How long does it take to feel better after an Epley maneuver. What factors influence the response time to BPPV treatment. Why might repeated sessions be necessary for some patients. How effective is the Epley maneuver for posterior canal BPPV.

Understanding BPPV and the Epley Maneuver

Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder characterized by brief episodes of vertigo triggered by certain head movements. The Epley maneuver is a widely used canalith repositioning procedure (CRP) designed to treat BPPV, particularly when it affects the posterior semicircular canal.

What is BPPV?

BPPV occurs when otoconia (tiny calcium carbonate crystals) become dislodged from their normal position in the utricle and migrate into the semicircular canals. This displacement causes false sensations of movement when the head changes position relative to gravity. The posterior canal is most commonly affected due to its anatomical orientation.

Key features of BPPV:

• Episodic vertigo lasting less than 30 seconds
• Self-limiting nature
• Triggered by specific head positions or movements
• More prevalent in older adults and females (2:1 ratio compared to males)

The Epley Maneuver: A Targeted Treatment for Posterior Canal BPPV

The Epley maneuver, developed by Dr. John Epley, is a series of head and body position changes designed to guide displaced otoconia out of the affected semicircular canal and back into the utricle where they can be reabsorbed.

Why is the Epley maneuver effective?

The Epley maneuver capitalizes on gravity and the natural anatomy of the inner ear to reposition the problematic otoconia. By moving the head through specific positions, the loose particles are encouraged to exit the semicircular canal, alleviating the symptoms of BPPV.

Clinical Response Time to the Epley Maneuver: A Hospital-Based Study

A recent hospital-based study investigated the clinical response time of Epley maneuvers in treating BPPV. The research aimed to address the variability in treatment outcomes reported in previous studies and provide insights into factors affecting response times.

Study details:

• 132 patients aged 30-50 years
• Conducted from 2019 to 2020
• Focused on posterior canal BPPV
• Utilized Dix-Hallpike maneuver for diagnosis
• Administered Dizziness Handicap Inventory for screening

Factors Influencing BPPV Treatment Response

The study identified several factors that can affect how quickly and effectively patients respond to the Epley maneuver:

1. Type of BPPV (single vs. multiple canal involvement)
2. Number of CRP cycles performed in each session
3. Duration of patient follow-up
4. Individual patient characteristics

Understanding these factors is crucial for setting realistic expectations and tailoring treatment plans for BPPV patients.

Epley Maneuver Effectiveness: Key Findings

The study revealed important insights into the effectiveness of the Epley maneuver for treating posterior canal BPPV:

Immediate response rates:

37.69% of patients became asymptomatic after a single Epley maneuver session. This demonstrates the potential for rapid relief in a significant portion of BPPV cases.

Need for repeated sessions:

61.52% of patients required multiple Epley maneuver sessions to achieve symptom resolution. This highlights the importance of follow-up care and patient persistence in treatment.

Non-responders:

A small percentage (0.76%) of patients showed no response to repeated CRP sessions over a 6-month period. This underscores the need for alternative treatment options in rare, refractory cases.

Optimizing BPPV Treatment with the Epley Maneuver

To maximize the benefits of the Epley maneuver for BPPV patients, healthcare providers should consider the following approaches:

Proper training and technique:

Ensuring that healthcare professionals are well-trained in performing the Epley maneuver is crucial for optimal outcomes. Precise execution of the maneuver increases the likelihood of successful otoconia repositioning.

Patient education and follow-up:

Educating patients about the potential need for multiple treatment sessions and the importance of follow-up care can improve compliance and overall treatment success. Patients should be encouraged to report any persistent or recurring symptoms promptly.

Monitoring for canal switching:

In some cases, partial response to treatment may be due to canal switching, where otoconia move from one semicircular canal to another during the repositioning procedure. Healthcare providers should be vigilant for this possibility and adjust treatment plans accordingly.

Long-Term Management of BPPV

While the Epley maneuver can provide significant relief for many BPPV patients, long-term management strategies are essential for optimal outcomes:

Regular follow-up assessments:

Scheduling periodic check-ups allows healthcare providers to monitor for recurrence and address any ongoing balance issues promptly.

Home exercises and preventive measures:

Teaching patients modified Epley maneuvers or Brandt-Daroff exercises for home use can help maintain symptom relief and potentially prevent recurrences.

Addressing underlying risk factors:

Identifying and managing conditions that may contribute to BPPV, such as osteoporosis or vitamin D deficiency, can help reduce the likelihood of future episodes.

The Cost-Effectiveness of the Epley Maneuver

One of the significant advantages of the Epley maneuver is its cost-effectiveness in treating BPPV:

Why is the Epley maneuver considered cost-effective?

• Non-invasive procedure requiring no special equipment
• Can be performed in an outpatient setting
• Potential for rapid symptom relief, reducing the need for prolonged treatment
• Minimal risk of complications compared to more invasive interventions

By offering a simple yet effective treatment option, the Epley maneuver can significantly reduce the economic burden of BPPV on both patients and healthcare systems.

Future Directions in BPPV Research and Treatment

As our understanding of BPPV and its treatment continues to evolve, several areas warrant further investigation:

Personalized treatment protocols:

Developing algorithms to predict which patients are likely to respond to a single Epley maneuver session versus those who may require multiple treatments could help optimize care delivery.

Technological advancements:

Exploring the use of virtual reality or smartphone applications to guide patients through home-based repositioning maneuvers may improve treatment accessibility and compliance.

Underlying mechanisms:

Continued research into the pathophysiology of BPPV and factors contributing to otoconia dislodgement could lead to new preventive strategies and treatment approaches.

In conclusion, the Epley maneuver remains a cornerstone in the treatment of posterior canal BPPV. While many patients experience rapid relief after a single session, healthcare providers should be prepared to offer multiple treatments and ongoing support to achieve optimal outcomes. By understanding the factors influencing treatment response and employing a patient-centered approach, clinicians can maximize the effectiveness of this simple yet powerful intervention in managing BPPV.

The Clinical Response Time of Epley Maneuvers for Treatment of BPPV: A Hospital Based Study

Indian J Otolaryngol Head Neck Surg. 2020 Dec; 72(4): 503–507.

Published online 2020 Aug 11. doi: 10.1007/s12070-020-02038-x

¹ and ²

Author information Article notes Copyright and License information Disclaimer

The Epley maneuver is one of the most effective canalith repositioning procedures for treatment of posterior canal benign paroxysmal positional vertigo. It was found that response to BPPV varies with various factors such as types, single versus multiple canals BPPV, single or repeated cycles of head maneuvers in each session and duration of follow up of patient. Furthermore, less uniform result exists after treatment of BPPV among studies. Hence, the present study was taken with aim to investigate “The clinical response time of Epley maneuvers in treatment of BPPV: A Hospital Based Study. A total of 132 patients were included in study with age ranging from 30 to 50 years These patient visited department of ENT from 2019 to 2020 with complaint of vertigo. The subjective balancing assessments along with Dix-Hallpike maneuver were done and dizziness handicap inventory were administrated for screening of BPPV. The patients, who were diagnosed as posterior canal BPPV, were treated with Canal repositioning procedure i.e. Epley’s Maneuvers during the initial visit. In addition, the same maneuvers were repeated after 1 week of sequential sessions if the patient reported no benefit or partial benefit from first session until the patient became asymptomatic and Dix-Hallpike maneuver were negative. The total number of sessions of Epley maneuver required by each patient was recorded. The findings of present study suggested that 37.69% of cases with posterior canal BPPV were asymptomatic after first CRP session of Epleys maneuver whereas repeated sessions were required in 61.52% of cases of BPPV and 0.76% of cases showed no response to repeated CRP up to 6 months. BPPV involving posterior canals may be easily detected by position test with good response to Epley maneuver. Short-term and long term control of symptoms of unilateral posterior SCC through this easy and simple procedure can be achieved. This cost effective approach requires proper trained and committed professionals. The repeated session may be required as complete recovery may not be immediate. Sometimes partial response can be due to canal switching during BPPV Hence, it is necessary to counsel the patient regarding the importance of follow-up.

Keywords: Vertigo, CRP, Canalith repositioning procedure, Vestibular, Dix-Hallpike, Benign

The Epley maneuver is one of the most effective canalith repositioning procedures (CRP) for treatment of posterior canal Benign paroxysmal positional vertigo (BPPV) [1]. BPPV is benign peripheral disorder of vestibular system and episodic vertigo is most common symptom with duration of vertigo of less than 30 s [1] and vertigo is self -limiting [2]. The term benign means it is not life-threatening, Paroxysmal means it comes in sudden, brief spells, Positional means it gets triggered by certain head positions or movements and vertigo means a false spinning sensation [1]. In most patients with BPPV, the otoconia are dislodged from their usual position and migrate over time into semicircular canals (Canalithiasis) in which posterior canal BPPV is most common among three semicircular canal because of it’s anatomical orientation relative to gravity [1, 2]. The free floating otoconia particles falls to the lowest part of posterior SCC under the influence of gravity thus giving false information of angular acceleration during changes in head position with respect to gravity [1, 2]. The prevalence of BPPV is 10.7–140/100,000 population and especially seen in the elderly [3], furthermore, the prevalence of BPPV is higher in females than males with ratio of 2:1 [4]. Previous studies reported that proper case history and eye-findings during positional testing i.e. Dix-Hallpike maneuver are the gold standards for diagnosing BPPV [1, 5]. It was also found that treatment response of BPPV depends on various factors such as type, single versus multiple canals BPPV. Response depends on single or multiple cycles of head maneuvers in each session and duration of follow up [6, 7]. Furthermore, less uniform results are reported after treatment of BPPV among various studies [6–10]. Hence, the present study was done to evaluate “The clinical response time of Epley maneuvers for treatment of BPPV”.

The total of 132 patients with complaint of vertigo who visited department of ENT from 2019 to 2020 were included in this study after ruling other diseases like any neurological abnormality, ophthalmic disorder, hearing disorders like acoustic neuroma, Meniere’s diseases etc. Metabolic diseases, kidney diseases, diabetes, cerebellar disorder, cardio vascular disorders, head and neck trauma, central vestibular disorders such as vertebrobasilar insufficiency, cervical spondylosis, migraine etc. were excluded. The patients who were taking vestibular toxic drugs and alcohol were also excluded. The Patients with continuous and atypical nystagmus were also excluded. The patient who had history of transient vertigo associated with changing head position from 1 day to 2 years and controlled blood pressure were included in this study. Each patient was instructed to discontinue all anti-vertigo drugs or sedative medication 48 h before vestibular examination and CRP. The blood pressure was also tested before examination. The proper case history, otoscopic examination, audiological evaluation such as pure tone audiometry, impedance audiometry, OAE and subjective vestibular evaluation were done for differential diagnosis between peripheral versus central vestibular disorders. The behavior balancing assessment i.e. sharpened Romberg test, Fukuda stepping (Unterberger’s) test, tandem walk, dysdiadochokinesia test, past pointing (finger-to-nose) test, heel to knee test, grasp test, subjective visual vertical (SVV) and subjective visual horizontal (SVH) were done. All the patients had classical findings of BPPV based on history of episodic vertigo (< 30 s) associated with changes in the position of the head, confirmed by subjective examination i.e. Dix-Hallpike maneuver [5] for posterior canal BPPV and supine roll test for diagnosis of horizontal canal BPPV. Bilateral posterior canal BPPV were confirmed when Dix-Hallpike test was positive on the both sides. Horizontal canal BPPV were confirmed when supine roll test was positive. Dizziness handicap inventory (DHI) was administrated for screening of BPPV [11] and to check the physical, functional and/or emotional change before and after the CRP. Previous Studies reported that DHI is very useful as self assessment inventory for subjective measures of patient’s perception to handicap due to dizziness [11–13]. The patients, who were diagnosed as posterior canal BPPV were treated with CRP i.e. Epley’s maneuvers during the initial visit. In addition, the same maneuvers were repeated after 1 week of sequential sessions if the patient reported no benefit or partial benefit till Dix-Hallpike maneuver were negative. The total number of sessions of Epley maneuver required by each patient was recorded. Supine roll over test was administered for diagnosis of horizontal canal BPPV and forced prolong position maneuver were used for treatment of horizontal canal BPPV (Fig.  ).

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Indicate otoconia particle distribution of posterior semi-circular canal BPPV

Out of total 132 case included in study 130 cases were diagnosed as posterior canal BPPV and 02 cases were diagnosed as horizontal canal BPPV (Fig. ). In 130 cases of posterior canal BPPV, 129 cases were found as unilateral and only 01 case had bilateral BPPV. The subjective evaluation findings of Romberg test were positive in 98% of cases, 58% of cases showed deviation (> 45°) and 42% of cases showed no deviation but were not stable in Fukuda stepping test. Tandom gait test was affected only 16% of cases, 5% cases had positive dysdiadochokinesia, 2% cases had positive past pointing and 68% of cases had positive SVV and SVH test. Heel to knee test and grasp test were appropriate for all the cases with BPPV. In this study, the dizziness handicap inventory score was 24–78 points (mean 51) before CRP and 12–26 (mean 19) after CRP. The recovery findings of present study suggested that 37. 69% of cases with posterior canal BPPV responded in single session considering as complete recovery followed by 61.52% of cases which required repeated session for recovery. 41.52% of cases required two to 4 sessions from 15 days to 1 month were considered as partial recovery and 20% of cases required greater than four sessions (more than 1 month) to become asymptomatic considered as late recovery. 0.76% of cases did not recovered up to 6 months and were considered as no response (Table ; Fig. ).

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Different types of BPPV found in this study

Table 1

Clinical response time of Epley maneuver for treatment of posterior canal-BPPV

SN.	Stages of recovery	No. of sessions	Duration of Epley’s Maneuver	% of cases
1.	Complete response	1	1 day	37.69%
2.	Partial response	2	15 days	20.76%
		3	21 days	11.53%
		4	1 month	9.23%
3.	Late response	> 4 up to 24 sessions	> 1 months up to 6 months	20%
4.	No response	> 24 session	> 6 months	0.76%

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Indicate the clinical response time after Epley Maneuver for treatment of Posterior canal BPPV

The present study was taken with aim to investigate “the clinical response time of Epley maneuver for treatment of posterior canal BPPV. The result of current study suggested that maximum number of patient with posterior SCC BPPV were benefited within 1 month of CRP. In this study, the clinical data were used to determine the clinical response time of Epley maneuvers with negative Dix-Hallpike test considered as strict criteria for completely cure of patient with BPPV. Previous study also supported that Dix-Hallpike test should be used for diagnosing posterior canal BPPV [14] and Epley maneuver was effective for treatment of posterior SCC BPPV [15]. It was observed that Epley maneuver provided high efficacy with long lasting control of symptoms in patient with BPPV [15, 16]. Previous study suggested that conversion of Dix-Hallpike maneuver from positive to negative after Epley maneuver and efficacy of Epley maneuver is better than Sham maneuver for treatment of BPPV [17]. However time course for recovery were not studied. It also revealed that Epley maneuver is also effective in p-BPPV who was symptomatic after the first session [18]. In this study counseling regarding the post treatment instruction such as avoid sleeping on the affected side, avoid doing fast head movement were given to each patient without any postural restriction. However various studies reported that postural restrictions do not influence the efficacy and success rate of Epley maneuver for management of BPPV [19–22].

In Romberg test, all the cases with BPPV were not able to maintain balance during closed eye condition suggestive of peripheral vestibular disorder. The Romberg test were positive in all cases with BPPV, it is suggested that testing should be done on foam in close eye position for avoiding vision and proprioception sensory cues for maintain balance. Previous studies also reported that Romberg test in compliant surface is more sensitive than fixed surface [23]. In Fukuda stepping test, 58% of cases with BPPV showed deviation greater than 45° and remaining cases had no deviation but were not stable showing displacement greater than 1 m and could not complete the task indicativing of suspected peripheral vestibular disorder. Tandem walk test were affected only in 20% cases of BPPV and 80% cases of BPPV were able to maintain static balance, since testing were done on fixed surface with eyes open position. 5% cases had positive dysdiadochokinesia test Fast pointing (finger-to-nose) test, heel to knee test and, grasp test were found as negative for all cases with BPPV, suggested intact cerebellar functioning. Subjective visual vertical and subjective visual horizontal test were positive in 88% of BPPV revealing otolith dysfunction and 11% cases with BPPV were negative. It was observed that patient with acute BPPV have a tendency to set the bar toward the side of the lesion in SVH and SVV tests.

In this study, the findings of dizziness handicap inventory score indicated that BPPV is associated with considerable dizziness handicap and after CRP, the dizziness handicap score was improved. In recent study by [12] also found the improved dizziness handicap score after CRP.

In the present study, two cases (0.76%) in which one case have bilateral posterior canal BPPV and another one case with horizontal canal BPPV were not benefitted with CRP within 6 months considered as no recovery this can be explained by difficulty in observation of provoked nystagmus, during the diagnostic positional maneuvers as it is the most significant factor in diagnosis of the type of BPPV resulting, erroneous diagnosis of pseudo-bilateral posterior SCC BPPV. Hence, Brandt-Daroff Exercises were recommended in this case for further treatment. Previous study also reported that Brandt-Daroff Exercises were also effective in the treatment of BPPV [24].One case the recovery of horizontal canal BPPV was delayed. For this delayed recovery; explanation could be that small amount of residual debris might be present in the canal after performing CRP. In this case forced prolong position (FPP) were recommended first as the patient was complaining of neck pain and difficulty in observing the geotropic and apogeotropic types of nystagmus. Previous study also reported that geotropic is more common than apogeotropic in horizontal canal BPPV [13]. Hence, in this condition FPP was considered as first choice for treatment. In addition, in the same case horizontal canal BPPV converted to posterior semicircular canal BPPV. It may be considered that displaced free floating otoconia particles may falls downwards from horizontal SCC to posterior canal due to influence of gravity. In previous published literatures, it was mentioned regarding possibility of canal switching or canal re-entry of otoconia particles from one SCC to another SCC after CRP [25].Vestibular rehabilitation should also recommend in presence of residual symptoms after CRP. Previous study also reported that it may possible for otoconia to switch canal from horizontal to posterior canal BPPV [25]. Hence, this clinical evidence suggests that multiple sessions may be required for therapeutic improvement in BPPV. In certain cases, central vestibular adaptation may also play major role in cure of persistant residual symptoms of BPPV.

BPPV involving posterior canals may be easily detected and cured. Short-term treatment by canal reposition maneuver and long term follow up protocol is required for the management of unilateral posterior SCC which is easy and simple procedure can be done on opd basis. Epley maneuver can be used as evaluation tool in treatment outcomes assessment as used in this study. Repeated session may be required as complete recovery may not be immediate. Audiologist and otolaryngologist should be aware of canal switching phenomena during BPPV. Vestibular rehabilitation may be included along with CRP treatment for improving the quality of life. Hence, it is necessary to counsel the patient regarding the importance of follow-up. This study was done with limited sample size. A study with large sample size can be done with different types of BPPV to measure clinical response time of BPPV.

KS was involved in study design, data collection and interpretation. TS was involved in study design, analysis of the data, interpretation and writing the manuscript. The manuscript has been read and approved by all the authors, that the requirements for authorship as stated earlier in this document have been met, and that each author believes that the manuscript represents honest work.

There is no funding by any agency for the manuscript.

Conflict of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Informed consent

Informed consent was obtained from each participant for the participants of the study.

Ethical considerations

In the current study, all testing procedures were carried out using non-invasive techniques and all the procedures were explained to the participants for the participants of the study.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Still Dizzy After the Epley Maneuver Vertigo Treatment?

A few years ago, I did a post here discussing patients that continued to complain of imbalance and “fleeting disorientation” after successful treatment using the Epley maneuver or some other form of canalith repositioning. So let’s revisit that and explore some related newer reports, as well as talk about people that do not improve after repositioning for BPPV type of vertigo.

Residual Dizziness: Repositioning Failure?

Some patients continue to complain of positional vertigo after undergoing treatment with the Epley maneuver. First, no treatment works on everybody, but repositioning for BPPV has a very high success rate. In fact, success rate is so high that if the treatment fails, it is more likely that the diagnosis is wrong than it is that the repositioning procedure failed to move otoconia out of the posterior canal.

Numerous studies put the success rate for BPPV of the posterior canal in the high 90% range. There are other forms of BPPV where the otoconia enter the horizontal canal, and very rarely the anterior canal. The Epley maneuver is specifically for posterior canal BPPV and would not help BPPV of the horizontal canal. There are procedures for horizontal canal BPPV, but with lower success rates.

One particular form of horizontal canal BPPV, where the otoconia is believed to be in the long arm of the canal, close to the ampulla, is particularly resistant to repositioning. This form of BPPV is characterized by ageotropic horizontal nystagmus where the nystagmus beat to the  left after rolling onto the right side, and then change to right beating horizontal nystagmus after rolling onto the left side. There is a recommended treatment for this, known as the Gufoni maneuver, but it does not enjoy nearly the same success rate as the Epley maneuver for posterior canal BPPV.

Residual Non-Vertigo Dizziness Following the Epley Manuever

A high percentage of patients will report resolution of positional vertigo after undergoing a repositioning treatment, but more than one in three will continue to describe more vague symptoms of imbalance and movement related visual disorientation and instability in the days to weeks following treatment.

There are two schools of thought regarding these residual symptoms. One theory involves utricular dysfunction. A damaged utricle is the source of BPPV (that is where the otoconia debris comes from). I can’t add much to that discussion, but a review of available literature can be found here.

A second theory is that there is a neural dampening or “cerebellar clamp” process. We know that the brain has the ability to reduce the gain of the vestibular ocular reflex (VOR) in the healthy ear following an acute unilateral vestibular loss. It is also possible, but currently unproven, that the brain’s response to intermittent bursts of increased unilateral discharge (which occurs with BPPV) is to dampen it’s connection to the affected ear, or maybe just the affected canal.

With canalith repositioning, there is not a gradual recovery, but rather an immediate repair. It is plausible that it takes some time for the brain to readjust to a newly healthy labyrinth. This theory has been explored by Faralli et al:

“According to Faralli et al. point of view, the genesis of residual dizziness (RD) could reside in the inability of the vestibular system to readapt quickly to a new functional state: in detail the persistence of debris in the semicircular canal could alter the tonic discharge from the affected labyrinth and could induce a new central adaptation rebalancing the vestibular nuclei activity, in order to minimize the peripheral asymmetry. This new equilibrium tends to stabilize the perturbation produced by the otoconia that is free to float in the semicircular canals. After successful maneuvers, the brain adapted to the new condition is unable to quickly readjust to the old pattern and this could be the cause of RD”

The Bottom Line

Residual non-vertigo dizziness is a common complaint after successful canalith repositioning for BPPV. It generally goes away in a week or two with normal activity, but recovery may be accelerated by performing VOR exercises.

How to become a game developer if you are a realtor / Habr

Good afternoon, Habr.

Two years and a few months ago, I wrote here my first and only post on how, having no experience in game development, I created my first android application. Let him spend all his vacation at the time on this. Although it was hard to call it a game, hehe.

You warmly received this post and it gave me a good push in the right direction. During these two years, I tried and learned a lot: I worked with 3D models, got acquainted with C ++, drew textures, recorded sounds, wrote texts and design docks, but most importantly, I found the right development environment for myself, namely, the divine Unreal Engine 4.

I hesitated to write anything until I could do something that could please at least me. And I think I succeeded. It’s quite nice to see the big and thorny path that has been traveled, so that, starting from the picture at the beginning of the article, to get to what is under the cut;)

I can complete it on my own, along the way using developments from my other projects on UE4.

A huge number of lessons available and a rather responsive community allowed me to plunge into the study of the engine with my head, simultaneously combining all this with my main job. Sitting at the computer until 3-4 am, I gained experience and gradually understood the limits of my abilities.

The game is a third-person quest novel where the player has to explore a city that has suffered a terrible fate. As he progresses, he will meet other characters, solve puzzles, explore the city and its surroundings, get acquainted with the lore of the world and try to find out the reasons for what happened. One of my friends described the setting as “a pacifistic mix of The Witcher and Dark Souls.” By and large, this is how it is, but with hints of Howard Lovecraft.

But screenshots aren’t everything. I even created a demo version of the game with one of the game locations, including music, texts, and the voice acting of one of the characters. For the voice acting, by the way, many thanks to the GamesVoice studio, as well as to the actors Andrey Astrov and Konstantin Fedoseev. It may sound like an advertisement, but the guys offered to voice the demo absolutely free.

And even went a little further, overcoming his dislike for public speaking by filming a video demonstrating gameplay and presenting the project for crowdfunding.

You can download the demo from these links :
Yandex.Disk 64-bit, 32-bit (Windows).

Google Drive 64-bit, 32-bit (Windows).

I would love to hear your criticism. Constructive and not so. In addition, I have no way to massively test the optimization and stability of the game.

Epilogue

I realized a long time ago that games are a real art. Well, good games, of course. It is an extremely complex and harmonious product, the parts of which must complement each other. If one of these parts does not work or lags significantly behind, the whole atmosphere of the game flies to hell. It was exactly what has been happening in the gaming industry over the past few years that was the trigger for me to start development.