I have implemented the use of the Windows speech recognition in Vista and also with Windows 7 and I've noticed some significant changes that have limited the functionality in Win7.
The user I had set up with speech recognition in Vista was able to use the command "Click" to left-click wherever the mouse pointer happened to be and this no longer works in Windows 7. The newer interface seems to require a specified location of exactly what to click on i.e. "Click Save" or "Click Close" and the command that's needed is "Click [current mouse location]".
This person works with maps that require a large amount of mouse clicks to draw updated elements of the map. The "click" command that worked with Vista does not exist in Windows 7 Speech Recognition.
It looks like there may be some hope to create a macro to set this up, but I will need to know how to phrase the commands needed and associated syntax.
Yes, it would work however, this would require about 6 - 8 voice commands per click when the simple command "click" used to work in Vista. That isn't an acceptable solution when you're talking about entering 50+ points on a map.. each one consisting of long voice commands.