Old thread I realize, but any progress on this? I'm also blind and using Reaper with a screen reader (NVDA on Windows 10, in my case) and have found the region playlist to be a super helpful songwriting tool. As you mentioned, while it's all technically doable with a screen reader, it's not the most comfortable nor intuitive experience. Btw I know C#, JavaScript, some Java and bits and pieces of other languages if I can be of any use. Not sure what the Reaper scripts are written in.