There should be a shortcut to launch Orca (ideally the same as Gnome uses) to allow people that manage to log in to also get the screen reader to work. There was an attempt to get that to work, but make sure it actually does.
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workspace/plasma-desktop/kaccess has some stuff in kaccess.cpp, I'm not sure if that's started reliably and if the shortcut then works. Looks like it should be meta-alt-s, that doesn't seem to work for me right now.
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I just tried it, orca is working. Dropped kdelibs4support while looking into the code to make sure it's working.