I think I know why many injured developers turn to macros to try and solve their problem. When you acquire disability as an adult, it really fucks with your head. Every time you turn around, you're confronted with what you can't do anymore. Even a mild disability like mine I've had days where I could barely feed myself because it hurts too much to whole silverware. Thankfully those days are gone. Now things are better although I still need to hold the bottom as well as the sides of the glass to keep from dropping it when my hand spasms open.
Creating macros is a way someone can take control back from the disability. If I write some macros to do some of my work, I've taken back some of what I've lost. I used to be very critical of all these not fully useful solutions that disabled developers can come up with and I've become much kinder about it because it's more about the process of learning how to live with a disability and take back some of your agency that it is about creating any sort of accessibility tool.
It's hard to convey just how different the user experience is in your hands don't work and you try new speech recognition. One way to think of the relationship between the disabled person and UI customization tools is that customization tools are my agent or proxy for my hands. The macro solution send you down the path of having to memorize context specific commands and say a whole lot of words to get a small effect. A good adaptation looks inside the application context both in terms of what can be done and what data has to be operated on and then interprets natural language to generate what the system thinks is the desired result. That's the beauty of things like chatGPT. It's interpretation was right is usually pretty damn close.
With coding, this is why I like copilot. It takes my natural language and context of the code generated and generates code that is pretty darn close to correct. I speak a little bit and get a big result. I'll never have a force multiplier like chatGPT or copilot with macros.
btw, small pushback. The way we use tools and programs is not abnormal. Your comment shows just how much judgment people have when a user violates a designers UI vision or perceived physical norms. They think that speech interface is mediated by some form of artificial stupid should be the normalize standard but, whom I to judge. :-)
If a user can't make use of the UI provided, it's not the users fault, that belong squarely on the UI developer.