apple OSes. I just checked and I can select some text, left click and just click speech. Plus there are tons of other features you might find handy.
You don't have to own a Mac to try macOS. just look for hackintosh on internet. It's really easy to install macOS on any PC nowadays.