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Think about that: The internet is anything but linear—website code is nested and cryptic, and often looks jumbled and out of order. (Right click, view source! Oh, yikes, maybe don't.) Websites often have multiple visual directions, or sometimes none at all. Yet audio screen readers—and Braille modules, which display about one line of text at a time—have to render them in sequence, somehow. And listeners have to make sense of it, to develop some kind of intuition for a site's layout and structure based on very, very small amounts of information, all out of order.
Screen reading software, like VoiceOver in OS X or JAWS for Windows, is more clever than I've made it sound. It parses websites for headers, and sometimes navigational elements. It can give you a literal description of a page's layout—"three columns, two rows"—and its surprisingly unrobotic voices reflect all kinds of punctuation. It even differentiates between outwardly identical tags. My editor actually just sent us an email to this effect: Stop using < EM > and < I > tags interchangeably. One is for italics, and one is for emphasis. It's a difference you can't see, but it's a difference some will hear.
People who design websites have to be vigilant about including headers to divide large blocks of text, to include alternative text for images, and to use their tags properly