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The Quick Check is often the best way to check for accessibility before attempting to use a PDF. The Quick Check will reveal whether a document has real text, structure tags and appropriate security for a screen reader to discern it properly.
To run a Quick Check in Adobe Acrobat Pro 9, from your file menu go to Advanced > Accessibility > Quick Check.
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Figure 1: Acrobat Advanced Menu drop down

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Quick

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Check

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Results

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Adobe

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Inc,

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2009

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Results will vary. Below is a list of possible results and actions you can take.
"This document has logical structure but it is not a Tagged PDF. Some accessibility information may be missing."
Quick Check has found an underlying document structure in the document, so Acrobat will use the available document structure to control the reading order, rather than analyzing the document itself. However, this untagged document structure might be incomplete or unreliable, so assistive software and the accessibility features in Acrobat (such as the Read Out Loud) may not read the page properly. If the reading order of the page seems to be wrong, select Override the Reading Order in Tagged Documents in the Reading panel of the Preferences dialog box.
"This document is not structured, so the reading order may not be correct. Try different reading orders using the Reading Preferences panel. "
Quick Check has found no underlying document structure that Acrobat can use for reading order. Acrobat will analyze the reading order of the document using the current analysis method set in the Reading Order preference, but this PDF might not be read correctly by screen readers. If the reading order seems wrong, select a different option for Reading Order in the Reading panel of the Preferences dialog box.
"No accessibility problems were detected in this quick check. Choose the Full Check command to check more thoroughly. "
Quick Check has found that the PDF contains searchable text, is tagged, has an underlying document structure, and has no security settings that prohibit access for screen readers. To check for other types of accessibility problems that may be present in the PDF, use Full Check.
"This document's security settings prevent access by screen readers. "
Quick Check has found that the PDF has security settings that interfere with screen readers' ability to extract text for conversion to speech. You may be able to use a screen reader with this document if your assistive technology product is registered with Adobe as a Trusted Agent. Contact your assistive technology product vendor.
"This document appears to contain no text. It may be a scanned image. "
Quick Check has found that the PDF contains no searchable text, probably because the document consists entirely of one or more scanned images. This means that screen readers, Read Out Loud, Reflow view, and most other accessibility features--which rely on text as input--will not work with this document

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