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The game contains eight stages with five rhythm games and one remix of the previous five each, adding up to 48 different mini-games total. Each game can be completed without hitting every note perfectly, although doing so will unlock various rhythm-related bonus games and modes, such as a drum set where you have to mimic what the drummer does.

Much like the Wario Ware series of games, Rhythm Tengoku is all about following your senses and trying to be aware of various cues in the visuals and audio. This emphasis on sense instead of language makes it quite easy for anyone to pick up and play, even though the game is entirely in Japanese (and consequently only available in the Asian region or through an import website).

For example, one of the game's levels has you rapping with a computer-controlled character. He'll speak a colour-coded Japanese phrase, and the player must press 'A' in different rhythms. Although the game explains what rhythms to do for which phrase, non-Japanese speaking players can watch hand movements on-screen to figure it out without the need for language.

Occasionally, challenges will crop up, asking you to complete a level without any mistakes. Doing so earns you a certificate for that level, and a pink heart with a 'P' on it appears in that level's description.