Physical therapy modalities are passive tools that are used in physical therapy clinics, beside the exercise program and manual therapy, that promote blood flow, decrease inflammation, and improve range of motion and function. Electrical stimulation, ultrasound, ice, and heat were analyzed in this review. The purpose of this quantitative review is to use the research that has been conducted over the past 30 years to determine if physical therapy modalities are effective at decreasing inflammation, increasing range of motion and function, decreasing pain, and to draw a conclusion about whether or not they should still be used on patients today. Systematic reviews and meta analysis were analyzed and compared to qualitative surveys and patient/therapist surveys conducted in this study to determine if ultrasound, electrical stimulation, ice, and heat were effective. The results showed that both electrical stimulation and ultrasound were effective for decreasing pain, increasing functionality, and decreasing inflammation (Ashrafi, 2017; Bistolfi, 2018; Ferronato, 2017; Fuentes, 2010; Haile, 2021; Yu, 2015). However, the types of injuries, frequency, and duration of the modalities used still need to be further researched to understand how to maximize the effectiveness of these modalities. Ice therapy was significantly effective at decreasing inflammation, while heat therapy was significantly effective at decreasing pain, both in the short term (Wang et al., 2021).

Accessing adequate healthcare, particularly essential services like physical therapy, presents a significant challenge for individuals with Down syndrome. This demographic often encounters obstacles such as limited accessibility, scarce resources, and a lack of tailored solutions that specifically address their unique needs. The resulting disparity leads to inconsistent care and suboptimal healthcare experiences. Recognizing the importance of eliminating these barriers is crucial to create a more inclusive healthcare environment for individuals with Down syndrome. Rainbow Monster Madness serves as a multifaceted solution to the social determinants of health that significantly impact individuals with Down syndrome. The game's design directly tackles several of these determinants by offering accessible, engaging, and family-centered therapy. In terms of healthcare access and quality, the game empowers parents to actively participate in their child's therapy, ensuring the correct administration of exercises and the consistent provision of quality care. The game's design addresses neighborly and built environment determinants by providing an accessible and inclusive therapy option that can be implemented within the comfort of one's home. This approach fosters a sense of safety and familiarity for children undergoing therapy, promoting a more relaxed and conducive environment. Additionally, Rainbow Monster Madness encourages social community engagement by fostering a collaborative atmosphere between parents and children during therapy sessions. This collaborative approach creates a supportive and engaging environment, positively impacting the overall therapeutic experience. Adhering to the principles of Self-Determination Theory, the game cultivates intrinsic motivation and psychological well-being among children with Down syndrome. This approach enables active engagement in therapy and contributes to their overall health and well-being. The exercises included in Rainbow Monster Madness are carefully selected to cater to the unique needs of individuals with Down syndrome. This regimen combines muscle-strengthening, cardio, and balance exercises, tailored to this specific population. The modification of exercises and thematic design ensures that children remain enthusiastic about their therapy, ultimately promoting better adherence and more effective results. In summary, Rainbow Monster Madness represents a comprehensive solution to the multitude of challenges faced by individuals with Down syndrome in accessing healthcare. Simultaneously, it addresses the broader social determinants of health, thereby fostering a healthier and more inclusive future for this deserving population.