VoiceCode works great with a hands-free mouse such as the SmartNav. If you can use a regular mouse with no pain, there is no reason to go completely hands-free (unless you like the idea of standing up while working, or if you want to go hands-free for another reason)
The best place to purchase the SmartNav is: http://www.rjcooper.com/smartnav/index.html
The one you want is: HMEGX-11-USB EG for Mac OS X (SmartNav EG w/switch clicking) - $499
It comes with the software you need as well, which is a great value, since if you buy it somewhere else you do not get the software included and have to purchase it separately for $200.
Here are the configuration settings that seem to work best with the SmartNav.
If you experience any glitchy behavior in the mouse-movement, try running this command from the command-line to boost processor priority for the SmartNav:
`sudo renice -19 -p $(pgrep SmartNav)`
It's important to set up the reflector in a way that gives consistent and accurate mouse movement. Here is one solution that has worked well. It works specifically well because it uses a cylindrical reflector that does not change viewing size as you turn your head side to side, so the SmartNav has an easier time tracking its center of mass. It's also convenient because it is detachable.
Cut a small piece of the drinking straw, roughly the same width as the diameter of the straw
Cut a strip of the reflective material, about the right size to wrap all the way around the small piece of the straw from step 1.