There is a utility called untex, that strips LaTeX formating from a tex file. I didn't test it with ConTeXt, but it may work too. If you can produce a dvi file, there is couple of programs: dvi2tty and catdvi that can extract text from a dvi file, Finally, pdftotext, which I believe is a part of the xpdf package, can extract text from many pdf files.
Finally, there is a program called tex2page, that convert TeX to html. Unlike latex2html, it can handle at least some plain TeX, so it may be possible to use it on ConTeXt files. Again, I didn't try it. If you want to experiment with it, it is at http://www.ccs.neu.edu/home/dorai/tex2page/tex2page-doc.html
since most context commands are instances of more generic ones, you can define another style to process the file to something suited for blind, say:
\setuphead[chapter][style=normal]
but that could be a lot of work. More simple is to use pdftotext which works ok for most cases,
\setuplayout[header=0pt,footer=0pt] \setupcolumns[n=1]
is then probably enough
btw, there are ways to get auditive info in the pdf file, for instance let the voice engine speak and so
Hans
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