Open Broadcaster Software as referred to in the below guide is now called OBS Classic. The latest rebuild of the project is called OBS Studio and as of the current writing of this note this newer iteration does not have the same accessibility support as Classic. This notice will be removed if or hopefully when that changes.
This article is designed to help those wishing to stream games with the assistance of a screen reader, highlighting pitfalls and interesting quirks that might be encountered.
(note: It's good if you have both 32 and 64 bit versions of OBS on your PC, for reasons that I'll go into later)
Speaking of the source menu, That's probably the only context menu you'll need to use. The program is, apart from the above minor inconvenience which is just that at best and irritating at worst, fine with NVDA.
Bitrates: The recommended bitrate is 3000 KBPS - around that at least. This is way too high for most people, even twitch partners. After I did some initial tests and reading on various forums and such, I discovered that around 1800 or so was good for my specific setup. I'd suggest tailing it back to around 1500/1600 kbps, and then seeing what results you get and running tests.
It's fairly obviously designed for people who aren't visually impaired (note the use of screenshots that don't have alt text), but it's easy enough to understand with a little patience. The settings dialog is activated by a button in the main window, which can be found by using the tab key. Alternatively, it's probably easier just to use shift+tab and go over to it.
I've never had a need for scenes in recording my gameplay, I just select a source I've added (by right clicking as explained above in the sources list and go to the global sources submenu.
If you want to add a global source for later use, you can go to the global sources button in the main OBS window and when the dialog appears, click add and follow the instructions.
(Note: game capture is generally reserved for applications, such as games running in services like Steam. Video capture is generally used for things like capture cards or other video devices.)
From there, create an account by clicking sign up. As of the time of writing the account creation process is a little complicated, having a few little quirks. One such oddment is that you have to root your mouse into the date boxes, then arrow around. However, this could've been a glitch. Yet another possible glitch comes in the captcha area of things, where you seem to have to download the audio file just to get the sound to play. But results may vary.
Once you've got your account set up, use the latter parts of the aforementioned guide to get your stream key etc (you need to be logged in to access these features of course). However, if you stream and aren't logged in to twitch, OBS doesn't seem to care,it just streams for you, saving your a lot of extra hassle!
One last strange glitch that it's probably worth being aware of is that when you want to interact with stream chat, your browser window must be maximised to show the controls. Why is this the case? I have no idea. But after figuring it out in the first couple of days and thinking it might've been a screen reader specific issue, I was pleased to find it was easily solved.
I will update this section if I find anything worthy of note to add.
Happy streaming and best of luck!