As everywhere else, the proof of the pie is in the eating. As Acrobats built-in accessibility features like read aloud, reflow or export to accessible text are very limited it is a good idea to use the same tools for quality assurance that users with disabilities would use on a daily basis. There are quite a number of such tools out there, depending on whether you have no vision, limited vision, cognitive disabilities or whether you are deaf, have limited mobility or suffer from other limitations.
One of the more easy to "get hold of" tools is JAWS Screenreader as it can be downloaded freely and be run for 40 minutes without functional limitations (after 40 minutes, if you wanted to use JAWS some more, you would have to reboot your machine). JAWS Screenreader 13 (the latest version as of January 2012) is available from Freedom Scientific at http://www.freedomscientific.com/downloads/jaws/jaws-downloads.asp.
As it becomes obvious very quickly, JAWS Screenreader runs on Windows only, no Mac or Linux version available.
If you really have to rely on JAWS Screenreader, you will want to get a decent training. If you are using it just to familiarize yourself with it, or to carry out some quality assurance for you tagged PDFs, the following list of keyboard commands might be helpful. Please understand, that Freedom Scientific has to charge for continuous professional use of their software. If you use JAWS Screenreader more than for trying out, you should purchase a license.
JAWS standard reading keys
Note: None of the following keys is specific to interacting with a PDF or Acrobat, but most if not all of them work in Adobe Reader or Adobe Acrobat the same way they would for interacting with a web page in Internet Explorer or other browser supporting accessible access.
To move through a web page:
To move and read in tables:
Source of the list above: Website of the Royal National Institute of Blind People (RNIB) in the UK, http://www.rnib.org.uk/professionals/webaccessibility/articles/Pages/accessing_pdf.aspx (Last updated: 11 September 2009)