Threat Actors may establish persistence and/or elevate privileges by executing malicious content triggered by accessibility features. Windows contains accessibility features that may be launched with a key combination before a user has logged in (ex: when the user is on the Windows logon screen). An adversary can modify the way these programs are launched to get a command prompt or backdoor without logging in to the system.
This type of attack technique cannot be easily mitigated with preventive controls since it is based on the abuse of system features.