Active pause without any limitations for handicapped users

Official Microsoft Flight Simulator Wishlist
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Many of us can move only one arm, for any change of parameters we have to release the joystick. The plane drops many feet and sometimes stalls, during the active pause you can’t use the keyboard, so you can’t change parameters, or answer ATC, or anything. Only if you can buy a device with thrust levers, flaps and aerobrakes you can change these parameters

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Have you considered something like VoiceAttack? I don’t know that it will do what you want, but there’s a plugin for MSFS and some free profiles that could probably be modified.