The present paper is concerned with the description of highly excited rotational and/or vibrational states of molecules in terms of localized vibrations or local modes. Local mode effects are most common in molecules with multiple equivalent H-X bonds, which give rise to equivalent H-X local mode stretching vibrations, and the theory is outlined for the simplest such case, that of an H 2 X molecule. In the local mode picture of molecular vibration, experimentally observed, initially unexpected near-degeneracies of vibrational states at high vibrational excitation, and of rotation-vibration states at high rotational excitation, can be explained in a relatively straightforward manner. The local mode theory predicts relations between the conventional rotation-vibration parameters whose values are determined in least-squares fittings to observed rotation-vibration transition frequencies or wavenumbers. It should be emphasized, however, that such relations are valid only for particular forms of the effective rotation-vibration Hamiltonian used in the spectral analysis. We illustrate the theory with examples of experimental spectroscopic work where local mode effects play an important role in the interpretation of the experimental findings. The fact that local mode vibrations not only cause clustering of highly excited vibrational energy levels, but also of highly rotationally excited rotation-vibration energy levels, has been understood fairly recently. We outline the theoretical background for this phenomenon and relate it to the existing experimental work.